Midwives and medical negligence
Over the years women have had more freedom to choose their pregnancy care and birth journeys. Many expectant parents opt to deliver their babies at home or at a facility with the assistance of a midwife. Malpractice in midwifery has resultantly also been on the increase and a recent episode of Carte Blanche named Midwife Misery placed the spotlight once again on the pros and cons of enlisting the services of a midwife.
Interestingly, the first registered nurse-midwife in the world was Sister Louisa Jane Barrett, who received training in Kimberley, South Africa, in 1891. In Government hospitals, primary maternity services are provided by qualified midwives in the public sector who assist gynaecologists and obstetricians when they aren’t immediately available.
Increased anxiety by patients
Many parents are worried about choosing midwifery-led care following horror stories reported in the news. The Citizen also recently published an article titled The impact of negligence on midwifery in SA.
As with any other medical procedures, part of a patient’s role is to make sure that they use the services of a qualified and reputable healthcare expert. Due to a shortage of gynaecologists and obstetricians in South Africa’s public hospitals and clinics, midwives in the public sector work interdependently with medical doctors in secondary and tertiary healthcare settings. In many cultures, the traditional birth attendant, often referred to as an ababelithisi, has played an integral role in African medicine for centuries. There is still widespread use of traditional midwives due to spiritual beliefs and the inability to access formal healthcare services. The majority of traditional midwives are located in rural areas and informal settlements, however they are generally not professional nurses or regulated by law.
What is a midwife?
Midwives are nurses who focus on the care of pregnant women and the delivery of babies. In South Africa the midwifery profession is regulated under the Nursing Act, Act No 3 of 2005. The South African Nursing Council (SANC) is the regulatory body of midwifery in South Africa. Training includes aspects of midwifery, general nursing, community nursing and psychiatry, and can be achieved as either a four-year degree or a four-year diploma.
A midwife is thus a trained health professional who helps healthy women during labour, delivery, and after the birth of their babies. Midwives may deliver babies at birthing centres or at home, but most can also deliver babies at a hospital or specially equipped facilities. They should also be able to diagnose possible difficulties or complications and refer patients to qualified obstetricians if they have any concerns.
What can and can’t midwifes do?
- Women who choose midwives usually want very little medical intervention and have had no complications during their pregnancy. Thus high risk pregnancies should be carefully managed and referred where appropriate.
- Midwives are not allowed to prescribe medications, such as magnesium sulphate and oxytocin which are used to treat pre-eclampsia and postpartum haemorrhage, respectively. Midwives are dependent on medical practitioners for these.
- Cephalopelvic disproportion (CPD) is a pregnancy complication in which there is a size mismatch between the mother’s pelvis and the fetus’ head. The baby’s head is proportionally too large or the mother’s pelvis is too small to easily allow the baby to fit through the pelvic opening. A midwife should advise a parent if this is a risk and refer the case to an obstetrician to ensure that there are no complications during the birthing process.
- The World Health Organisation has set a requirement that every practicing midwife needs to work in conjunction with a gynaecologist during pregnancy. It is a prerequisite for a woman to see a gynaecologist at 28 and 36 weeks.
- In cases of premature birth, delayed or prolonged labour, a midwife should also contact an obstetrician (in case there is a need for an emergency c-section) and a paediatrician as there could be oxygen deprivation or even meconium aspiration (swallowing of amniotic fluid).
- Because giving birth to twins is more complicated than giving birth to a single baby, many doctors don’t recommend using a midwife unless under the direct supervision of a doctor.
Midwifery malpractice concerns
If you have any concerns about your birthing experience, resulting in harm to your or your baby, feel free to contact Paul du Plessis Attorneys at 012 809 1588 or send us an email at paul@pauldup.co.za