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Positive Birth in South Africa: This is Candice Petersen

The Gate-Keepers: A Portraiture Project

This is a portraiture project, documenting the “gatekeepers” of a growing movement regarding positive birth experiences in our country.  My aim: to promote those who are enabling women to identify with their power and femininity and therefore normalize birth and the body.

These are their stories / anecdotes / opinions about what they do and how they see it…accompanied by my portraits and some general information on each sitter.

Candice Petersen is a South African midwife working in the public sector. She’s an advanced midwife with a background in nursing. Candice worked at Mowbray Maternity Hospital for 7.5 years before she moved to Khayelitsha District Hospital where she stayed for 5 months. She is currently working at Mitchell’s Plain District Hospital.

Candice Petersen Midwife South Africa - Photographed by Leah Hawker

My journey to midwifery began after the birth of my daughter nearly 17 years ago. I had a negative experience during my labour. Despite this, the moment i gave birth, I was in awe. It was wonderful. It was then that I decided to become a midwife.

I completed my training as a professional nurse in 2007. I started working at a specialised obstetric hospital in the government sector. Much has changed over the years in this sector with regards to birthing. Most of the old practices have been stopped (shaving, enemas, routine episiotomies, etc). Most hospitals have become more baby and mother friendly.

However, I do still believe that birthing in S.A is largely medicalized. The caesarean section is amongst the highest in the world.

I am still often shocked by the lack of patient care I see around me, the protocols are just something I often can’t agree with,- there is just so much intervention!

It often seems to me that the system is setting patients (in labour) up for failure (caesarean). I have often just felt that patients were being treated like livestock and not people. Each place I have worked at has been quite different, some definitely have much more evident care and compassion for the labouring woman however some facilities are incredibly hard to work at, psychologically…

What it means to me to be a midwife in the dominant world of medicine is to be an advocate for the women who are in my care. To ensure that her experience during labour is positive and without fear, that she may birth as she intends with the least intervention. I have come to experience many times that a softer approach and reassurance to the mom yields far greater results than a strictly clinical approach.

To engage with my patients and gain their trust, to share in their joy, their sorrow and to help to dispel their fears means so much to me.

The statistics I would like to see is a decline in the Caesarean section rate in this country. I believe we can achieve this by adopting more natural approaches to birthing. Women need to be empowered. Empowerment through education. There is too much fear surrounding birth, which in its essence, should be a natural, instinctive and physiological event.

• (I invite more participants to join the project, you are welcome to email me for more information).

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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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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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