Tag Archives: labour

A Conversation with Independent Midwife Angela Wakeford

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”.

HappyWomensDay controversial advert by BIC

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!

Monty Pythons Meaning Of Life BIRTH 001

“What do I do?!”, to which the reply “Nothing Dear, you’re not qualified!”.

Monty Pythons Meaning Of Life BIRTH 002

The Positive Birth Movement

The Positive Birth Movement which Angela initiated in the Cape Peninsula and Southern Suburbs areas as well as the CBD is her proactive way of implementing change.

Screen Shot 2016-03-30 at 6.30.00 PM

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.

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Birth: This is Alexia’s Story
The Birth of Isa, 15 September 2015


Alexia and Theo invited me into their birth space to document the birth of their baby girl. Alexia sent me a message on the morning of the 15th, four months ago already, and warned me that she had gone into labour during the early hours of the morning. We had planned to meet that morning to discuss her feelings about birth photography and having me in her space. No time for that now, she trusted my integrity and I awaited further instructions.


Not much later they moved from home to the Cape Medi-Clinic where I joined them mid-morning. I discreetly slipped into the labour room and greeted them both, almost the only words I spoke for the next 6 hours, and the only words I spoke to Alexia during her labour and birth.

It was a phenomenal and mind-altering experience. There are not many opportunities for one to be present at a birth (having no responsibility from a support or medical perspective) and it left me feeling like an honored witness and like a guardian of her space.


I’ve felt so “precious” about the resulting images (and experience) that it’s taken me months to publish! A few weeks after the birth Alexia sent me a reply to some questions I had for her about her choices and perspective, these I have incorporated along with the images to share her story.


How did you prepare yourself for your labour and birth?

I was so excited for the birth right from the start. I’ve had times, before falling pregnant, where the thought of natural birth was scary for me, but when I fell pregnant I was overcome by the faith and realization that natural childbirth is what my female body was made to do and that I am just one of many many women over many, many years that had given birth naturally.


I never for one moment doubted I, and my babe, could do it, and I never focused on the perceived ‘pain’ of labour but instead focused on the miracle of the journey and where that intensity could take me on other body levels – emotionally, mentally, spiritually.


Tell me a bit about your experience in labour and birthing your babe.

Wow. An intense, magical, challenging journey that took me into the deepest parts of myself. Physically one is taken to a place where you face yourself head on. I’d describe it as transcendental.
I was really aware that my daughter Isa and I were undertaking this challenging experience together, hand in hand so to speak.

I really wanted to be consciously present for her as she entered the world. Saying all that I was also quite amazed by just how physical it is. Nitty gritty basic physical human stuff! Pretty grounding & humbling. Seven weeks later and I’m still processing!


The above image reflects how Alexia looked throughout her labour,- like a Greek goddess, totally serene, inside her own world, peaceful. She reminded me so much of the two below paintings (of Danae).



What was your reason for wanting a natural birth in a hospital environment?

I wanted to birth as naturally as possible. I initially wanted a home birth but for various validated reasons my husband wasn’t comfortable with it and I was happy to accommodate him so that he could also have the birthing experience he desired. I chose a hospital I felt safe and comfortable in.


 In hindsight, at home or in hospital, I managed to experience the birth I desired by going inward – the physical environment and happenings around me didn’t make much of a difference in the end.



How did you feel having me present in your birthing space?

I loved having you there! You were like a little guardian angel, quietly present.
You have a beautiful nurturing, gentle energy and I don’t think it would have been the same without you!

For a while you were the only woman in the room with us and I was very aware of that at the time and grateful for your presence.
The images speak for this I feel.



The moment Isa was born Alexia’s intense powerful and feminine force changed to emotion and wonder as she reached out crying and took her baby.


It was such a dramatic change in tone in the room I had to look up from the eyepiece of my camera for a second, bewildered that it was the same person who had just morphed life phases in those split seconds… I was astounded, the moment very surreal.



I documented the experience as objectively and honestly as I could. This meant that those moments which are so often excluded from our stories were ones that Alexia could choose to retain if she wanted to. For example; the birthing of her placenta which was intense, quite rough and painful, the blood and instruments that littered the trolley standing next to her bed….I incorporated it all.


Afterwards I asked Alexia what she wanted to see and she asked for everything.
She said  that from her own perspective she had no idea of the goings-on outside the boundaries of her own body. Now, she wanted to see the experience from a the outside.



You made comments about your experiences in the weeks following the birth and that you felt that there was much information here that you would like to share?

Yes! Personally, I was quite shocked by how unprepared I was for those first weeks following the birth. I’ve grown up around babies, au paired new borns etc so I come from a place with some experience yet I felt completely overwhelmed at first.


 I personally experienced huge amounts of emotional healing during this time, never mind the normal physical challenges and lifestyle changes (which one doesn’t really get until one experiences it) and with no personal support system, I found a huge need to share and connect with other moms.


 I do feel there is a pressure to be socially silent about the challenges faced during this time for various reasons.
I do think there is a need, living in a modern, disjointed community, for open and honest sharing.

As with pregnancy and birthing, I really believe knowledge is the key to a positive experience. There is so much info and discussion around pregnancy and birthing but I feel a huge lack of communication about the postnatal phase of the experience.

I’m on a mission to really open up about this fourth trimester  – I call it “keeping it real”.


It is so emotional to look at these images now!

I was so deep within myself at the time, I was unaware of so much going on around me. What a gift to be able to have that special moment recorded. And I’m thrilled my baby girl gets to witness her incredible entry into this world.

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A Documentary Series:
More Business of Being Born – S.1, E.2
Celebrity Birth Stories


Celebrity Birth Stories, Episode 2 of a 4 part series

The duo (Abby Epstein and Ricki Lake) host the informative TV series More Business of Being Born (2011). It’s a follow-on to a documentary they produced together in 2008 titled “The Business of Being Born”, which explored contemporary child birthing experiences in the U.S.

In this second episode they discuss the expectations, doubts, fears, labours and experiences of motherhood with a selection of celebrities.


A friend of mine, when I was about 20 weeks pregnant, invited me to go to a yoga class with Gurmukh. And in that class Gurmukh really starts reminding us that we are not sick when we are pregnant, if anything, she’s like “You’re actually stronger when you’re pregnant. Why would it work that God, or whatever you believe in, would make you weaker?”. You are stronger! Women have been giving birth naturally you know, for gazillions of years.
Cindy Crawford

I wanted to pull quite a few quotes from the episode because I was impressed to hear these women had such particular opinions regarding birth.
Some quotes are below and some are incorporated into the screen grabs I took whilst watching the documentary.

I never wanted to have a hospital birth. I didn’t want to be induced. I didn’t want to have any interventions at all. I wasn’t so sure about the idea of a home birth necessarily but I did have some friends who had had home births so I knew of it because of them.
-Christy Turlington Burns

I like to have goals and I like to reach my goals and, interestingly, giving birth naturally was a very big goal for me. And I think that it was partly that my mom gave birth naturally so I was like “I can do it!”.
If my mom can do it, I can totally do it.
-Kellie Martin

Christy Turlington Burns (left) & Kellie Martin (right).

Christy Turlington Burns (left) & Kellie Martin (right).

One of the women interviewed, Laila Ali, was incredibly passionate and pro home birth, against the grain of all those surrounding her who had very different opinions and were preferring hospitalised birth and selective surgery.

Interviewees talk about how much negative influence, specifically from their obstetricians/doctors, had on their pregnancy and birth experience as well as their feelings of safety and trust in their own bodies ability to do this thing. Because of this most of them had opted to educate themselves and have natural or home births.


I love all three above images, especially the middle which is of Brazilian Giselle Bundchen, with their new borns.
The women discuss their birthing experiences, most of which are very positive and empowering, although Morissette (below) explains, rather comically, how hard it had been up until the moment she was holding her baby in her arms.


I was as “prepared” as a woman could possibly be …and there was nothing that could prepare me for it! Nope.
And I’d watched all the videos of the women going into the field and giving birth to they own children. And that wasn’t so much my experience. 

– Alanis Morissette


So much amazing wisdom from these very different and highly influential women. Their very pro-active approach to knowledge and education was one of the most inspiring aspects of the documentary.


It is the most empowering experience ever… You’re deeply inside yourself but you’re also outside of yourself in the experience of labor and I think you get to actually look at your self and go,”Wow, look what I can do! Look what I’m made to be able to do! What an amazing thing!”I mean it gives you such an appreciation and a value in yourself which I think for women is really hard. In our culture too there’s such a self-loathing thing that happens and people aren’t happy and its always like “I can be better and I should look better”. To know that just by the nature of who you are and how you were made you’re able to do the most incredible thing ever. It just puts things into perspective in a way that think nothing else can.
-Christy Turlington Burns

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An Interview with Two South African Midwives | Doulas

I met Ruth Ehrhardt and Lana Petersen at one of their Home Birth Gatherings at the end of last year which I attended in order to learn more about pregnancy and birthing experiences for South African women.

I later contacted them and asked if they would be willing to meet and discuss some more questions and ideas I had around the subject.
We met at Marianne Littlejohns birthing clinic, Mtwana Birth House, in Muizenberg.


We talked about a number of different things revolving around what they do as well as my interest in some issues I’ve noticed related to the subject of pregnancy and birth for women.
How long have you been interested in birth and what made you decide to make it your vocation?

Lana: For me, my interest started when I worked in a primary health care facility where mother and their newborns would attend the clinic for postnatal care. I would hear their birth stories which ranged from ecstatic to traumatic. I became obsessed with everything related to pregnancy & birth when I was trying to conceive my 1st child and even more so once I had given birth – which was a life-changing experience, I knew I had been bitten with the oxytocin bug and needed to be around labouring women….I then trained as a doula and as demand grew, left my work at the clinic to pursue attending births full-time – best decision ever!

Ruth: Even though my mother was a midwife, I was completely uninterested in birth and babies (I think I was very self absorbed and selfish beforehand) until I had my own first birth and that experience completely transformed me. Wow! What an experience – eye opening, scary, empowering, enriching, beautiful, angry, painful, ecstatic, peaceful, energetic, strong, pathetic, humbling, awesome…I could go on.
And throughout…: This calm, quiet presence of my mother holding me, reassuring me with a soft touch, or a soft gaze.
Afterwards I thought, “I wanna do that!”

What is your personal birth philosophy?

Ruth: The more I experience working with pregnant, labouring, birthing and new mothers, the more I feel that my role, more than anything, is to provide a feeling of safety and security. It is not about giving birth in a particular way, or any particular outcome, but ensuring, as much as possible, that the mother and baby bond is intact and that the mother feels secure in her bond and ability to parent this baby.
I walk away after the birth. The new mother has to parent this child, and just as she innately knows where the best place is to birth that child, she knows instinctively what the needs of that child are.

My role is to protect that space for mother and baby, so that mother and baby can safely find their way.


Which are the most significant moments of a birth for you?

Lana: Geez, there are so many….

When a mother has put plans in place for her optimum birth and she feels excited and empowered for the experience of labour.

Moments when mothers feel desperate and afraid but then go ahead and do it anyway.


I absolutely love the moments when a woman is  naked and labouring hard and then suddenly, she looks like a Goddess! – breathtakingly beautiful!

The faces of fathers/siblings/extended family seeing a baby being born…those moments have brought me to tears often.

And finally – that moment when a mum realizes “she did it”….best thing ever.


Ruth: The moment the mother realises that only SHE can give birth to this baby, only SHE.

And when she accepts that and finally surrenders to the process, it is quite miraculous and beautiful what unfolds.

Ruth said about her experience as a doula & midwife: fulfilling, exhausting, privileged, humbling, peaceful.

Ruth said about her experience as a doula & midwife: fulfilling, exhausting, privileged, humbling, peaceful.

It was great to be able to join an educational get-together with you both when I met you on the Home Birth Gathering last year. Ive since gone through your amazing resource site and been amazed at the feeling of community and sharing of information I found there.

Im fascinated by the descriptions I have read of the transition labouring women go through from self-consciousness/awareness to the primal instinctivness and responsiveness of the body (generally described in the cases of natural birthers). You must bare witness to this often.

I’ve noticed how often the issues of tearing and or stretching come up for women as a “problematic issue” post-birth. In a society that is quite effected by media influences about gender identity and sexuality, how have you found your experience on the issue of vaginal tearing and the issues with aesthetics associated around this for women?

Lana: The large majority of the women I work with come to realize that the body and the pelvic floor specifically is designed to withstand and recover from the experience of birth. My focus would be more to teach women to make the connection with their vagina’s and learn to trust that if they are healthy, choose to birth instinctively (specifically not being coached to push!) …then their perineums will weather the passing of  a baby either in tact or with minimal to moderate damage and to remember that vagina’s are fantastic and healing themselves afterwards!

A still from the birthing room at the Mtwana clinic in Muizenberg

A still from the birthing room at the Mtwana clinic in Muizenberg

I was sent this link to an interesting article about French photographer Christian Berthelot who documented a series of images of brand new babies, moments after their (cesarian) birth into the world.

From the article I found this piece quite interesting:

“When I saw [my son] for the first time, he was bloodied and covered in this white substance called vernix,” Berthelot recalled of his first experience with a caesarean. “He was like a warrior who has just won his first battle, like an angel out of darkness. What a joy to hear him scream”.
The babies captured through Berthelot’s lens reveal various ways to enter the world. Some scream and cry, some gesticulate wildly, while others appear still and calm, and a few, in the words of the artist, “do not yet appear to belong to the world of the living.”

Leanne - born April 8, 2014 at 8:31 am
1kg 745 - 13 seconds of life. Photograph by Christian Berthalot

Leanne – born April 8, 2014 at 8:31 am
1kg 745 – 13 seconds of life. Photograph by Christian Berthalot

His images are raw, beautiful and dramatic and are so very different to the pristine, rosey-cheeked newborn images one more often sees. Berthelots images, however, represent the messy miracle of birth in the way that only midwives and obstetricians really get to see; those first living moments of a human being. What do you think about the images or about your perception of birth as apposed to societies adjusted one?

Liza - born February 26, 2013 at 8:45 am 
3kg 200 - 3 seconds of life. Photograph by Christian Berthelot

Liza – born February 26, 2013 at 8:45 am 
3kg 200 – 3 seconds of life. Photograph by Christian Berthelot

 Ruth: When I first saw these images I thought, “That’s it! That’s that moment! That’s what we get to see!”

There is still a part of me that wonders at whether we should be allowed to capture this very sacred and personal moment but at the same time I see how for people who do not work in this field, it is so incredible to see how fresh and raw and real these images are.

A still from the birthing room at the Mtwana clinic in Muizenberg

A still from the birthing room at the Mtwana clinic in Muizenberg

I remember the first image of a birth I ever saw, it was an incredible and very beautiful B&W, grainy image, I’ve never forgotten it.

At that stage, about 10 years ago, I had never considered these moments from a photographic perspective and am interested in the idea since I find the idea of birth to be such an intimate experience for a couple. How do you feel about having a photographer present and working on births and what are the differing feelings about this subject you’ve heard from clients?

 Ruth: We have all obviously been influence by images of birth, breast feeding and babies and what wonderful tools they are to show what we want to teach and convey.
At the same time though, and as I said previously, are we tampering with the sacredness of it all by having someone there snapping away?
Does it change anything? Does it alter the event?

Would we have someone there to photograph the intimacy of our wedding night? Giving birth is as intimate and personal as that and I completely understand wanting the moment captured but I sometimes wonder at what cost?

Dr. Michel Odent talks about observers (including cameras) at a birth inhibiting the release of oxytocin during labour (the hormone which contracts the uterus, but also the hormone of love) so basically, if a mother is aware of a camera or an observer, this may hinder the labouring process.

Just something to consider and think about.

Clients are usually very happy and grateful for the photos they have of their births. I know I am of mine. But I do remember feeling slightly distracted by having photos taken…

After our meeting Ruth sent me a link to a series of photographs of “half born humans” which we had discussed.
They show the moment that also Berthelot discussed when he explained how the brand new baby does “not yet appear to belong to the world of the living”, I’d never quite put my mind to it in this way, but that is exactly what it is, a kind of in-between moment… these incredible images are by Jaydene Freund:

From her series of "Amazing Birth photos of Half Born Humans". Photography by Jaydene Freund

From her series of “Amazing Birth photos of Half Born Humans”.
Photography by Jaydene Freund

Jaydene writes:

“I have rarely shared images of the actual moment of birth to protect my client’s privacy, however I have received permission to post these incredible images of these little super-humans when they were only half earth-side. Don’t be scared to be amazed by these images! This is human life before it has taken it’s first breath. Suspended between 2 worlds, life is waiting for that final push to be born.” 

From her series of "Amazing Birth photos of Half Born Humans". Photography by Jaydene Freund

From her series of “Amazing Birth photos of Half Born Humans”.
Photography by Jaydene Freund

If you could communicate one message to women about the birth experience, what would that be?

Ruth: Listen to yourself and what your needs are…the decisions you make around your pregnancy and birth are your first parenting decisions, so find a caregiver who really gets you and what you want.

I asked Lana & Ruth which 5 words best describe their experience as a doula or midwife. Lana: "awesome, sleep-depriving, life-affirming, addictive, soul-fulfilling! "

I asked Lana & Ruth which 5 words best describe their experience as a doula. Lana: “awesome, sleep-depriving, life-affirming, addictive, soul-fulfilling! “

Lana: Women are not doing nearly enough research into pregnancy & birth in this day and age! There’s far too much focus on obtaining the latest gadgets that will “make parenting easier”….Nonsense! Parenting is the hardest thing you’ll ever do – otherwise you’re doing it wrong!…

Rather focus on what type of pregnancy and birth you would like and explore ALL the options …..you only get to have your 1st birth experience once!

Make sure its a good one!

A still from the birthing room at the Mtwana clinic in Muizenberg

A still from the birthing room at the Mtwana clinic in Muizenberg

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