Baby love: Midwives are the key to cutting mortality rates
A new initiative to save the lives of mothers and babies in childbirth is a cheaper option for many women
Could midwives be the solution to curbing SA’s dismal maternal mortality rate, which is among the highest in the world? Rheumatologist and health economist Brian Ruff thinks so. He is the CEO of private healthcare management company PPO Serve.
To make births safer and cheaper for women in the lower middle class who lack health insurance and are often unable to afford high-quality private-sector deliveries, his company created the Birthing Team in June 2017, an initiative based on midwifery.
About 134 mothers die in childbirth for every 100,000 children who are born in SA. Although this death rate has dropped by almost a third in public hospitals in recent years, according to research published by the peer-reviewed SA Medical Journal, specialists say urgent interventions are needed to halve these losses by 2030.
“In the UK all low-risk pregnancy patients are managed by midwives,” said gynaecologist Howard Manyonga, who leads the Birthing Team. He said midwives employed by private hospitals in SA are “underused and become de-skilled,” and that the best ones often leave the country.
The Birthing Team’s initiative is underway at three private hospitals in Durban, Johannesburg and Pretoria. Obstetrician Selina Ramatsoso, a team member in Pretoria, said the initiative empowered these specialist caregivers. “We are giving midwifery back to the midwives,” she said. With specialised nurses and a few doctors who support them, each hospital’s team manages everything related to birth, and at a reduced cost.
The Birthing Team’s care package covers mothers and babies starting at 20 weeks of pregnancy and until six weeks after birth, and comprises everything from tests to examinations, medication, three ultrasounds and delivery – including a C-section if necessary. It costs about R21,000.
In contrast, women who have health insurance pay R38,000 on average for delivery and accommodation in a private hospital, according to Discovery Health Medical Scheme, the largest private health insurer in SA. At overcrowded public hospitals uninsured women can spend up to 36 hours in labour waiting for an emergency caesarean. Such long waits can lead to babies being born with brain damage.
Ruff’s holistic approach can bridge these gaps. In the private sector, which serves about 16% of the population, obstetric specialists usually tend to all pregnant women, whereas a midwife supported by a team of doctors could manage uncomplicated pregnancies, saving time and money.
That is why the Birthing Team’s model costs less; obstetricians treat patients only twice during their pregnancy (at their first appointment and at 36 weeks, unless they present complications) and a midwife manages most appointments and deliveries. The team’s scope does not include highly complex cases or patients who are likely to deliver prematurely –although so far they have only rejected 5% of all the cases.
The patient’s medical files are discussed weekly among midwives and doctors, who remain fully available for telephone consultations. Ramatsoso, who now only attends patients who suffer complications, believes the system helps doctors to use their skills more efficiently.
As a result, the initiative assisted 250 births in the past year, none of which resulted in maternal or child deaths. “One baby was born without enough oxygen but after a few days in intensive care, the baby recovered completely and had no lasting brain damage,” Manyonga said.
And while about 62% of middle-class women with medical aid plans have C-sections, according to the latest Council for Medical Schemes report, the Birthing Team system has managed to drop C-section rates among its patients to only 40%. “We monitor women’s experiences. They enjoy being managed by a midwife who can afford to spend up to an hour with them at each appointment,” said Manyonga.
A Johannesburg mother, Natascha Loubser, used the Birthing Team for her pregnancy and 14-hour labour. “Throughout my pregnancy and checkups they were wonderful,” she said, adding that she’s grateful to everyone who assisted in bringing her “princess” into the world - particularly to her midwife.
This year, the Birthing Team bid for a government tender that would enable the approach to enter the planned National Health Insurance system and assist with high-risk pregnancies. If granted, the teams would “assist in 11 districts across the country with antenatal care and high-risk deliveries,” said Manyonga, adding that discussions with low-cost insurance providers were also underway. Over time, the team aims to roll out the programme nationwide.