'SA hospitals are not conducive to giving birth'
Suzette Bester-Cloete aspires to guard the sacredness of birth by creating the most conducive environment for women to give birth.
She had this in mind when she set out to open the largest private maternity birth boutique hospital in South Africa. The Origin Family-Centred Maternity Hospital, nestled in Parow in the Western Cape, will open its doors on 1 December.
Bester-Cloete, who is passionate about human rights in childbirth and natural birth, is the founder and CEO of Origin. She gave birth to her two children in water, supported by a midwife, or doula, and an obstetrician. As a doula herself, she has assisted many women in childbirth.
The environment in which a women labours and gives birth in is crucial, said Bester-Cloete adding that very few people understand how a natural birth unfolds, and that hospital rooms are not conducive to labour.
Women need to feel safe
"Absolutely not one hospital room whether private or public is conducive for labour," she told Health24.
Bester-Cloete explained that the hormonal orchestration of physiological birth cannot take place in a non-conducive environment.
"If the hormones cannot lead the birth ... then all medical interventions come into play that takes the birth off track."
"Women need to feel safe, which is difficult in a sterile, cold hospital room with medical equipment. The room or hospital creates anxiety; it is a place where sick people are treated, and for some women it holds memories of pain and disease or even death. This is not conducive for birth."
A 2004 study Do Not Disturb: The Importance of Privacy in Labour in The Journal of Perinatal Education points out that when a labouring woman does not feel safe or protected, or when the progress of her normal labour is altered, then the levels of the stress hormones catecholamine rise and labour can either slow down or stop.
"In early labour, catecholamines have the potential to stop labour. When a woman is very frightened of pain, of the hospital, of the unknown labour fails to progress. Contractions can become very strong and difficult to handle or, more typically, they become weaker. In both instances, the contractions become ineffective."
It further states that women choose to give birth in hospitals because they believe it is safer than birth outside the hospital, however it notes that labouring and giving birth in most hospitals create a set of physiologic responses that occur when we feel unsafe and unprotected.
Room must be warm
"In the typical hospital environment, women are disturbed at every turn with machines, intrusions, strangers, and a pervasive lack of privacy. The shadow of things going terribly wrong at any moment follows women from one contraction to another. Together, these fears contribute in powerful ways to the release of stress hormones, moving women into an attitude of physiologic fight or flight."
There are certain basic needs a women has in labour in order for nature to take its course, said Bester-Cloete.
"The light needs to be dimmed or the room needs to be dark for melatonin to release. The room also needs to be warm – you cannot secrete melatonin if you are cold.
The women cannot be interrupted by staff coming in and out of the room, or noise from the hospital. Having a birth pool at hand for her to labour in relaxes her and helps her to cope with labour pains. The women needs to feel private and unobserved – privacy is incredibly important."
Origin's Chief Operations Officer, esteemed midwife and trainer Sydney Grove, says the facility specialises in a maternity care model that can't be found anywhere in South Africa which sees midwives and obstetricians work hand-in-hand.
"The midwives appointed so far all have 20-plus years of experience, and all have an advanced diploma or master's level qualification in midwifery practice. They are practitioners of the midwifery profession, looking after women during pregnancy and in labour and making that space sacred. Internationally it is known that midwives are the experts in natural birth."
Grove pointed out that the beds are custom-made, along with the rest of the French Provencal furniture that will together with art and crystal chandeliers grace the rooms.
Origin boasts 6 luxurious birthing suites, each with a water birth pool, en-suite bathrooms and queen-size beds for father/family to stay over, plus three standard, well-equipped birth rooms, and three separate postnatal double rooms, all with en suite bathrooms.
Too few obstetricians
There is also one major operating theatre equipped for emergencies, a coffee shop, large training room/board room, and full- time/sessional rooms for doctors and therapists.
Apart from natural birth, Origin is also equipped should a Caesarean section be necessary for medical reasons.
According to Health Minister Aaron Motsaoledi, 85% of Caesarean sections are for profit and he wants to put an end to that, Bester-Cloete points out. However, she goes on to question what is being done to bring about this reduction.
"It is all fine and well to say you want to reduce the C-section rate, but if the hospitals and the insurance companies and the training of the midwives are not changing, how can they reduce the C-section rate?" she asks. "In effect [the Origin] model is an attempt to do that."
Bester-Cloete said South Africa has approximately 900 registered gynaecologists with only about 550 doing obstetrics. She added that obstetricians pay an incredibly high insurance premium and are forced out of obstetrics due to these high premiums and the fear of litigation.
"Who will be looking after the high-risk pregnant women and doing the emergency C-sections if we don't have enough obstetricians?" she asks.
She says the model of maternity care of Origin can help lower the C-section rate, adding that with more research, hopefully insurance companies can be convinced to lower their rates too.
Origin's Clinical Risk Committee is made up of external specialist consultants including executive nurses, specialist doctors and medico-legal specialists.
The facility also offers a Well Women Programme (teenage, well mother, well baby, family planning and menopause care), as well as full antenatal care and a mobile postnatal care unit to visit mothers and babies at home after they have left Origin.