Humanising Birth: A Practical Experience

Gauri Lowe is a Doctor currently doing her internship after graduating from the University of Cape Town.  I had the pleasure of being her midwife for the birth of her son halfway through her medical degree. Gauri noticed the vast difference between her fulfilling natural birth experience and how birth happens in hospitals for most women. She was alarmed by the impersonal medicalization of childbirth that she and her fellow students were being taught and she wrote this report for her fifth year elective.

HUMANISING CHILDBIRTH – by Gauri Lowe

In 2005 the experience of giving birth to my son (at home without any intervention) changed my life. I understood the profound and empowering opportunity giving birth can be – to a woman. My rotations in obstetrics in 4^th and 5^th year were met with disappointment as I realized an enormous gaping hole in our training. As doctors we are taught to intervene and manage risky pregnancies and labours in very busy wards – generally a scary and disempowering experience to women and babies. This is quite opposite to my experience of birthing. This formed my incentive for my learning objective for my elective. I wanted to be trained in managing low risk pregnancies, labours, births and postnatal periods with compassion, care and understanding of the importance of this event for the mother, baby and family.

The empowerment of trusting my body, nature and my baby in giving birth to my own child laid a foundation to my experience and approach to parenting and life from then on. In a most powerful and positive way in terms of bonding, understanding life and growth, my outlook was changed. Understanding the profound depth of this event to a mother, baby and family and their future (and thereby the future growth, well-being and influences for the child) – I am moved to support natural birth as I can as a future doctor. As well as have a positive and beneficial attitude and utilization of interventions and technology when it is needed to prevent perinatal morbidity and mortality.

I believe that pregnancy and birthing is where our innate experience of “what life is” starts. If we are gestated in a peaceful and loving atmosphere and birthed in a loving and kind environment – this is what is “normal” to us. If we are birthed in stress, struggle and harsh words, fear and knives – this is our first experience of life and enters our consciousness as “what life is.” Hence pregnancy and birth is a profound and primary opportunity to imprint and influence a peaceful loving community. (References and elaboration on this paradigm of approaching birth is beyond the limits of this write-up but is available and very exciting – Eleni Torretti: birthasweknowit.com and Dr Michel Odent, Dr Sarah Buckley.)

Placement description

In view of these learning objectives I chose to spend my elective with a private midwife (Marianne) in practice for fifteen years in the area. (She was also my own midwife so I had personal experience of her expertise and manner.) Her rooms are in Observatory where she sees antenatal clients. She is also part of the teaching staff for 6^th semester MBChB students. These clients are either referred from Liesbeeck Active Birth Unit (LABU), from private people or doctors (obstetricians) who do not offer a natural or home birth. Her clientele vary greatly – including all races, cultures, religions and areas (from Tableview and Sea Point to Kensington and Kuilsriver), including people on medical aid and people without medical aid. They were all low risk woman who actively sought out a private midwife – for various reasons.

The deliveries ranged from home to LABU and Vincent Palloti Hospital. People present at deliveries were the patient, midwife and other family members the patient requested. (Most often husband and if at home the patient’s mother was present too.) Postnatal visits were done at home and hospitals and most antenatal visits at the consultation rooms in Observatory.

On an average clinic day we would see about 6 people. There was about one or two clinic days a week. Each consultation lasts about an hour. Some clients came to find out what a private midwife offers and some appointments were booking visits or antenatal check-ups. They included the physical examination and investigations of antenatal check-ups as well as a personal chat about the person’s stressors, expectations, challenges, lifestyle adjustments (diet, exercise, smoking, hobbies, work) and preparations for childbirth. The patient was accompanied by their mother or and partner.

Sister Littlejohn books a maximum of 6-8 deliveries per month. This was a busy month and three post-dates (from the previous month) delivering while I was there. There were 8 deliveries, therefore 8 post natal mothers and babies to check up and many antenatal clients were seen too. I also attended one antenatal class in the evening. The days and nights were dynamic depending whether there was a delivery or not.

In 2005 the experience of giving birth to my son (at home without any intervention) changed my life. I understood the profound and empowering opportunity giving birth can be – to a woman. My rotations in obstetrics in 4^th and 5^th year were met with disappointment as I realized an enormous gaping hole in our training. As doctors we are taught to intervene and manage risky pregnancies and labours in very busy wards – generally a scary and disempowering experience to women and babies. This is quite opposite to my experience of birthing. This formed my incentive for my learning objective for my elective. I wanted to be trained in managing low risk pregnancies, labours, births and postnatal periods with compassion, care and understanding of the importance of this event for the mother, baby and family.

The empowerment of trusting my body, nature and my baby in giving birth to my own child laid a foundation to my experience and approach to parenting and life from then on. In a most powerful and positive way in terms of bonding, understanding life and growth, my outlook was changed. Understanding the profound depth of this event to a mother, baby and family and their future (and thereby the future growth, well-being and influences for the child) – I am moved to support natural birth as I can as a future doctor. As well as have a positive and beneficial attitude and utilization of interventions and technology when it is needed to prevent perinatal morbidity and mortality.

I believe that pregnancy and birthing is where our innate experience of “what life is” starts. If we are gestated in a peaceful and loving atmosphere and birthed in a loving and kind environment – this is what is “normal” to us. If we are birthed in stress, struggle and harsh words, fear and knives – this is our first experience of life and enters our consciousness as “what life is.” Hence pregnancy and birth is a profound and primary opportunity to imprint and influence a peaceful loving community. (References and elaboration on this paradigm of approaching birth is beyond the limits of this write-up but is available and very exciting – Eleni Torretti: birthasweknowit.com and Dr Michel Odent, Dr Sarah Buckley.)

Placement description

In view of these learning objectives I chose to spend my elective with a private midwife (Marianne) in practice for fifteen years in the area. (She was also my own midwife so I had personal experience of her expertise and manner.) Her rooms are in Observatory where she sees antenatal clients. She is also part of the teaching staff for 6^th semester MBChB students. These clients are either referred from Liesbeeck Active Birth Unit (LABU), from private people or doctors (obstetricians) who do not offer a natural or home birth. Her clientele vary greatly – including all races, cultures, religions and areas (from Tableview and Sea Point to Kensington and Kuilsriver), including people on medical aid and people without medical aid. They were all low risk woman who actively sought out a private midwife – for various reasons.

The deliveries ranged from home to LABU and Vincent Palloti Hospital. People present at deliveries were the patient, midwife and other family members the patient requested. (Most often husband and if at home the patient’s mother was present too.) Postnatal visits were done at home and hospitals and most antenatal visits at the consultation rooms in Observatory.

On an average clinic day we would see about 6 people. There was about one or two clinic days a week. Each consultation lasts about an hour. Some clients came to find out what a private midwife offers and some appointments were booking visits or antenatal check-ups. They included the physical examination and investigations of antenatal check-ups as well as a personal chat about the person’s stressors, expectations, challenges, lifestyle adjustments (diet, exercise, smoking, hobbies, work) and preparations for childbirth. The patient was accompanied by their mother or and partner.

Sister Littlejohn books a maximum of 6-8 deliveries per month. This was a busy month and three post-dates (from the previous month) delivering while I was there. There were 8 deliveries, therefore 8 post natal mothers and babies to check up and many antenatal clients were seen too. I also attended one antenatal class in the evening. The days and nights were dynamic depending whether there was a delivery or not.

My personal learning objectives were deeply met and I am satisfied as well as inspired in this field of health. I am grateful for the opportunity and look forward to carrying what I have learnt into my medical practice as well as my community. As I plan to be actively involved in perinatal care of my patients on a community level as a primary care doctor.

The positive experiences include being part of a precious moment and entering the world of different cultures and individuals, learning how to manage labour with a cool head and having faith in nature. The negative experiences were the transfer of baby Luke and his resuscitation but this too turned into a positive experience as the outcome was good. A negative experience was when one patient changed from a private midwife to a private obstetrician and understanding the pressures and relationship and gender dynamics as well as the outside social and political dynamics that influence these choices. I was also saddened by the limited perspective in managing neonates as well as labouring mothers in the public and private health sectors.

A very positive outcome from this experience has been the offer from Dr Rhoda (neonatology) to do a presentation from my experiences to the neonate group on recommendations for the first week of life. I am hoping this offer can come to be in a wonderfully constructive way!

As mentioned previously, the gaping hole of training in natural birth as well as my passion for the field, incites me to highly recommend every doctor (especially those considering doing deliveries) to experience what a conscious (active) birth is like with a trained and experienced private midwife. I highly recommend this too for every female student – as they will inevitably give birth too one day! This could be an elective or just an open option to join this experience once.