Michelle on learning about the maternal health plights of South African women

For my activist project, I chose to shadow two independent practice midwives, Susan and Ciska.  They work every day to help women have healthy, normal births and work against a system that has overmedicalized birth to the point of endangering women’s lives. I knew that I wanted to complete an activist project in the field of women’s health, as it has always been a special interest to me. I found Ciska and Susan through the Well Mother and Baby Clinic in Rondebosch. The sister (nurse) there gave me Ciska’s number, and soon after I began shadowing Susan and Ciska during their weekly consultations. I shadow them on Tuesdays, from 8:30 a.m. until early afternoon. I met with them for roughly 11 weeks, giving me a total of about 77 hours, plus a hospital birth and an additional home visit. In total my hours add up to about 80+.

My main duties were small, like filling out paperwork, organising blood work, taking blood pressure, and doing urine dips. In actuality, I probably gained more out of the experience than I gave back to Susan and Ciska. Not only did I learn invaluable information about the challenges of women’s health and maternity care in South Africa, but I also found my personal calling and have decided to follow the demanding life-path of midwife.

In talking with Susan and Ciska about their lives, their jobs, and the births they attend,  I was offered a glimpse into the life of a full-time on-call midwife. Susan and Ciska practice together, and see clients every Tuesday and Thursday. On Mondays and Wednesdays they conduct home visits for future home births. They do this so that they know how to find the house when they are called, and also to make sure that the home is equipped with everything they will need.  Sue and Ciska rotate being on call on a weekly basis. This means that for any given week, one person will be on call and the other will conduct appointments in the office. This is done in order to give each client a chance to meet with both Susan and Ciska a few times before their birth.

I felt that it was important for me to learn about how Sue and Ciska’s practice functions, and what purpose it serves in the greater scope of women’s health care. As a future women’s health care provider, I feel like it is imperative to be able to explain the midwife’s role and how she functions in relation to the rest of the medical community. When I accompanied Ciska at a hospital birth, I was able to see first-hand how midwives are treated within the medical arena. Even though Ciska is an incredibly experienced advanced practice nurse, the other sisters in the ward treated her like she was a witch-doctor of sorts. They refused to help her, show her where things were, or provide support for her in the hospital. Not only was this incredibly mean-spirited, but should she actually have needed medical assistance, it was down-right dangerous.

Ciska also explained to me that the OB/GYNs are very threatened by the midwives. The OBs have horrible statistics as far as c-section and episiotomy rates go (almost 90% c-section rate in private hospitals) and the midwives have lower rates of both, and better outcomes. This means that the OBs themselves see the midwives as a threat, and attempt to work against them instead of with them. This creates a system of competition and back-stabbing instead of cooperation and learning from each others’ strengths. Seeing this dynamic really gave me an insight into the kinds of battles midwives wage every day that they practice.

Even though I feel like I have learned more through this process than I have actually given back, I think that in the long run I will be able to contribute to society and women’s health as a whole because of what I have learned with Susan and Ciska. I have determined that my path lies down the difficult road of women’s health provider. I have also learned valuable information that I have shared, and will continue to disseminate to friends and family about the importance of natural birth and the empowerment natural birth can provide to women.