Birth in South Africa The Travelling Midwife

The Travelling Midwife: More about Birth Trauma

Anna after Annushka's 'natural' birth in hospital

Approximately 10% (5 million) of the women in South Africa who can afford medical aid give birth in private hospitals and of these 80% will undergo a caesarian section. The other 20% of white women will have epidurals, inductions, vacuum and forceps deliveries, be induced with prostaglandins, or augmented with pitocin for no good medical reason. They will have

Anna after Annushka's 'natural' birth in hospital
Annushka born naturally in a private hospital without unnecessary intervention!

episiotomies, be separated from their babies after birth, and subsequently struggle to breastfeed. Perhaps less than 3% of women will give birth spontaneously, without trauma to her or her infant. Most of these women experience their births as traumatic. Therefore 97% of white babies in South Africa experience birth as traumatic. The birth is rushed and ‘pushing’ is forced, babies are pulled out not ‘born’. The baby is born to bright lights, an unfamiliar person, and examined before being given to the mother. The umbilical cord is clamped and cut immediately, the baby’s skin is routinely scrubbed down by the hospital midwives with a rough dry towel.

What worries me about these behaviours is that they appear to be torturous to the baby as almost all babies scream during these procedures. Kindness does not seem to be the order of the day. These are the first lessons white babies are learning in South Africa: How to dominate and subjugate another human being by using power, technology, money and knowledge.

Mother and Babies in Rural South Africa
Mother and Babies in Rural South Africa

Of the 60 million people inhabiting South Africa, only 10% are white, most of whom can afford to pay installments on a medical fund that will allow admission at a private hospital. Of the 48 million black people in the country, only 7,9% can afford medical aid coverage. Most black women give birth in understaffed public hospitals that do not have adequate equipment, or facilities. Black women and babies diegiving birth in South Africa. White women rarely die. Black women give birth in open wards with no privacy, are not allowed to have a support person or family member with them, give birth in training institutions. Sometimes there may be as many as 20 people around a patient’s bed discussing the case. Women’s needs are ignored, they are prohibited from walking around by staff, forced to lie on their backs to give birth, shouted at and bullied by staff to ‘push’ the baby out. They often do not eat for days as there is no food served. Babies are also treated roughly after the birth, the cord is clamped and cut sometimes before the baby’s shoulder is born. Mother and baby are then left abandoned on the bed while available staff tend to other births and emergencies. When a mother is discharged the next day from hospital with her baby she may travel or walk for hours before she arrives home. What are the first lessons black babies learn from their birth experience in South Africa?

Black babies are learning that they and their mothers are bullied and co-erced, abandoned and neglected, that they have meagre resources and that they are not really wanted. What does this engender in non-white or black children? Perhaps underlying feelings of worthlessness, helplessness and rage? Perhaps the need for revenge later in life?

We would do well to introduce compassion in our South African national maternity care services by training our midwifery students and obstetricians in the real skills of ‘Being with Women’ in labour, of delaying clamping and cutting the cord, of maintaining the maternal-infant dyad after birth, of allowing upright positions for birth, of facilitating spontaneous expulsion of the baby from the womb.

Is it possible to teach a young adult to be humane and to treat others with kindness if he was not treated with kindness himself when he was born?

19 thoughts on “The Travelling Midwife: More about Birth Trauma”

  1. Hi my girlfriend is pregnant 7mnths and we don’t have the
    funds for a private hospital and after reading your article I am
    scared for us and our baby,can you give me any advise please.

    1. Dear Mitch,

      You need to find an independent midwife in your area who will assist you, protect your integrity and offer you the best possible chance of giving birth in a non-traumatic way. Prepare fpr the birth by attending hypnobirthing classes at or check out the website for workshops. If you can’t find a midwife having a Doula with you is the next best option. Best of luck. Marianne

  2. Thanks Marianne, you said it nicely. I believe “figthing the system” can be done by empowering one woman at a time. It’s just so sad to me that there are so many disempowered woman who do not even know that they can make this decision for themselves. Not even the well educated “independent woman of the day” know it. It’s them I would like to at least give substantial information to. Thanks for the links, I will have a look at it. Am reading a lot at the moment, second miricle due 30 Oct (though she is already lying very low @ 34 weeks today ;-D)… much love, Karien

  3. Dear Marianne, I got your web-link from a very dear friend of mine and I love it to bits. My first born was with Heather Pieterse (Midwife in PTA) and abselutely the high-light of both Danie (husband) and my own life. I am a psychologist (spefically interested in positive psychology) and I love the conversation you are provoking. My question however, is how can we fight the system?
    Where can we get and give information, solid well researched information to woman to empower them to make the right decisions? My personal experience with friends and family is that if there is a Dr’s opinion involved or they themselves are less conscious (def of Consciousness as recently discussed all over in spiritual intelligence), they just opt for the technological options because it is “safer”…
    I think my biggest frustration, is that I know what these woman are deprived from and even deprive from themselves, not even bringing the baby (which is much much more) into it. In short, where can we find substantial research that will convince these woman to make a more “conscious” choise?

    1. Dear Karien, Thank you for your interest and passion. Firstly I must say that I do not fight the system although it often feels like they are fighting with me. I assist those women who seek and have sought to work outside the accepted medical paradigm and are connected to their feelings or bodies in a way that impels them to seek a different model of care. So my aim is to help women, educate women and ‘be there’ for them, to empower women. There are some good sources of information for instance Childbirth Connection in the USA offers scientific evidence to women for a midwifery model of care. The Cochrane Collaboration is also a great source of information.

      Much of the information out there is fear-based knowledge, aligned with the premise that childbirth is dangerous for women and babies. What we need to give women is confidence in themselves and their bodies to do what nature intended. Pre-conceptual counselling is key if women can be reached early, then much of the work is done during the pregnancy. Any emotional drama or traumatic memories can interfere with the birth process. When birth goes well it is the most empowering experience a woman, man and their baby will ever have in their lives.

      Much love and respect to you Marianne

  4. Well spoken out Marianne! I think that the overwhelming aftertaste for babies of all races, being born in either of the conventional systems, both public and private, is a profound unconscious realisation that the world is NOT a place that is sensitive to their needs, with little or no respect shown for THEIR experience of birth and the beginning of their lives. I believe that this definitely “calibrates the scale” for how we experience life. As for the birthing woman… the conventional model simply completely disempowers her, and discredits her natural wisdom, intuition and power,instead of helping her to believe in the Goddess that she naturally is as she makes the journey from woman to mother.

  5. Marianne, I think it is so hard to research these outcomes. How about my take on it: women are disempowered by the way they are forced to give birth – in both settings. They start motherhood with a feeling of not being in control, and with a feeling of not being able to do something they should be able to do. So they start of feeling that their bodies are not capable of mothering – and this often works it way into their breastfeeding experience. They hand over the responsibility to the medical professionals – instead of learning to trust themselves.

    1. Dear Ellen,

      I agree with you that most women on both sides of the socio-economic and previously racial divide are disconnected from their core selves. Historically women’s empowerment is in its infancy and it is barely 200 years ago that we secured the right to vote, never mind any other rights equal to the rights men have. The enculturation of girls in their families and society separates girls from their strengths and their powers. Society does not honour that girls carry the wisdom of millenia in their bodies, hearts and minds.

  6. This post had me in tears! I am truly blessed to have had a magical birth experience and honored to have found the support I needed. Thank you for sharing this (I feel like I am on a crusade on educating woman on their power within)

  7. I’m not sure I agree with your take on the situation in SA. Yes, there are great disparities between the rich and the poor (btw, where did you get your 60 million people from? last count there were about 46 million…). But the birth situation is not ideal for any of them, rich or poor. The c/section rate is shockingly high in private health care. So high that one has to fight to get a natural birth, let alone a home birth. In the government hospitals, the situation is not good either, and no, mothers don’t get treated well. but this is a sign of the times, and not a reinforcement of racial roles in the country. Service delivery is shocking in most places. But even in the government hospitals, there used to be much more compassion than nowadays. My domestic worker told me that 20 years ago, she was coached during labour, 3 years ago she was shouted at…. Same hospital.

    1. Thank you Ellen for your comment, I appreciate the feedback. I agree with you that the rate of (unnecessary) caesarian sections in private hospitals is shockingly high and perhaps I did not emphasize this enough. Caesarian section births are traumatic for babies and their first experience of life is an overwhelming exposure to technology, power (the obstetrician), and usually separation from the mother rather than physiological process, gentle birth and reunion with the mother (or father) for optimal bonding and restoring homeostasis. Most white babies in this country are born by caesarian section. My suggestion is that this affects long term outcomes and it would interest me to do research on how the type of birth affects long term character and social/emotional intelligence.

  8. I see these types of births often in US hospitals as well. I focus on educating the parents on what to expect and empowering them to speak up to delay the after care that seems so important that the do before mother and baby have even met sometimes…i am thankful there is a shift in consciousness in birth workers across the globe and i envision the day where we have shown the light to ALL birth professionals! It is coming!

  9. yes, Gauri, you are right. How can one change when one cannot see the other world that is possible? This is the work to be done, the education, to show by example over and over and over again. Such a powerful inquiry Marianne, thank you so! Keep writing, keep teaching and educating about what you know! The world and all those babies and Mamas need you. With love, Stephanie

  10. Please note that most midwives attending this situation described above were also birthed in such a way. It is beyond their paradigm to negotiate change. They are simply carrying out their experience again and again re-inforcing it for themselves. How can they give what they do not have? This simply reiterates the need to change….from educating!!! in their training…but then they are trained by the same in their condition…circles….. we must keep going by our example it will touch the hearts that are ready…

What do you think?