I met Angela in her home in Fish Hoek at the end of 2015. She qualified and began working in nursing and midwifery in 1993 in South Africa and spent 15 years gaining extensive knowledge in the UK where she worked in varied care systems spanning prenatal, birth and perinatal care as well as advanced models of training: working intensively on hands-on “case studies” with immigrant women from India and Somalia.
She returned to South Africa in 2010 and immediately set up her own independent midwifery practice which functions from her home base where we met to chat.
Being a midwife verses working in government facilities, or, “the system”:
Angela spoke about her experiences working in South African Government run hospitals, which, apart from being badly subsidised, are also a space where most forms of the natural processes of birth have been lost by overworked staff who have lost sight of holistic midwifery due to the systemised nature of government hospital practices. One of the typical outcomes of government facilities are therefore the fast offer of drugged pain relief and swiftly diverted labours which may show any complications directly into the hands of surgeons.
Angela’s experience of witnessing labouring and pregnant women processed through this system is predominantly what led her to independent practice,- a space with both a better income, kinder working hours and a holistic approach to midwifery, one which really encompasses individualised care, and the treatment of labour and birth.
Our birthing industry is money and fear driven:
It is cheaper and safer to have a natural, home birth attended by a highly qualified midwife and doula as apposed to entering the hospital system. This fact is true for every woman who can afford medical aid in SA yet the insurance companies have set surprisingly low rates for natural birthing. Thus, those who can afford to make the choices are goaded into medicalised birthing and those women who can’t afford to make choices are fear driven to deliver their babies in hospitals due to, very often, a lack of access to knowledge.
Medicalised birth, Hollywood and the difficulties in wanting to be informed in our society…
Last year when I started looking into birthing and pregnancy in South Africa I became increasingly aware that I needed to explain myself to others when seeking information. I questioned this need to defend myself and came to the occlusion that, basically, its not ok to know about birth, but it is ok to sexualise women’s bodies.
Funnily enough Angela brought this up herself when she spoke about a recent add campaign launched by South African Stationary brand BIC who, in celebration of Women’s Day last year posted the below add with the text reading: “Look like a girl, act like a lady, think like a man, work like a boss”.
The advert which went viral on all online platforms defines how I feel when needing to explain that I’d like to educate myself about my body and birthing.
Images have become such a central point in much of our interpretations of our bodies: Round bellied and romantic portraits of happy couples and rosey-cheeked newborns are what we’ve learned is the expected and normal. Everything in-between (birth and labour specifically) is illustrated by Hollywood. Screaming women in stirrups, the doctor-hero, the partner: emasculated and helpless. Birth is apparently not a place for us at all, leave it to the professionals, since our bodies obviously don’t know what they’re doing…so well illustrated by Monty Python in their 1983 film The Meaning of Life, they were so ahead of their time!
The Positive Birth Movement
The monthly PBM meetings she hosts consist of a mix of clients, doulas, midwives and other interested parties. The gatherings provide a sharing platform which is ultimately empowering for expecting parents. It provides discussions and information sharing in a relaxed setting which is conducive to creating a mind-set shift for how we approach birth.
This sounds like such an obvious, simple concept yet its not at all easy-to-come-by knowledge in South Africa.
Topics Angela mentioned had recently been covered included:
- Giving men a more empowered role in birthing
- The importance of seeing realistic images of labour and birth
- The incorrect expectations created by media and Hollywood about birth
She’s found that opening communication channels like the PBM, has led to women making more natural decisions with regard to their birth.
How she works with her clients.
Midwives need a very supportive family since their working hours are so variable. Angela has created a structure and system that works beautifully for her: she only consults and does meetings/ classes (antenatal classes) in the morning and stands on-call for around five births a month (making her very much in demand!). As of January this year Angela has joined Birth Options Midwifery Team.
65% of her clients choose homebirths and the majority are water births. She works with her clients from 6 weeks onward, building a detailed knowledge about the their history and pregnancy.
Because independent midwives have such an intimate and ongoing relationship with their clients it translates into excellent and very educated choices during pregnancy and the onset of labour.
During the last months of pregnancy she sees her patients weekly. This harmonious approach, (in comparison to an obstetrical who walks into the delivery ward, while pulling on a pair of gloves, during the last 30 minutes of labour) seems, to me, to be the most obvious and natural way forward in the process.
In conclusion we discussed statistics on birthing in SA and some ideas around this which could bring change.
Angela had a student, shadowing her for some time recently who had had the brilliant idea to create a new data base or set of statistics for independent midwives. This platform would enable them to add data regarding the births they attend and the outcomes, thus creating a new set of statistics, one which would of course not be effected my medical aids and the like. A way to provide women with better information on which to make decisions regarding birth.
After meeting with Angela I realise how important it is for individuals (and communities of women like the PBM) to instigate changes through education and information sharing.