The beekeeper’s wife and the Aloe Tree birthing house

Most doctors will tell you that they can recall receiving some strange calls in their life.

One of my most memorable happened at 2am on a Thursday about eight years ago.

The midwife on call in the labour ward called to inform me of a new admission.

A woman was in labour with her first baby. She had not received any formal antenatal care and had decided on an unattended home birth on their farm.

Her husband, who was a beekeeper with no medical training, had apparently been the only one helping her through this ordeal.

Her water had broken four days before and she had had contractions for two days.

When she then eventually had a convulsion he had decided to bring her to the hospital.

When I arrived at the hospital she was fully dilated, but I could not deliver the baby successfully and took her for a caesarean.

She had drained 2l of urine on insertion of her catheter and this had stretched her bladder to the point of covering her uterus.

She had clearly been in advanced labour for many hours as the foetal head only obstructs the bladder deep in the pelvis and close to delivery.

Luckily all was well with the incredibly resilient baby and the mother recovered well though she had to keep her catheter for an extended time due to her bladder trauma.

Home birthing is a controversial topic, especially in countries with well-developed health-care systems.

In most developed countries the rate is less than 2% but the Netherlands is the exception and the main flag bearer for home birthing protagonists.

About 30% of all births in the Netherlands are at home.

This has been explained by a very strong tradition of home birthing as well as the costs involved in a hospital birth.

Midwives and gynaecologists are often on the opposite poles of the debate and it does seem that the number of home births is on the decline.

But what makes home birthing an attractive option for soon-to-be mothers?

Many women prefer to deliver in relaxed, familiar surroundings with the support of their families and partners, including the midwife of their choice.

They desire freedom of choice and often fear medical interventions including rising caesarean rates.

Home birthing is much cheaper than institutional birth. Culture and religion may also play a role.

There are very important prerequisites to consider before deciding on this route.

Formal antenatal care is essential to determine if patients are low risk and thus qualify.

The attending midwife needs to be fully qualified in advanced midwifery and trained in foetal resuscitation.

A referral system needs to be in place if complications arise including a readily available ambulance to a hospital, preferably within 30 minutes.

This is likely the obstetrician’s biggest gripe with home births.

Advanced midwives are excellent in diagnosing problems in labour and make timely decision to refer, but do we have a reliable ambulance service cater for these patients?

The obstetrician also now has to deal with a prolonged, complicated labour and this increases litigation risk.

Sister Colleen Pedersen is a well-known Port Elizabeth midwife and has been conducting home births as well as acting as  a doula in hospital for several years.

She had a vision of developing a custom-made home birthing centre in Port Elizabeth after visiting two such homes in the US.

This inspiration will hopefully now culminate in the opening of the Aloe Tree birthing house in Park Drive.

This manor house was identified as the perfect space for this birthing home due to its location in a peaceful neighbourhood and its proximity to a private hospital.

In maternity, safety is the primary concern and   Pedersen strongly advocates that only low-risk patients be accepted to deliver at their centre.

She and her passionate team of fellow midwives have launched a fundraising campaign to acquire and develop the manor house.

There are many administrative and logistical hurdles to navigate through their journey, but, knowing these midwives, I know they are up to the task.

Aloe Tree will be a non-profit company and can be followed on Facebook at “Aloe Tree Birth House”

Those of us who have chosen a career in support and advancement of maternal health need to acknowledge the need for multiple layers of care.

Pregnancy need not be treated as a disease, but we cannot disregard all the advances made over the last century in decreasing maternal and neonatal mortality and morbidity.

We need to strive to balance the mother’s wants and needs, and what health-care workers deem to be the correct level of care.

We can achieve this with open, unbiased dialogue.

So let’s not throw the baby out with the (birthing) bathwater.

Dr T is a registered medical practitioner in Nelson Mandela Bay