Your antenatal care – Your birth choice
Your decision about how and where to give birth to your baby will be a very personal one.
A century ago, nearly all babies were born at home, usually with a midwife attending the birth. But these days, most babies are born in hospitals. A small but growing number of parents choose to have their baby at home or in the more homely setting of a midwife-operated birth centre within a hospital.
The best environment for you to birth your baby is a place in which you feel safe and comfortable – and that will differ for every couple.
You will also need to decide who will provide your medical care throughout your pregnancy (e. g. a midwife, doctor or obstetrician) and who will be with you for the birth (including birth attendants such as family members).
Before deciding what is right for you, it’s important to find out more about the various options available to you.
Your birthing options:
Public Delivery Ward
Private Hospital Birth
You might decide to change your choice as your pregnancy progresses; but in some areas, the available resources can be booked up quite early, so it’s a good idea to approach your preferred care provider soon after you discover you are pregnant.
As your pregnancy progresses, you may also find that certain options are less suitable or not available to you, for example if your pregnancy becomes higher-risk due to very high blood pressure, conditions like placenta praevia, or concerns about the baby’s health, you may be advised to undergo an early induced birth.
However, most pregnancies (more than 85 %) lead to a normal and straightforward birth, so it is likely that you can stay with your original choice.
It may not always be possible to ensure that the person who is your healthcare provider throughout your pregnancy will also be the person that will look after you when you deliver your baby. Whatever the case may be, it’s really important that you are able to relax and trust the doctors, midwives or healthcare professionals, who will be your main caregivers.
If you have any qualms or discomfort with the person or people involved in your care, it’s a good idea to consider changing to another care provider to reduce any potential problems when giving birth.
It’s also a good idea to get a second opinion if you receive any information that you don’t feel comfortable about.
Do your research thoroughly and be aware that there can be disagreements between the experts; no one option is the best for everyone, so be open-minded and prepared to seek a second opinion if you feel uneasy with the options presented to you.
The most common way to be introduced to birth options is through a referral from your General Practitioner; you may also want to discuss birth options with your doctor at the time you seek a referral.
By far the majority of births in South Africa take place in the maternity delivery rooms of our public and private hospitals.
Hospitals differ widely in the facilities and options that they offer for maternity patients.
Public Hospital Delivery Ward
You will attend the hospital’s ante-natal clinic for your pregnancy care, with the hospitals doctors and midwives attending to you.
Patients who have private health cover or who choose to pay the cost are also able to use the facilities of a public hospital and choose their own obstetrician (if that doctor is registered with the hospital).
Hospital delivery wards are generally equipped for every eventuality that may occur during a birth including most medical emergencies.
Private Hospital Birth
Many pregnant women choose their obstetrician first and then select from the private hospitals that are visited by their chosen specialist.
However if you prefer, you may first choose the private hospital that suits you best and contact them asking for a list of their obstetricians.
It is a good idea to make this choice early as many obstetricians can be “booked out” quite quickly.
Some hospitals may offer a birth centre, where a small team of midwives are involved in all of the pregnancy care as well as deliveries and postnatal care.
In most instances, only midwives are involved in the pre-natal care and delivery, but should assistance be required, obstetricians are readily available.
The birth centres are often set up to emulate a home and they encourage a natural approach to delivery with minimal intervention. Some have rooms with large baths and large double beds and bean bags to make birthing parents feel as comfortable as possible and give more natural options for pain relief.
Once again, birth centres often book out very quickly, so it is a good idea to make this choice as soon as possible.
A small percentage of births take place in a home setting, with a professional midwife attending the birth. Usually the same midwife will to deliver the baby, will monitor the woman throughout the pregnancy.
In a normal healthy pregnancy, most women go into ‘spontaneous labour’ and are often advised to spend the early hours of their labour in the familiar surroundings of their own home before moving to the place where the baby will be delivered.
In a home birth, your attending midwife is contacted when you go into labour and will come to your home, staying until after the baby has arrived.
A lot of freedom and choice is available to mothers birthing at home; you do not need to travel while in labour and remain in familiar surroundings.
There is no pressure to hurry the birth and a natural approach to pain management and delivery is encouraged, although you can arrange a prescription for some pain relief options in advance if you wish.
Couples who choose to have their baby at home can join a home birth support group or simply contact an independent midwife who will guide them through the choices available.
Many women choose to rent a ‘birthing pool’ which can be set up in their home to enable a water birth if desired.
Home births are not publicly funded and are not usually covered by private health insurance, so the midwife fees are paid privately.