Women's experiences of a vaginal delivery conducted by a private midwife

Abstract

During the last decade the process of childbirth has undergone many changes in South Africa. Most women currently give birth in the hospital under the supervision of a medical practitioner because they b elong to a medical aidscheme which enables them to consult an obstetrician for their delivery. Due to this fact, a large number of deliveries
take place in a hospital setting, be it private or provincial. Research undertaken in South Africa (Du Plessis, 1991:58) with regard to women's experience of childbirth in a hospital while under the care of a medical practitioner; found that they were dissatisfied with their birthing experience and felt disempowered. They felt a loss of control
during the labour process, experienced a sense of abandonment and lack of involvement. Different modern approaches to childbirth have developed all over the world, essentially in response to the progressive medicalisation of birth with an increase in the number of home deliveries by a midwife (Robertson, 1988:2). In South Africa, there
seems to be an increase in the demand by mothers for a less technological medicalised birthing experience. There is furthermore an increase in the number of women who are beginning to express a preference for deliveries with a private midwife. In South Africa the trend back towards delivering with a private midwife is relatively recent and the
field of private practising (independent) midwives a growing one. Research pertaining to this topic has been carried out in the United States of America, the United Kingdom and the Netherlands which concluded that the mother's experience of the birthing process with a midwife was a superior one. The experiences of the mother who delivered
with a private midwife is an area in South Africa where very little documented research has been carried out. Due to this fact minimal documented research is available. Statistics with regard to the number of babies delivered by private midwives are unknown and no register exists of the names and numbers of private midwives available. The purpose of this research study was to explore and describe the experiences of women related to their exposure of birthing with a private midwife. This allows recommendations to be made with regard to the practice of private midwifery in South Africa. The private midwives can use these guidelines to improve their practice and contribute to a better birthing experience. A qualitative, descriptive, explorative and contextual research design was utilised to
conduct this research. The focus was to obtain information that would facilitate understanding of the women's experiences of labor while under the care of a private midwife in a midwife obstetric unit. A qualitative design was used where the phenomenological method was employed. Purposeful, convenient sampling was done where the researcher consciously selected certain subjects from a midwife obstetric unit in Gauteng. The collection and analysis of data involved exploring and describing the women's birthing experiences by means of analysis of naïve sketches collected prior to discharge; unstructured in-depth interviews and a focus group. These interviews were
transcribed verbatim to add depth to the findings. Tesch's descriptive method was used to analyse data. Data were clustered into relevant themes. A thorough literature study was performed in order to try and describe the phenomena as seen by others. Books relating to the research topic, relevant research material and newspaper articles were
utilised. Guidelines were discussed and formulated. Lincoln and Guba's measures to ensure trustworthiness were applied. Two main themes were extracted. They were that a therapeutic relationship developed with the midwife, but at the same time they had unrealistic expectations with regard to the birthing process. These two themes were
further divided into subthemes which will be discussed with regards to the research findings and will be verified by means of a literature control. All information will be supported by direct quotes obtained from the data collected during the interviews. The researcher found that women who delivered with a private midwife found it to be a hugely positive experience. They felt that they were in control of their birth and the midwife remained unobtrusive, they felt safe and secure which enabled them to relax and enjoy the birthing process, they felt that they were not rushed because a therapeutic relationship had developed between the mother and midwife, and the midwife took time to
concentrate on the mother as an individual. The bonding within the family unit was enhanced.

Keywords: birthing process; private midwife; midwife obstetric unit

Health SA Gesondheid Vol. 10 (3) 2005: pp. 23-35