There are some benefits to doing the deed at home:

1) Giving birth at home can be less expensive than giving birth in a hospital.

2) Getting to the hospital while in labour can be painful/uncomfortable or very difficult.

3) Giving birth at home can give mom more control over what happens.

Here are some studies you can look up for more information A growing body of evidence demonstrates that, for low-risk women, home birth is at least as safe as hospital birth (Gyte & Dodwell, 2008). Risk is involved wherever birth takes place; somewhat different risks accrue in different settings. The question is whether, on balance, hospital birth is safer than home birth for low-risk women

The first, a nationwide cohort study of over half a million births in the Netherlands, concluded that “planned home birth in a low-risk population was not associated with higher perinatal mortality rates or an increased risk of admission to a NICU compared with planned hospital births” (de Jonge et al., 2009, p. 1181). The authors noted that the safety of home birth is enhanced by good referral and transportation systems, which facilitate transfer when needed.

The second study used data from the province of British Columbia on planned home births attended by registered midwives, and planned hospital births meeting the eligibility requirements for home births and attended by the same cohort of midwives and a matched sample of physician-attended planned hospital births (Janssen et al., 2009). The researchers likewise found that “planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric interventions and other adverse perinatal outcomes compared with planned hospital birth attended by a midwife or physician.”

Hospitals carry their own set of risks that aren’t ever mentioned in studies. Unfortunately, babies die and moms die there too. There are just not big articles about it because the big money is behind the hospitals. It is absolutely true that caesarian section rates and unnecessary interventions are way higher at hospitals. Hospitals CAUSE many complications then take the credit for “saving” the situation.

Here are some studies people can look up for more information.

• Articles About Homebirth Amazon.com allows you to purchase digital copies of certain magazines and journals.  By searching for homebirth safety you will have access to many studies you can read instantly.

• The Cochrane Collaboration is the ultimate in evidence based research.  This review of the research found no strong evidence of either homebirth or hospital birth being safer than the other.  You can see all their recommendations for pregnancy and childbirth here.

• The Midwives Alliance of North America maintains an extensive list of research about homebirth.  You may be able to access some of the journals listed through your local library, or by getting a library card at a nearby university library.

• Citizens for Midwifery maintains a list of resources regarding midwifery issues.  Scrolling through this list will reveal several homebirth safety studies and fact sheets for you to use while educating yourself or others.

• The Homebirth Reference Site maintains an index of homebirth research you can review.  You can view the references, or click on them to see the research.

• Read the study in BMJ using hospital births from the 70s and 80s. You can read the entire text of the study here: www.bmj.com/content/330/7505/1416

• This is a small list of the many myths about homebirth,  like Bring Birth Home and My Best Birth’s “Advocacy & Research” resource list.

An excellent book is called “The Thinking Women’s Guide to a Better Birth.”  Those Henci is a powerful women and opinionated, her book shows volumes of evidence based research about birth. Despite this body of literature, there are still some physicians who persist in torturing the data in an attempt to frame their personal opinions as “science.”

Research-oriented blogs & websites:

• Childbirth Connection:  www.childbirthconnection.org
• Science & Sensibility: http://www.scienceandsensibility.org/
• Stand and Deliver: occasional research-oriented posts: http://rixarixa.blogspot.com/
• RH Reality Check:  http://www.rhrealitycheck.org/
• Academic OB/GYN:  http://academicobgyn.com/
• Our Bodies, Our Blog:  http://www.ourbodiesourblog.org/
• Women’s Health News (blog by a librarian): http://womenshealthnews.wordpress.com/

References

De Jonge, A., Van der Goes, B. Y., Ravelli, A. C. J., Amelink-Verburg, M. P., Mol, B. W., Nijhuis, J. G, et al. Perinatal mortality and morbidity in a nationwide cohort of 529,688 low-risk planned home and hospital births. British Journal of Obstetrics and Gynaecology. 2009; 116 (9):1177–1184.

Janssen, P. A., Saxell, L, Page, L. A., Klein, M. C., Liston, R. M, Lee, S. K. Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician. Canadian Medical Association Journal. 2009; 181(6–7):377–383.

Midwives attending home births carry essential obstetric equipment to monitor the wellbeing of mother and baby and to deal with problems that may occur unexpectedly at birth. Essential equipment for home births is fairly minimal, easily fitting into a couple of bags. Parents are often surprised how little is used for a normal birth and also how little mess there is. Discussing equipment with women and taking time to briefly explain the mechanism of birth and infant transition to extra-uterine life enables them to feel confident in their bodies, which in turn facilitates the process.

As a homebirth midwife, I need a few supplies. At around 36 weeks I will take a birth kit to the house and the contents are explained to the woman and her partner so there are no surprises on the day. it is of outmost importance that the parents should see the contents. Therefore, the contents of the emergency bag are presented just in case the baby needs resuscitation. Parents find it helpful to know that the baby will not immediately be pink or that it may not cry. It is essential to prepare women and their partners for the birth. The opportunity is also taken to educate parents and birth partners on how to deliver a baby in the unlikely event that it arrives before the midwives do. A midwife should explain to the family that the only essential equipment they will need is warm towels or a blanket to keep baby and mother warm until the midwife or the paramedics arrive.

Most of my home births produce little mess, which is easily contained with some good pre-planning. I tell the family that they need plastic sheeting to protect the carpet, bed, birth mat or mattress, sofa etc. Plastic table cloths work well and a fitted plastic mattress covers alway go well.

I ask Women to have

Any old sheets or linen. Prospective grandparents are a useful source.

Hot water bottle to put on back or front of Mum in labour and to put on tummy afterwards for afterpains.

Nourishing, easily digested snacks of choice, yoghourts, Jordan bars, sugary sweets, dextrose tablets, bananas, Honey, crisps etc.

Nourishing fluids of choice

A nice soft big old towel to cover mum and baby together after the birth.

Sanitary Pads

A small soft towel to wrap baby in if necessary

Practically all the births I attended  at home, I have found a good waterproof protection for the floor, sofa, bed or wherever we end up, is a couple of metres of that waterproof table cloth that can be bought by the metre at good hardware or kitchen shops. It has a cloth backing and used cloth side up it is comfortable to walk on  it, and the midwife does not slide around all over the place.

The birth bag contains

• Five incontinence pads

• A surgical delivery pack

• IV’s for mom if she becomes dehydrated or addiitional nutrients

• Lots of sterile gloves

• Foetoscopes or ultrasonic stethoscopes

• Medications to slow or stop a haemorrhage

• Special herbal preparations, homeopathic remedies, massage supplies/techniques and even acupuncture needles

• Items for suturing tears

• A surgical delivery pack

• An in/out catheter (which is rarely used).

• Oxygen for the baby if needed

• IV’s for mom if she becomes dehydrated or needs additional nutrients

• Bloodpressure monitor

• Cylinders of Entenox, mouth pieaces and mask

• One Cylinder of Oxygen

• Pethidine and Narcan

• Suturing materials and local anaesthetics

Emergency Bag Contents

An emergency bag contains:

• A neonatal bag and mask

• A laryngoscope

• Extra syringes

 Drugs

Drugs are Syntocinon, Syntometrine and Ergometrine, Pethidine and Narcan, Vitamin K

The practice’s sterile delivery pack contains a plastic cord clamp, a pair of episiotomy scissors, two cord clamps and a pair of cord scissors.

• 1 large Ziplock bag (for placenta)

• 2 large garbage bags (for general clean-up)

• 6 packets of EmergenC vitimin drink

Old sheets for covering floors & carpets

You don’t need to have a fancy house or apartment. You don’t need to have a clean house. There will be blood, there will be fluids but midwives know what they’re doing and know how to clean up after them.

Other Handy Items…

• camera with extra film and/or EMPTY flash/memory card

• video Recorder

• tape Recorder

• phone list

• note pad and/or diary

Birth is NOT gory, or traumatic! It is a natural thing to happen, women are built to give birth and to allow the process to happen the way nature intends is the only way to go. Women always have the right to change their minds. If a woman decide in labour that she would prefer to go to hospital, that is always an option. As midwife I always carried nitrous oxide/entenox (laughing gas) to a home birth, which is a very effective form of pain relief for many women. Otherwise, I was allowed to give opiods at home in my country.

I am trained to provide emergency treatment if there are complications after the birth. Just like most other midwives, I do carry oxygen and resuscitation equipment for babies who are slow to breathe as well as intravenous fluids and drugs to treat heavy bleeding after birth. I have sutured many tears or episiotomies. Twice I had to transfer to hospital because of meconium stained liquor.

“Throughout history, the immediate postpartum period has been as much a victim of fashion and misconception as has labor and birth.  And standard practice still varies among countries, hospitals, doctors, and midwives.  The first act that usually occurs after the slippery baby emerges is the cutting of the umbilical cord.  …The act also forces the newborn to breathe air through its lungs for the first time.  Perhaps because of the symbolism of that moment, cord cutting has been a magnet for drama, ceremony, and superstition.

In most hospitals today, cutting the cord is such an uneventful routine that it can pass unnoticed by the overwhelmed mother.  Doctors generally wait about thirty seconds a time period long enough, they believe, for the baby to receive all the blood it needs from the placenta.  …They then apply two clamps, break out the scissors, and often ask the father if he wants to cut between the ligatures.  Doing all of this quickly also allows for the baby to be suctioned, weighed, and swaddled, before it gets cold.

Some childbirth experts argue that, rather than being guided by a clock, it’s best to wait until the cord stops pulsing before cutting, allowing the baby to receive all the blood it was meant to receive from the placenta.  They say it helps the mother as well, because the placenta shrinks as it pumps out extra blood, making it easier to deliver.”

The research that SUPPORTS delayed cord clamping/cutting:

Delayed Umbilical Cord Clamping Boosts Iron In Infants (2006): A report of a study conducted by UC Davis nutrition professor Kathryn Dewey that revealed a two-minute delay in cord clamping at birth significantly increases a child’s iron status at 6 months of age.  This study documented for the first time that the beneficial effects of delayed cord clamping last beyond the age of 3 months.

Early versus delayed umbilical cord clamping in preterm infants (2004): A Cochrane review (considered the “gold standard” of research and evidenced based practice) of studies on babies born prematurely which revealed that delaying cord clamping for greater than 30 to 120 seconds, rather than early clamping as is the current obstetrical practice, seems to be associated with less need for transfusion, less intraventricular haemorrhage, and helped the babies adjust to their new surroundings better.

Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes (2008): A Cochrane review that showed no significant difference in postpartum hemorrhage rates when early and late cord clamping were compared. The review also reported growing evidence that delayed cord clamping confers improved iron status in infants up to six months after birth, with a possible additional risk of jaundice that requires phototherapy.  (It is important to note however that the act of placing the baby on the mother’s abdomen skin-to-skin above the level of the placenta assures that blood will continue to flow, but not to excess.)

The PROS of Delayed Cord Clamping/Cutting

Below is a summary of the literature regarding the pros and cons of immediate vs. delayed clamping of the cord.

1) The blood in the placenta rightfully belongs to the baby, and babies not receiving this blood have the deal with the equivalent of a major blood loss or hemorrhage at birth.  It is estimated that early clamping deprives the baby of 54 to 160 ml of blood, which represents up to half of a baby’s total blood volume at birth.

2) There is a significant amount of iron in the cord blood which the baby needs for optimal health and for the prevention of anemia.

3) Babies benefit from the increased oxygen available to them from the cord-blood when the taking these first few breathes.  The earlier the cord is clamped, the more likely the incidents of respiratory distress.

4) The blood that babies receives through the cord after birth acts as a source of nourishment that protects infants against the breakdown of body protein.

5) As an added bonus, delayed cord clamping keeps babies in their mother’s arms, the ideal place to regulate their temperature and initiate bonding and breastfeeding.

The CONS of Delayed Cord Clamping/Cutting 

1)     May increase the baby’s risk for jaundice, a condition that many newborns develop related to the baby’s immature liver that cannot process bilirubin, a yellow byproduct of the breakdown of old red blood cells.

It seemed to me that the PROS of delayed cord clamping outweigh the CONS however I feel that it is important to explore the subject of newborn jaundice more…that is, Is it something that parents should be worried about?  Is it serious enough to trump all of the research supported benefits of delayed cord clamping?

Berwald, M. (2009). Late vs Early Clamping of the Umbilical Cord in Newborn Babies. Birth Bliss. Retrieved from website: http://birthbliss.wordpress.com/2009/01/30/late-vs-early-clamping-of-the-umbilical-cord-in-newborn-babies/

Buckley, S. (2005). Leaving well alone: A natural approach to the third stage of labour. http://www.sarahbuckley.com/leaving-well-alone-a-natural-approach-to-the-third-stage-of-labour/

Cassidy, T.  (2006). Birth: The Surprising History of How We Are Born. Atlantic Monthly Press. http://www.tinacassidy.info/

Medical interference in pregnancy, labour and birth is well documented, and the negative sequellae are well researched. However, medical management of the third stage of labour – the time between the baby’s birth, and the emergence of the placenta – to my mind, more insidious. At the time when Mother Nature prescribes awe and ecstasy, we have injections, examinations, and clamping and pulling on the cord. Instead of body heat and skin to skin contact, we have separation and wrapping. Where time should stand still for those eternal moments of first contact, as mother and baby fall deeply in love, we have haste to deliver the placenta and clean up for the next ‘case’.

Medical Management of the Third Stage

This ‘management’ of the third stage, which has been taken even further in the last ten years, with the popularity of “active management of the third stage” (see below), has its own risks for mother and baby. While much of the activity is designed to reduce the risk of maternal bleeding, or postpartum haemorrhage (PPH), which is most certainly a serious event, it seems that, as with the active management of labour, the medical approach to labour and birth actually leads to many of the problems that active management is designed to address.

Active management also creates specific and potentially life-threatening problems for mother and baby. In particular, use of active management leads to a newborn baby being deprived of up to half of his or her expected blood volume. This extra blood, which is intended to perfuse the newly functioning lungs and other vital organs, is discarded along with the placenta when active management is used, with possible sequellae such as breathing difficulties and anaemia, especially in vulnerable babies.

Drugs used in active management have documented risks for the mother, including death, and we do not know the long-term effects of these drugs, which are given at a critical stage of brain development, for the baby.

Your hormones in the third stage

As a mammalian species – that is, we have mammary glands that produce milk for our young – we share almost all features of labour and birth with our fellow mammals. We have in common the complex orchestration of labour hormones, produced deep within our “mammalian”, or middle brain, to aid us and ultimately ensure the survival of our offspring.

We are helped in birth by three major mammalian hormone systems, all of which play important roles in the third stage as well. The hormone oxytocin causes the uterine contractions that signal labour, as well as helping us to enact our instinctive mothering behaviours. Endorphins, the body’s natural opiates, produce an altered state of consciousness and aid us in transmuting pain: and the fight or flight hormones adrenaline and noradrenaline (epinephrine and norepinephrine – also known as catecholamines or CAs) give us the burst of energy that we need to push our babies out in second stage.

During the third stage of labour, strong uterine contractions continue at regular intervals, under the continuing influence of oxytocin. The uterine muscle fibres shorten, or retract, with each contraction, leading to a gradual decrease in the size of the uterus, which helps to ‘shear’ the placenta away from its attachment site. Third stage is complete when the placenta is delivered.

For the new mother, the third stage is a time of reaping the rewards of her labour. Mother Nature provides peak levels of oxytocin, the hormone of love, and endorphins, hormones of pleasure for both mother and baby. Skin to skin contact and the baby’s first attempts to breast feed further augment maternal oxytocin levels, strengthening the uterine contractions that will help the placenta to separate, and the uterus to contract down. In this way, oxytocin acts to prevent haemorrhage, as well as to establish, in concert with the other hormones, the close bond that will ensure a mother’s care and protection, and thus her baby’s survival.

At this time, the high adrenaline levels of second stage, which have kept mother and baby wide-eyed and alert at first contact, will be falling, and a very warm atmosphere is necessary to counteract the cold, shivering feelings that a woman has as her adrenaline levels drop. If the environment is not well heated, and/or the mother is worried or distracted, continuing high levels of adrenaline will counteract oxytocin’s beneficial effects on her uterus, therefore, according to Odent (1992), increasing the risk of haemorrhage.

For the baby as well, the reduction in fight or flight hormones, which have also peaked at birth, is critical. If, because of extended separation, these hormones are not soothed by contact with the mother, the baby can go into psychological shock which, according to author Joseph Chilton Pearce, will prevent the activation of specific brain functions that is nature’s blueprint for this time. Pearce believes that the separation of mother and baby after birth is, “the most devastating event of life, which leaves us emotionally and psychologically crippled” (Pearce 1992)

One might wonder whether the modern epidemic of “stress” – the term was invented by researchers in the early 20th century- and stress-related illness in our culture is a further outcome of current third-stage practices. It is scientifically plausible that our entire Hypothalamic-Pituatary-Adrenal (HPA) axis, which mediates long-term stress responses and immune function, as well as short-term fight-or-flight reaction, is permanently mis-set by the continuing high stress hormone levels that ensue when newborn babies are routinely separated from their mothers.

Michel Odent, in his review of research on the “primal period” (the time between conception and the first birthday), concludes that interference or dysfunction at this time affects the development of our “capacity to love”, which is particularly vulnerable around the time of birth, being connected hormonally to the oxytocin system. (Odent, 1998) Research by Jacobsen (1990, 1997) and Raine (1994), among others, suggests that contemporary tragedies such as suicide, drug addiction and violent criminality may be linked to problems in the perinatal period such as exposure to drugs, birth complications and separation or rejection from the mother.

A crucial role for birth attendants in these times is to ensure that a woman’s mammalian instincts are protected and valued during pregnancy, birth and afterwards. Ensuring unhurried and uninterrupted contact between mother and baby after birth, adjusting the temperature to accommodate a shivering mother, and to allow skin-to-skin contact and breastfeeding, and not removing the baby for any reason- these are practices that are sensible, intuitive and safe, and help to synchronise our hormonal systems with our genetic blueprint, giving maximum success and pleasure for both partners, in the critical function of child-rearing.

The baby, the cord, and active management

Adaptation to life outside the womb is the major physiological task for the baby in third stage. In utero, the wondrous placenta fulfills the functions of lungs, kidney, gut and liver for our babies. Blood flow to these organs is minimal until the baby takes a first breath, at which time huge changes begin in the organisation of the circulatory system.

Within the baby’s body, blood becomes, over several minutes, diverted away from the umbilical cord and placenta and, as the lungs fill with air, blood is sucked into the pulmonary (lung) circulation. Mother Nature ensures a reservoir of blood in the cord and placenta, that provides the additional blood necessary for these newly-perfused pulmonary and organ systems.

The transfer of this reservoir of blood from the placenta to the baby happens in a step-wise progression, with blood entering the baby with each third-stage contraction, and some blood returning to the placenta between contractions. Crying slows the intake of blood, which is also controlled by constriction of the vessels within the cord (Gunther 1957) – both of which imply that the baby may be able to regulate the transfusion according to individual need.

Gravity will affect the transfer of blood, with optimal transfer occurring when the baby remains at or below the level of the uterus until the cessation of cord pulsation signals that the transfer is complete. This process of “physiological clamping” typically takes 3 minutes, but may be longer, or can be complete in only one minute. (Linderkamp 1982)

This elegant and time-tested system, which ensures that an optimum, but not a standard, amount of blood is transferred, is rendered inoperable by the current practice of early clamping of the cord- usually within 30 seconds of birth.

Early clamping has been widely adopted in Western obstetrics as part of the package known as active management of the third stage. This comprises the use of an oxytocic agent – a drug that, like oxytocin, causes the uterus to contract strongly – given usually by injection into the mothers thigh as the baby is born, as well as early cord clamping, and ‘controlled cord traction’ – that is, pulling on the cord to deliver the placenta as quickly as possible.

Haste becomes necessary, because the oxytocic injection will, within a few minutes, cause very strong uterine contractions that can trap an undelivered placenta, making an operation and ‘manual removal’ necessary. Furthermore, if the cord is not clamped before the oxytocic effect commences, the baby is at risk of having too much blood suddenly pumped from the placenta by the over-zealous contractions.

While the aim of active management is to reduce the risk of haemorrhage for the mother, “its widespread acceptance was not preceded by studies evaluating the effects of depriving neonates [newborn babies] of a significant volume of blood” (Piscane 1996)

It is estimated that early clamping deprives the baby of 54 to 160 ml of blood, (Usher 1963) which represents up to half of a baby’s total blood volume at birth. “Clamping the cord before the infant’s first breath results in blood being sacrificed from other organs to establish pulmonary perfusion.[blood supply to the lungs].Fatality may result if the child is already hypovolemic [low in blood volume].” (Morley 1997)

Where the baby is lifted above the uterus before clamping – for example during caesarean surgery – blood will drain back to the placenta by gravity, making these babies especially liable to receive less than their expected blood volume. The consequence of this may be an increased risk of respiratory (breathing) distress- several studies have shown this condition, which is common in caesarean-born babies, to be eliminated when a full placental transfusion was allowed. (Peltonen 1981, Landau 1953).

The baby whose cord is clamped early also loses the iron contained within that blood – early clamping has been linked with an extra risk of anaemia in infancy. (Grajeda 1997,Michaelson 1995).

These sequellae of early clamping were recognised as far back as 1801, when Erasmus Darwin wrote: “Another thing very injurious to the child is the tying and cutting of the navel string too soon; which should always be left till the child has not only repeatedly breathed but till all pulsation in the cord ceases. As otherwise the child is much weaker than it ought to be, a part of the blood being left in the placenta which ought to have been in the child” (Darwin 1801).

In one study, premature babies experiencing delayed cord clamping – the delay was only 30 seconds – showed a reduced need for transfusion, less severe breathing problems, better oxygen levels, and indications of probable improved long-term outcomes, compared to those whose cords were clamped immediately. (Kinmond 1993).

Some studies have shown an increased risk of polycythemia (more red blood cells in the blood) and jaundice when the cord is clamped later. Polycythemia may be beneficial, in that more red cells means more oxygen being delivered to the tissues. The risk that polycythemia will cause the blood to become too thick (hyperviscosity syndrome), which is often used as an argument against delayed cord clamping, seems to be negligible in healthy babies. (Morley 1998)

Jaundice is almost certain when a baby gets his or her full quota of blood, and is caused by the breakdown of the normal excess of blood to produce bilirubin, the pigment that causes the yellow appearance of a jaundiced baby. There is, however, no evidence of adverse effects from this. (Morley 1998). One author has proposed that jaundice, which is present in almost all human infants to some extent, and which is often prolonged by breastfeeding, may actually be beneficial because of the anti-oxidant properties of bilirubin. (Gartner 1998)

Early cord clamping carries the further disadvantage of depriving the baby of the oxygen-rich placental blood that mother nature provides to tide the baby over until breathing is well established. In situations of extreme distress- for example, if the baby takes several minutes to breathe-this reservoir of oxygenated blood can be life saving, but, ironically, standard practice is to cut the cord immediately if resuscitation is needed.

The placental circulation acts, when the cord is intact, as a conduit for any drug given to the mother, whether during pregnancy, labour or third stage. Garrison (1999) reports that Narcan, which is sometimes needed by the baby to counteract the sedating effect of pain-relieving drugs such as pethidine (demorol), given to the mother in labour, can be effectively administered via the mother’s veins in third stage, waking up the newborn baby in a matter of seconds.

The recent discovery of the amazing properties of cord blood, in particular the stem cells contained within it, heightens, for me, the need to ensure that a newborn baby gets its full quota. These cells are unique to this stage of development, and will migrate to the baby’s bone morrow soon after birth, transforming themselves into various types of blood-making cells,

Cord blood harvesting, which is currently being promoted to fill Cord Blood Banks for future treatment of children with leukaemia, involves immediate clamping, and up to 100 ml of this extraordinary blood can be taken from the baby to whom it belongs. Perhaps this is justifiable where active management is practiced, and the blood would be otherwise discarded, but, unfortunately, cord blood donation is incompatible with a physiological (natural) third stage.

Active Management and the Mother

Active management (oxytocic, early clamping and controlled cord traction) represents a further development in third stage interference that began in the mid-seventeenth century, when male attendants began confining women to bed, and cord clamping was introduced to spare the bed linen.

Pulling on the cord was first recommended by Mauriceau in 1673, who feared that the uterus might close before the placenta was spontaneously delivered (Inch 1984). In fact, the recumbent (lying) postures, increasingly adopted under doctor’s care meant that spontaneous delivery of the placenta was less likely: the upright postures that women and midwives have traditionally used encourage the placenta to fall out with the help of gravity.

The first oxytocic to be used medically was egot, derived from a fungal infection of rye. Ergot was known to to be used by 17th and 18th century European midwives. Its use was limited, however, by its toxicity. It was refined and revived as ergometrine in the 1930’s, and by the late 1940’s, some doctors were using it as a preventatively, as well as therapeutically, for post partum haemorrhage. (Inch 1984) Potential side effects from ergot derivatives include a rise in blood pressure, nausea, vomiting, headache, palpitations, cerebral haemorrhage, cardiac arrest, convulsion and even death.

Synthetic oxytocin, which mimics the effects of natural oxytocin on the uterus, was first marketed in the 1950’s, and has largely replaced ergometrine, although a combination drug, called syntometrine, is still used, especially for severe haemorrhage. Syntocinon causes an increase in the strength of contractions, whereas ergometrine causes a large, ‘tonic’ contraction, which also increases the chance of trapping the placenta. Ergometrine also interferes with the process of placental separation, increasing the chance of partial separation. (Sorbe 1978)

Recently active management has been proclaimed “the routine management of choice for women expecting a single baby by vaginal delivery in a maternity hospital” (Prendville 1999), mostly because of the results of the recent Hinchingbrooke trial, comparing active versus “expectant” (physiological) management.

In this trial (Rogers 1998), which involved only women at low risk of bleeding, active management was associated with a post partum hemorrhage (blood loss greater than 500ml) rate of 6.8%, compared with 16.5% for expectant (non-active) management. Rates of severe PPH (loss > 1000ml) were low in both groups- 1.7% active and 2.6% expectant.

The authors note further that, from these figures ten women would need to receive active management to prevent one PPH. They add “Some women “¦ may rate a small personal risk of PPH of little importance compared with intervention in an otherwise straightforward labour, whereas others may wish to take all measures to reduce the risk of PPH.”

Reading this paper, one must wonder how it is that almost 1 in 6 women bled after “physiological” management, and whether one or more components of western obstetric practices might not be actually increasing the rate of haemorrhage.

Botha (1968) attended over 26,000 Bantu women over 10 years, and reports that “a retained placenta was seldom seen… blood transfusion for postpartum haemorrhage was never necessary.” Bantu women deliver both baby and placenta while squatting, and the cord is not attended to until the placenta delivers itself by gravity.

There is some evidence that the practice of clamping the cord, which is not practiced by indigenous cultures, contributes to both PPH and retained placenta by trapping extra blood (around 100ml, as described above) within the placenta. This increases placental bulk, which the uterus cannot contract efficiently against, and which is more difficult to expel. (Walsh 1968)

Other western practices that may contribute to PPH include the use of oxytocin for induction and augmentation (speeding up labour) (Brinsden 1978, McKenzie 1979), episiotomy or perineal trauma, forceps delivery, caesarean and previous caesarean (because of placental problems- see Hemminki 1996).

Gilbert (1987) notes that PPH rates in her UK hospital more than doubled from 5% in 1969-70 to 11% in 1983-5, and concludes “The changes in labour ward practice over the last 20 years have resulted in the re-emergence of PPH as a significant problem.” In particular, she links an increased risk of bleeding with induction using oxytocin, forceps delivery, long first and second stages (but not prolonged pushing) and the use of epidurals, which increase the chance of forceps and of a long second stage.

As noted, western practices do not facilitate the production of a mother’s own oxytocin, neither is attention paid to reducing adrenaline levels in the minutes after birth, both of which are physiologically likely to improve uterine contractions and therefore reduce haemorrhage.

Clamping the cord, especially at an early stage, may also cause the extra blood trapped within the placenta to be forced back through the placenta into the mothers blood supply with the third stage contractions. (Doolittle 1966, Lapido 1971) This “feto-maternal transfusion” increases the chance of future blood group incompatibility problems, which occur when the current baby’s blood enters the mother’s blood stream, causing an immune reaction which can be reactivated and destroy the baby’s blood cells in a subsequent pregnancy, causing anaemia or even death.

The use of oxytocin, which strengthens contractions, either during labour, or in third stage, has also been linked to an increased risk of feto-maternal hemorrhage and blood group incompatibility problems. (Beer 1969, Weinstein 1971)

The World Health Organisation, in its 1996 publication Care in Normal Birth: a practical guide, argue that “In a healthy population (as is the case in most developed countries), postpartum blood loss up to 1000 ml may be considered as physiological and does not necessitate treatment other than oxytocics”. In relation to routine oxytocics and controlled cord traction, WHO cautions that “Recommendation of such a policy would imply that the benefits of such management would offset and even exceed the risks, including potentially rare but serious risks that might become manifest in the future”.

Choosing a Natural Third Stage

Choosing to forego preventative oxytocics, to clamp late (if at all), and to deliver the placenta by our own effort all require forethought, commitment, and that we choose birth attendants that are comfortable and experienced with these choices.

A natural third stage is more than this, however – we must ensure respect for the emotional and hormonal processes of both mother and baby, remembering how unique this time is. Michel Odent stresses the importance of not interrupting, even with words, and believes that ideally the new mother feels unobserved and uninhibited in the first encounter with her baby. (Odent 1992) This level of non-interference is uncommon, even in home and birth centre settings.

Third stage represents a first meeting, creating a powerful imprint upon the relationship between mother and baby. When both are undrugged and quiet, fully present and alert, new potentials are invoked, and we discover more about ourselves, and the sacred origins of our capacity to love.

Rachana. S. (2000).  Leaving the Umbilical Cord Intact. Lotus Birth. Greenwood Press, Yarra Glen

Buckley,  S.  (2005). Leaving Well Alone: A Natural Approach to the Third Stage of labour. Rerieved from website: http://www.sarahbuckley.com/leaving-well-alone-a-natural-approach-to-the-third-stage-of-labour/

Sarah J Buckley is a NZ-trained GP, and an internationally-published writer and advocate for gentle choices in pregnancy, birth and parenting. www.sarahjbuckley.com

• Not grow as well

• Show signs of foetal stress

• Have a harder time during labor.

The placenta has three functions. It is the gate between mother and baby, transferring food from the mother and waste from the baby; it makes hormones that signal to the mother what the baby needs; and it protects the baby from the mother’s immune system, which could attack the baby because it is “foreign” to the mother’s body because half of its genes come from the father. The development of the placenta begins when the embryo implants into the lining of the mother’s womb, on the eighth day after conception. The organ becomes fully functional in the tenth week of pregnancy. At birth its surface is oval in shape. It seems that the tissue along the length of the surface has different functions to tissue along the breadth.

Poor prenatal nutrition will affect the placenta. You are what you eat and so is the baby. Babies do not well on potato chips and sodas all day. There can be real consequences if moms do not take good nutritional care of their bodies and babies. Low levels of Vitamin D are now being connected to preeclampsia and gestational diabetes in pregnant women, as well as schizophrenia, autism, mental retardation and seizures in babies. Pregnant women should make sure to consume cod liver oil, fresh dark greens, vegetables, fruits, legumes, and wholesome grains all paired with exercise.

Belkacemi, L., Nelson, D. M., Desai, M., Ross, M. G. (2010). Maternal Undernutrition Influences Placental-Fetal Development. Biology of Reproduction. Vol. 83, No. 3 325-331.  http://www.biolreprod.org/content/83/3/325.abstract

Africa has the world’s highest proportion of binge drinkers. Africa has become a boom market for international brewers and distillers whose sales are often flagging in the wealthy world. Drinks companies want to keep up the momentum. SABMiller is investing up to $2.5-billion (U.S.) over the next five years to build and renovate breweries on the continent. Rival Diageo’s African sales have risen by an average 15 per cent in each of the last five years, and now account for 14 per cent of the group’s total.

For years, poor Africans were limited to home-brew sorghum or maize beer, sometimes made with dangerous ingredients such as battery acid to increase the potency. Commercial alcohol is now widely available in most African states and premium brands such as Johnny Walker whisky or Heineken beer are increasingly in reach of the average drinker.

Many South Africans are binge drinkers. South Africa has one of the biggest alcohol consumption rates in the world. South Africa’s Western Cape province, has the highest reported rate in the world. Foetal Alcohol Syndrome is very prevalent issue throughout South Africa wine-regions- the Western Cape where farm labourers were once paid in alcohol. A shocking 122 out of every 1 000 Grade 1 pupils in the Northern Cape town of De Aar have foetal alcohol syndrome – the highest incidence of the syndrome in one population anywhere in the world. And in the Western Cape, research shows that 88 out of every 1 000 Grade 1 pupils have the syndrome.

Cheap alcohol is common in South Africa, and the shebeen system doesn’t help. Also, poverty is at the root of the problem. The shebeen system is one of informal taverns dispensing alcohol because there’s lack of employment opportunities. So people open up shebeens trying to make a living. De Aar is a town in the Northern Cape Province has 95 shebeens in a population of 28,000. Alcohol abuse leads to unsafe sex and “many, many unplanned for and unwanted children,” and “no doubt” contributes to rising rates of fetal alcohol syndrome and HIV infection according to experts.

Denis Viljoen, a founder of the non-governmental organisation the Foundation for Alcohol Related Research (FARR), states, “Fetal alcohol spectrum disorder is the most common birth defect in South Africa, by far more common than Down syndrome and neural-tube defects combined.”The move is designed to cut one of the world’s highest rates of Fetal Alcohol Syndrome.

FASD is a term that describes a range of disabilities (physical, social, mental/emotional) that may affect people whose birth mothers drank alcohol while they were pregnant. Alcohol use appears to be the most harmful during the first 3 months of pregnancy; however, drinking alcohol any time during pregnancy can be harmful. As mentioned, alcohol can damage a growing baby’s brain, organs and body. This damage can affect how the baby thinks, acts, looks and learns as a child and as an adult. Alcohol damage doesn’t always show up before the child goes to school. And every pregnancy and every baby is different.

There is no cure for FASD and its effects last a lifetime. The World Health Organization recommends that pregnant women should avoid alcohol. The World Health Organization, for instance, says alcohol-related injuries such as road traffic accidents, burns, poisonings, falls and drownings making up more than a third of the burden of disease, all because of drinking. South Africa is considering introducing a law that bans retailers from selling alcohol to pregnant women. A large number of South Africans are misinformed about FASD and when we tell people that drinking just one or two glasses can harm their baby, they don’t believe me.

Causes

Alcohol is readily absorbed from the gastrointestinal tract into a pregnant woman’s bloodstream and circulates to the foetus by crossing the placenta. Here it interferes with the ability of the fetus to receive sufficient oxygen and nourishment for normal cell development in the brain and other organs. The consumption of alcohol directly contributes to malnutrition because it contains no vitamins or minerals, and it uses up what the woman has for metabolism. The foetus is most vulnerable to various types of injuries depending on the stage of development in which alcohol is encountered. During the first eight weeks of pregnancy, organogenesis (the formation of organs) is taking place, which places the embryo at a higher risk of deformities when exposed to teratogens.

Symptoms

A baby with fetal alcohol syndrome may have the following symptoms:

• Poor growth while the baby is in the womb and after birth
• Decreased muscle tone and poor coordination
• Delayed development and problems in three or more major areas: thinking, speech, movement, or social skills.
• Heart defects such as ventricular septal defect (VSD) or atrial septal defect (ASD).
• Problems with the face, including narrow, small eyes with large epicanthal folds
• Small head
• Small upper jaw
• Smooth groove in upper lip
• Smooth and thin upper lip

What happens to children born with Fetal Alcohol Syndrome?

• Their brain is permanently damaged, so they have trouble following simple instructions or remembering things.
• They’re small and don’t grow normally.
• Their faces may look different, such as small eyes and thin lips.
• They’re often colicky babies and hyperactive children.
• They might have trouble seeing, hearing or speaking.
• They might have heart or kidney trouble

The advice of midwives and nurses is likely to have the most powerful impact on pregnant women and help them to avoid the risks. It is essential that the advice given is up to date, consistent and evidence-based, alongside advice provided on other lifestyle choices such as drugs, smoking and nutrition. All health care providers at all levels should be trained to screen for, diagnose, prevent, and treat an alcohol-exposed pregnancy. Curriculum programs and materials tailored to meet the learning needs of these professionals should be developed and used. We need to better understand the many social and psychological processes that contribute to risky drinking and sexual activities in the environments in which these women live, and we must seek to delineate personal and societal interventions that are both acceptable and realizable.

TakeAway Theatre has been creating groundbreaking community theatre with South Africa’s leading Fetal Alcohol Syndrome (FAS)-related research and training organisation, the Foundation for Alcohol-Related Research (FARR), for the past four years. Another non-profit organization works in communities in the North and Western Cape of South Africa and they partnered with SAB Ltd to address the issue of Foetal Alcohol Syndrome. Young girls and adult women are taught the risks of drinking alcohol when pregnant, while young boys and adult men are encouraged to support their future girlfriends/wives not to drink during pregnancy. An independent impact assessment found that 82% of those involved said that their knowledge of FAS and the dangers of alcohol abuse had increased. Let me end with this phrase:

“The future of our country…
Does not only lie within our mothers’ wombs…
But also in the supporting hands of many…
Mothers, Fathers, Families, Community Leaders…
And yours…because in the end it takes a village to raise a child”
African Proverb

Sources

National Council on Alcoholism and Drug Dependency — www.ncadd.org
Fetal Alcohol Syndrome Family Resource Institute. www.fetalalcoholsyndrome.org
World Health Organization: http://www.who.int/bulletin/volumes/89/6/11-020611/en/

• Antenatal and Postnatal Care
• Home birth
• Waterbirth
• Hospital Birth
• Birth in Birth Centre
• Caesarian section attendance

Little Arrivals Private Midwife Services

Ntombi Mchunu

Address: Linkwood Hospital 24 12th Avenue Linksfield West,
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Home Visiting Midwife

Address: Roodepoort, Gauteng 1724
Tel: 071 6367692

lgvanderw@gmail.com

Hettie Grove: Carmi Clinic: Springs

RN, RCN, RM, BACurEdAdmin, advanced midwife, IBCLC, Internationally certified childbirth educator, Happiest kid on the block educator, Evergreen parent facilitator.Childbirth education, postnatal classes, well baby clinic, home phototherapy. PR 8806926.

TeL 011 815 2129
083 492 5861

Sue King www.sueking.co.za 082 573 5191
Xoli Makabane www.xolimakabane.com 082 667 7947

Marilyn Sher http://midwives-online.net/index.php 083 268 5422
Veronica Park http://midwives-online.net/index.php 082 741 9281

Nicolette Barkhuizen www.yourbirth.co.za 084 679 3026

Sharon Marsay 082 853 3445
Henny de Beer 082 788 2683
Karen v d Merwe 082 335 7731
Ntombi Mncunu 0729496058
Phindi Mashinini 084 910 7730
Ruwaida Moola 082 784 7949
Gail de Vos 082 855 5684
Verina Song 078 800 6939
Christy Loubser 0836110550
Benoni
Sue Cohen 0825599911

Boksburg
Kathleen van Heerden www.midwifedelivery.co.za 082 928 9841
Karen Powles www.thenestmotherandbabyclinic.co.za 083 629 4622
Randfontein
Jenni Clarence 082 897 6652

Pretoria
Heather Pieterse www.midwives-exclusive.com 082 829 5309
Erna Loedolf www.midwives-exclusive.com 012 304 1818
Esti Viljoen www.midwives-exclusive.com 012 304 1818

Pretoria North
Marietha Yasbek 082 576 3558

North West Province​

Brits Nnana Molefe 078 014 7197

Rustenburg Antza Bingle 0721154446 / 014 596 5699

​ Northern Cape​

Hartswater: Jane Keyser 082 703 7030

Eastern Cape​

Port Elizabeth​

Nicole Angling 0733895243 nicole@anglings.com

East London to Port Alfred

Karen Clarke www.birthworks.co.za 082 776 3622

Uitenhage to Kirkwood​

Mynie Bester 082 758 5149 mynie.bester@gmail.com

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Ingrid Groenewald www.sisteringrid.co.za 082 789 3021

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Hannelie Roodt www.neobies.co.za 082 828 5810

Kwa-Zulu Natal​

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Cheryl Rowe 083 288 8203

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Ballito

Liza Harkess 082 564 9786 www.ballitobabes.co.za

Pietermaritzburg

Arlen Edge 082 488 8417

Newcastle

Jabu Mlambo 082 786 8273

Kloof

Hilary Davis 072 073 9413

Munster

Sue Lamb 072 526 0325

Limpopo

Lebowakgomo Mabore

Elizabeth Senama 072 132 5173

Bela Bela / Thabazimbi / Modimolle

Corney Nel 083 340 5812 / 014 734 1985

​ Free State Province​

Bloemfontein and surrounding areas

Yolande Maritz  084 604 2921

​

​

Central
Cape Town
Birthworks
Karen Clark Registered nurse & midwife
PR No. 0092444
We hire birth pools, birth stools, Tens machines & birth balls nationwide
(021) 785-5670 / 082 776 3622 / www.birthworks.co.za

Mouille Point
Thula Baby Centre
Heather Wood Registered nurse & midwife
PR No. 0192031
Antenatal preparation classes, well baby clinic, home visits
(021) 434-2614 / 072 548 8506

Sea Point
Bella-Mia
Tania Wener
Perinatal instructor ICEA
PR No.
Birth preparation, nutrition, postnatal rehab, pelvic floor strengthening, core
083 408 8868
info@bellamiax.co.za

Gardens
Ruth Katzman
BSc Physiotherapy, IBCLC
PR No. 7222742
Physiotherapy for breastfeeding problems, hiring of Tens machine, pelvic floor rehabilitation
082 864 8232

Pinelands
Joann Lugt Childbirth Education
Joann Lugt
Registered nurse & midwife
PR No. 0880000032395
Antenatal classes, baby sign language workshops, postnatal visits
(021) 531-5422 / 084 879 8511

Northern suburbs
Milnerton
Be Prepared For Life
Devorah Gruss Registered nurse & midwife
PR No. 8804559
Childbirth education classes for couples
(021) 552-5872 / 083 463 8114

Milnerton
Sr Lyns Baby Clinic at Milnerton Medi-Clinic
Lyn Smit Registered nurse and midwife
PR No. 0016985
Well baby clinic offering immunisations, breastfeeding, weight & observation of newborns
(021) 529-9195 / (021) 552-8126

Milnerton
The Lactation Consultancy
Jean Ridler RN, RM, international board certified lactation consultant
PR No. 8809068
Breastfeeding classes for parents-to-be, home consultations for breastfeeding problems, breastpump hire
(021) 556-9162 / 082 668 1082

Milnerton
Paula Pedersen Qualified labour doula
PR No.
Certified childbirth companion for all births (home, hospital, water, vbac), breastfeeding support
083 334 2253 / www.paula.co.za / paula@paula.co.za

Tableview
Tenfold Baby Clinic
Jackie Butler
BCur Hons, registered midwife
PR No. 0880000056170
Antenatal classes, well baby clinic, breastfeeding support, immunisations, postnatal home visits
(021) 557-6066 / 082 297 2742

Table View
Robin Buck Physiotherapy
Angela Buck
BSc Physio
PR No. 0159263
Treatment of engorged breasts, cracked nipples, breastfeeding advice & infant massage
084 981 0232

Sunningdale
Blaauwberg Hospital
Delene Cloete Registered nurse
PR No. 0880000018082
Antenatal classes
(021) 556-8027 / 072 470 0435

Sunningdale
Storks Nest Netcare Blaauwberg Hospital
Barbara Chambers Registered nurse & midwife
PR No. 0880000003379
Antenatal classes, breastfeeding advice, well baby clinic, immunisations, milestones & development
(021) 554-9388/9

Melkbos
Marcha Izatt RN, RM, RPN
PR No. 0880000087580
Postnatal care, breastfeeding counselling, home phototherapy
078 138 2040

Panorama
Panorama Breastfeeding Clinic
Justine Geiger
BSc Nursing, RN, RM, RCHN
PR No. 8853088
Antenatal classes, breastfeeding advisors, all baby & child immunisations till preschool
(021) 939-9720 / (021) 930-8397 / after hours helpline 083 703 7711

Panorama
Panorama Antenatal Classes
Danelia Kok
Reg midwife, Comm Health, Nursing Education & Admin
PR No. 0880000118532
We offer Afrikaans and English antenatal classes at Panorama Medi-Clinic
(021) 938-2153

Goodwood
Storks Nest Clinic
Ronel Nortje Registered nurse & midwife
PR No. 0880000161764
Antenatal classes, well baby clinic, breastfeeding support, vaccinations, baby massage
(021) 590-4196/1

Bellville
Jeanne Roux / Tucker Physiotherapy
Jeanne Roux Registered Midwife
PR No. 0880000093416
Antenatal &∓ postnatal education, exercise, delivery & back care
(021) 957-6283 / (021) 948-1553

Bellville
Birth, Baby & Beyond
Rosemary Gauld Registered nurse & midwife, internationally certified childbirth educator, international board certified lactation consultant
PR No. 8812608
Antenatal classes, breastfeeding private home consultations
(021) 910-0606 / 082 372 3348

Bellville
Sr Jenny’s Pregnancy Centre
Jenny Visser RN, RM
PR No. 0024252
Antenatal classes, home & hospital births, postnatal & breastfeeding support
(021) 919-9000 / 082 508 5842

Durbanville
Baby and U
Merle Townsend Registered nurse & midwife, internationally certified childbirth educator
PR No. 0080010078921
Antenatal classes – childbirth education – relaxed and informative classes
(021) 976-5740 / 072 266 8864

Durbanville
Durbanville Family Care Centre Breastfeeding Clinic
Jessica Commaille RN, RM
PR No. 0880000157139
Fun childbirth education for moms and dads, well baby clinic, immunisations
(021) 975-3634 / 073 235 2869

Durbanville
All About Babies
Darol Wilmot RN, RM, ICCE, CIMI
PR No. 8809747
Antenatal classes, all follow-up help birth – 6 years including feeding & immunisations
083 335 4653

Durbanville
Magical Mums Clinic
Riana Stander Registered nurse & midwife
PR No. 8847398
Antenatal classes, well baby clinic, breastfeeding consultant
(021) 976-6477 / 082 771 4253

Durbanville
Proselect Mother & Baby Clinic
Rika Hoffman Registered nurse & midwife
PR No. 0217743
Infant massage, immunisations, breastfeeding consultant, antenatal classes, family planning
(021) 979-1970 / 082 575 3918

Welgedacht
Welmed Breastfeeding Clinic
Suzette Viljoen & Alma Strever RN, RM, BACur admin, comm health
PR No. 883870401
Antenatal classes, breastfeeding advice & weighing of baby, immunisations, baby massage, phototherapy
(021) 913-7024 / 082 674 1077

Kuils River
Storks Nest
Christine Swart RN, RM, RCHN, RPN, CNP
PR No.
Childbirth education, well baby clinic, breastfeeding, diabetes clinic, immunisations
(021) 900-6250

Brackenfell
Susan de Wet BCur, RN, RM, IAIM
PR No. 0880000226963
Presenting condensed antenatal classes (1 day) & specialising in multiple pregnancies
082 785 7770 / susandw@mweb.co.za

Brackenfell
Clicks Pharmacy Fairbridge
Silke Schmidt-Dumont BCur
PR No. 8841810
Well baby clinic, breastfeeding advice, immunisations, family planning
(021) 981-1144

Malmesbury
Natalie Hanekom Privaat Baba Kliniek
Natalie Hanekom Registered nurse and midwife
PR No. 0880000129186
Voorgeboorte klasse, fetalehart monitering, weeg van babas, immunisasies, borsvoedingskliniek, babamassering ens
(022) 487-2567 / 082 714 3276

Malmesbury
Mediese Sentrum
Jeannine Bruwer GV, GVV, GGV, PGS
PR No. 1582607
Immunisasie kliniek & weeg van babas
(022) 482-4589

Piketberg
Sujalet
Suzanne Burger
Geveg verpleeg in verloskunde, algemene, psigiatrisie en vermeenskapverpleeging
PR No. 880013013
Voorgeborrte klasse en nageboorte hulp, wat bosvoeding insluit en immunisering
076 703 2803

Saldanha
Baby Basics
Julia Slabber BSocSc Nursing
PR No. 0880008806187
Antenatal exercise & education classes
(022) 714-1427

Southern suburbs
Claremont
Kingsbury Hospital
Pauleen Nelson Registered nurse & midwife, international board certified lactation consultant
PR No. 0880000066389
Breastfeeding education and support, antenatal & postnatal private home consultations
(021) 696-5791 / 084 082 9104

Claremont
Cindy Homewood Registered nurse & midwife
PR No. 0880000098302
Breastfeeding counselling, infant & child nutrition advice, home visits
082 960 5940

Claremont
Lady Buxton Clinic Registered nurse & midwives
PR No.
Mon – Fri: 9am – 12 noon / Tues: 2:30 – 5:30pm
Support and advice to parents on babyhood & childhood, immunisations, family planning
(021) 674-3110

Plumstead
Birth Options
Kate Christie
BSc Nursing
PR No. 8840873
Independent midwives, home & hospital births, antenatal care, antenatal classes, postnatal care, breastfeeding advice
(021) 761-9623 / 082 785 3877

Plumstead
Birth Options
Glynnis Garrod Prof nurse & midwife
PR No. 8846502
Midwifery practice including home and hospital births, antenatal classes and postnatal care
(021) 761-9623 / 082 894 5934

Plumstead
Incredible Babies Clinic
Ceredwin Thomsen Registered nurse & midwife & community health science
Well baby clinic, parenting support, breastfeeding weighing, immunisations, nutrition, home visits
083 303 5552 / (021) 761-9623

Rondebosch
Well Mother & Child Clinic
Louise Naude Registered nurse & midwife
PR No. 8826277
Well baby clinic, breastfeeding care, immunisations, weighing, developmental screening, maternal support
(021) 689-6930 / 082 829 9788

Constantia
Constantia Antenatal & Baby Clinic
Lynne Heydenrych
BSc Nursing & midwifery, internationally certified childbirth educator, international board certified lactation consultant
PR No. 8814422
Internationally certified childbirth educator specialising in antenatal classes, breastfeeding baby clinic
(021) 715-2539w / (021) 715-2262h / 082 425 1151

Constantia
Kathryn Sutton
BSc Nursing, lactation consultant
PR No. 8813779
Breastfeeding consultations & home visits, well baby clinic
082 728 6629

Constantia
Healthwise
Suzanne Leighton Aromatherapy, reflexology, reiki, yoga
PR No. 1060000216224
Baby & pregnancy massage, postnatal depression & bi-polar disorder
(021) 794-2738

Kenilworth
Perfectly Pregnant
Jill Mathew Registered nurse & midwife
PR No. 8809224
Preparing for childbirth & parenting courses, paediatric CPR, antenatal & postnatal exercises
(021) 683-1404w / (021) 671-5294h / 072 329 0281

Tokai
McLeod & Orpen-Lyall Physiotherapy
Wendy Orpen-Lyall
BSc Physiotherapy
PR No. 0087483
Women’s health physiotherapy (pregnancy aches and pains and incontinence)
(021) 713-3766

Marina da Gama
Midwives Inc
Sandy Standish
CPN, registered midwife
PR No. 8814368
Antenatal and postnatal care, home and hospital deliveries
083 653 7794 / (021) 788-7199

Fish Hoek
Carol’s Clinic
Carol Martin Registered nurse, midwife, childbirth educator
PR No.
Antenatal & postnatal education & support, family planning, breastfeeding support
(021) 782-2124
084 989 0055

Fish Hoek
Labours of Love
Jennifer Skillen
BSc D.Phil, NCT childbirth educator
PR No.
Preparing for a natural birth in a high tech society
(021) 788-7867

Noordhoek
Noordhoek Baby Clinic
Sarah Philbrick
RGN,RM, BScHons
PR No. 0880000114561
Antenatal classes, breastfeeding support, baby care & advice, immunisations, postnatal home visits, weighing
083 437 7358

Southern suburbs

Southern suburbs
Sue Lees Registered nurse & midwife
PR No. 8818096
Antenatal care, home & hospital births, postnatal care
(021) 788-5997

Southern suburbs
Lalilu Doula Care
Lana Petersen PR No.
Childbirth companion for home, hospital and vbac, support at home
(021) 703-4291 / 073 514 9754 / lalilu@sybaweb.co.za

Southern suburbs
Tums2Tots
Kerry Pienaar
Doula / Mom
PR No.
Doula – labour, birth, breastfeeding assistance, postnatal care, labour & birth kits
(021) 785-3694 / 082 475 7776

Boland

Stellenbosch
Swanger Familie Konsultasie
Leana Habeck
BCur, RN,RM,RPN,CHN, dip peri ed, UNICEF breastfeeding counsellor
PR No. 0880000026174
Antenatal classes for couples and singles, Afrikaans or English, breastfeeding support
(021) 855-4657 / 083 415 4657

Paarl
Paarl Medi-Clinic
Annelise Nel
BACur
PR No. 0880000087815
Antenatal classes, breastfeeding clinic, well baby clinic, massage consultant
(021) 807-8129 / 807-8130

Paarl
Mariana Symington
BA Cur
PR No. 8824460
Well baby clinic with immunisations, all midwifery services, antenatal classes
082 807 5887 / (021) 872-5106

Worcester
Worcester Medi-Clinic
Heidi Jonker Registered nurse & midwife
PR No.
Antenatal & postnatal classes, well baby clinic, immunisations
(023) 348-1500 / (023) 348-1570

Robertson
Multi-Med Kliniek
Karien Orton
BCur Hons midwifery & neonatal
PR No. 8850186
Voorgeboorte klasse, gesonde baba kliniek, tuis bevallings, water geboortes
(023) 626-2022 / 082 334 3474

Vredendal
Miracle Babies Kliniek
Estelle Bornman
BCur, midwife, OHS
PR No. 88000177636
Antenatal classes, postnatal care & support, breastfeeding care & support
084 548 6841 / (027) 213-5323

Helderberg

Somerset West
Irene Bouquin Childbirth Parenting Course
Irene Bourquin Registered nurse & midwife, ICCE, ICPNE
PR No. 0880008801878
Childbirth & parenting classes for teens, single mums, couples and grandparents
(021) 852-3040

Somerset West
The Cape Midwife
Natasha Stadler Registered midwife & nursing sister
PR No. 0202584
Qualified personal care for you and your family, pregnancy, birth, early parenting
082 538 7707

Stellenbosch
Swanger Familie Konsultasie
Leana Habeck
BCur, RN,RM,RPN,CHN, dip peri ed, UNICEF breastfeeding counsellor
PR No. 0880000026174
Antenatal classes for couples and singles, Afrikaans or English, breastfeeding support
(021) 855-4657 / 083 415 4657

Stellenbosch and Cape Town
Mama Bamba
Robyn Sheldon RM
Doula Trainer Antenatal Classes, Soul Connection to unborn
E-mail: robyn@mamabamba.com
Telephone:  076 8886551
PR No.0880010218219
Website: www.mamabamba.com

Stellenberg
Helping Hands at Stellenberg Pharmacy
Elaine van Zyl RN, midwife, community health
PR No.
Breastfeeding advice, weighing, immunisations, postnatal advice
083 225 8880

Southern Cape

Hermanus – Onrusrivier
Anita’s Mom and Baby Clinic
Anita Rust Dip general & obstet, BCur, primary health care
PR No. 0880000168394
Prenatal education, lactation consultation, well women clinic, baby vaccination, screening
(028) 316-1717 / 082 929 4460

Hermanus & Stanford
Marie’s Antenatal Care
Marie du Plessis Registered nurse & midwife, psychiatry
PR No.
Antenatal classes
082 821 7144 / (028) 313-8138 / (028) 341-0643

Riversdal
Riversdal Gesonde Baba Kliniek
Rina Kapp
Geredestreerde verpleegkundige
PR No. 8830711
Voorgeboorte klasse
082 921 4415 / (028) 713-2500

George
George Medi-Clinic Registered nurses of labour ward
PR No.
Antenatal classes Mondays at 18h00, postnatal groups every second Thursday at 10h00 at the baby clinic
(044) 803-2312

George
Elon Clinic
Maureen Barnard Registered nurse & midwife, community health, operating theatre science, primary clinical care, nursing of patients with diabetes
PR No. 8829357
Well baby clinic, immunisations, lactation consultant, diabetes educator
(044) 874-6769 / 082 494
For those who cant afford care visit the government clinics: http://www.westerncape.gov.za/eng/directories/facilities/6439

There are times they want to give up. One problem is that many of new mom or even nursing staff have never seen a nursing mother and baby or grew up in a breastfeeding culture. This can make it difficult to learn the art and techniques associated with good nursing techniques like the proper latch and breastfeeding positions. By using good positioning with breastfeeding you can help avoid nipple pain and other breastfeeding problems.

If you feel I’ve missed important links for lactation experts, have a more up-to-date link for any of them or find any other problem, please find the following links:

• La Leche League International
• Lamaze International

For more basic practical breastfeeding information, I highly recommend that you check out Dr. Jack Newman’s articles which are great resources to help you know more about breastfeeding. Also be sure to check out “Gee Whiz” Lactation Facts for some surprising facts about breasfeeding. Breastfeeding is a learned behavior. It is not instinctual on the part of the mother and although a baby has the instinct to suckle, latching on properly and actually getting milk requires practice. A new mother and a new baby may get frustrated very quickly when things do not proceed smoothly. This is a comprehensive site regarding Breastfeeding, Birthing Centres, Breastfeeding Consultants, Midwives.

Addtional breastfeeding articles and links:

• Fenugreek
• Reglan
• Reverse Pressure Softening
• How Weaning Happens
• Breastfeeding Older Children
• Adventures in Tandem Nursing

So we know now that The BFHI was established to encourage maternity hospitals to implement the Ten Steps to Successful Breastfeeding and to practise in accordance with the International Code of Marketing of Breastmilk Substitutes.

The Baby Friendly Initiative works with the health-care system to ensure a high standard of care in relation to infant feeding for pregnant women and mothers and babies. Support is provided for health-care facilities that are seeking to implement best practice, and an assessment and accreditation process recognises those that have achieved the required standard.

Since its launching BFHI has grown, with more than 152 countries around the world implementing the initiative. The initiative has measurable and proven impact, increasing the likelihood of babies being exclusively breastfed for the first six months. Since the beginning of the BFHI, over 22,000 hospitals worldwide have become designated “Baby Friendly. However, the vast majority of hospitals in the world have failed to implement the Baby Friendly Hospital Initiative in the 20 years since this agreement was signed.

In South Africa, the BFHI was launched in 1994 and St Monica’s Maternity Hospital in Cape Town was the first hospital to be accredited Baby-Friendly. The Western Cape has 74 public and private hospitals with maternity wards, of which only 19 boasts the BFHI accreditation. 17 of the 19 are public hospitals. So we know now that nineteen hospitals in the Western Cape Province have received this accreditation. Alan Blyth Hospital celebrated its international Baby-Friendly Hospital Initiative (BFHI) accreditation by hosting a ceremony on Monday, 13 February 2012.

Nurses and midwives should take action. Advocate for Baby Friendly accreditation at your local hospitals. Join breastfeeding organizations such as La Leche. If you are not already a member, I urge you to attend a La Leche League Group regularly and become a member. or become a member of International Baby Food Action Network. Write letters to your local hospital administration, health minister, head of obstetrics, maternity ward, public health unit (health units can earn Baby Friendly accreditation as well), and health authority, advocating for a push to improve infant and maternal health via the Baby Friendly Hospital Initiative. Change the world, improve health, support women! One hospital at a time….