This past month we were lucky to catch up with Midwife Kathleen Van Heerden who managed to squeeze in time to answer our questions while supporting a bumper load of births over the busy September birthing season.
Kathleen owns and runs Kathleen’s Mother and Baby clinic, a “home away from home” birth centre based in Boksburg.
- Tell us a bit about yourself, your family life. How did you get into midwifery as a profession?
I am married to Braam van Heerden and I am the proud mother of three children – Benita (26), Sean (24) and Megan (20). I’m also grandma of two beautiful girls, Kate and Jamie.
I’ve lived in Boksburg for the past ten years. I studied nursing at University of Free State. After obtaining my degree I worked at Klerksdorp Provincial Hospital from 1990 until 1991 when I fell pregnant with my firstborn. I relocated to Witbank and started working at Witbank Provincial Hospital, maternity unit and that is where I really fell in love with midwifery and obtained my experience as an independent midwife.
I always knew that I wanted to be a professional nurse, but working in the maternity ward got me hooked on midwifery…I knew that this was my calling and that I wanted to be part of that special experience where a new mother gets to go through the natural birth process in a peaceful environment.
During 2001 I relocated to Pretoria and started working at Pretoria East Netcare Hospital, Maternity unit. We moved to the East Rand during 2005 and I started working at the Sunward Park Netcare Hospital, Maternity Unit. I started providing prenatal classes to expecting mothers as a service to the Hospital. A gynaecologist asked why I do not start my own prenatal classes from home….and that is where it all started. Two years on I was requested by the Hospital Management to join their team at the maternity unit to do midwifery deliveries. I accepted and continued as an independent midwife providing prenatal, midwifery, natural birth and postnatal services at the hospital. Two gynaecologists joined the hospital and informed management that should be midwives continue to provide services to the hospital, they would transfer to another facility.
I was already registered as an independent midwife, but then through God’s calling and grace started by own practice from home where I converted the apartment on our premises to a full homebirth clinic.
Ever since my practice has been growing from strength to strength with more expecting mothers opting for midwifery services due to the relationship that we build with our clients and the fact that we underwrite the natural birth process rather than opting for caesareans and unnecessary medical interventions.
- You are offering a home-away-from-home birth experience, tell us a bit more about how this works?
Once a client has expressed her wish to have a natural home birth, I will schedule an appointment with her to evaluate her and to inform her of the process of home-away-from-home birth. If she has not yet been for a scan, I refer for the first sonogram to a qualified sonographer as soon as possible. She will again be referred for a sonogram at 22 weeks and 32 weeks of pregnancy.
The client will see me throughout her pregnancy on a regular basis – during the first 28 weeks, she will consult with me every four weeks, thereafter every two weeks up to 36 weeks and thereafter weekly until her delivery.
My consulting rooms are in an established medical centre, whilst the birth takes place at my residence in an apartment which has been converted to a birth unit, consisting of two birth rooms, a living room where the extended family can await the arrival of the newborn baby and full bathroom. The birth unit is equipped with all necessary medical appliances, e.g. oxygen, suction equipment and emergency medication.
A home-away-from-home birth experience is a midwife led birth experience, which is ideal for healthy women with straightforward pregnancies who would like to give birth in a comfortable homely environment. As a qualified midwife, I provide support during the labour process to have a normal birth, with the option of hydrotherapy (water birth) or normal birth.
Women who choose to have a home-away-from home birth experience have fewer interventions during labour, which contributes to a faster recovery following the birth.
Should complications arise during the client’s pregnancy or delivery of the baby, I have two gynaecologists as back-up. I also have the ER24 ambulance service should the client have to be transported to the nearest medical facility.
After the baby is born and I am satisfied with the condition of both mother and baby, they can go home. Alternatively, I would advise that they remain until they are stable to ensure continues monitoring.
The client and baby will come for a postnatal check-up on day three and thereafter at two weeks and six weeks. During the client’s pregnancy and after birth I am 24 hours available for any advice and support.
- Tell us about any challenges you face as a midwife providing services, information and education on homebirth?
The biggest challenge with midwifery services is the ignorance of expecting mothers and their families on what the process entails and what services are offered. This is partly because of gynaecologists misinforming expecting mothers of the dangers associated with normal birth versa caesarean births and the misconception created by some gynaecologists that midwives are not fully qualified to perform home births.
A further challenge is to have gynaecologists and hospitals to serve as a back-up to midwives’ due to the fact that they regard independent midwives as a threat to their practice. It is a known fact that gynaecologist tend to lean more towards caesarean births as they can schedule them in advance. Midwives employed by Government hospitals also tend to show animosity towards independent midwives with their own practices.
There is still not enough information and education provided by health care practitioners on the alternative of home based births. Through referral of previous clients and their families as well as enlightened health care practitioners we are however fast overcoming this challenge.
When I started my practice almost all my clients did not have medical aid and therefor one of their main considerations was the financial implications of medical care at a hospital and associated costs of gynaecologists and paediatricians, compared to the cost of home births.
However, I would estimate that 30% of clients who come for consultation now have medical aid. A big challenge regarding medical aids remain the contribution they are paying midwives compared to other health care practitioners.
- What is the best part of homebirths for you?
If we look back at history, home births were the norm – that is until doctors and gynaecologists took over the role of midwives. This lead to an increasing number of women having their babies at hospitals. However, as awareness on the advantages and safety of home births increases, more women are willing to consider the option of having a home birth.
One of the biggest advantages of a homebirth is that the expecting mother can share the experience with family and friends.
A home birth affords the mother the freedom to move around, take a shower or a bath and enjoy the comfort of a home setting and a friendly environment compared to the clinical setting at a hospital or clinic.
The bond that forms between me as midwife and the expecting mother as well as the rest of her family, is something that is very precious to me. I have clients who still today send me pictures of babies I have delivered ten years ago as those babies grow into beautiful young children.
- What in your experience are some of the misperceptions around homebirth?
“Homebirths are dangerous”
There are many misconceptions about home births. I think the major misconception about home birth, is that it is dangerous. Some women have high-risk pregnancies and is such situation, a home birth may be unadvisable. But for most healthy women with normal pregnancies, home birth is an excellent option to avoid unnecessary interventions during the birth process.
Mortality rates are the same for home births as for low risk births performed in hospital. Add to this the reality that mortality rates for mother and baby are increasing in hospitals.
Standard care for midwives for emergencies includes pharmaceuticals, oxygen, IVs, equipment necessary to monitor and record vitals on both the mother and baby and other first aid equipment. To eliminate any risk, I have a back-up hospital and two gynaecologists in case of emergencies. I also have emergency medicines in the event of a medical emergency. With these backup options in place, home birth is a completely safe and secured method for expecting mothers.
“Hospitals are cleaner and a more sterile environment”
Germs are everywhere. The difference between a home birth clinic and hospital is, that the germs in my home birth unit, are ones you are regularly exposed to while hospital germs are unknown to your immune system and therefore a bigger threat.
“Your medical aid will not cover a home birth/ midwife”
Even though a home birth/ delivery by a midwife is usually much cheaper that a birth at a hospital or clinic, many women believe that a home birth or midwifery is not covered by medical aids.
Rules regarding home births/ midwifery expenses vary from medical aid to medical aid. However, that does not mean that your medical aid does not cover home births. As mentioned earlier I am experiencing that more and more clients who have medical aid cover are utilising the services of a midwife.
“Home births are messy”
When you opt for a home birth at my home birthing facility, you can be rest assured that you are in a clean, safe environment. The mother gives birth over chux pads, which are very large, disposable diaper-like squares to protect the bedding. The clean-up is minimal and the responsibility of the midwife. All clinical waste is removed and discarded in terms of health regulations.
“Postnatal care is expensive”
The kind of care you receive from a midwife is quite different from what you will receive from a General Practitioner or Gynaecologist. Instead of the 48 hour stay in hospital, your care with a qualified independent midwife is more frequent and more detailed. You will have postnatal visits at three days after birth, three weeks after birth and six weeks after the birth. During this period, I am also available 24 hours per day for any support and advice regarding breastfeeding, care of the mother and baby, etc.
“Only Hippie-mothers give birth at home birth clinics”
There is still a misconception that home births are very ‘alternative’ with most women opting for it being categorised as hippies or new-aged. The home birth experience I provide is according to professional nursing standards and does not necessarily entail water births. Although there is this option, most mothers opt for a normal natural birth.
“You must have a very high pain tolerance to deliver at home”
Normal labor at a hospital or clinic and labor at a home-birth clinic, requires the same amount of pain tolerance. The benefit of home births is however that you are in a comfortable environment, where you can take a bath prior to the delivery, you can walk around, and you have the support of family and friends who are there with you throughout the delivery process. Being able to relax in a calming environment, both during and after labor, is a wonderful way to experience the birth process.
Pain relief options are available, although you cannot have an epidural because it is a medical procedure that requires an anaesthetist. However, research shows that women who birth at home clinics need less pain relief than women who birth in hospital as they are more relaxed.
- Any highlights of homebirths you’ve attended that you care to share?
Every home birth is an exceptional and unique experience. However, the relationship that I build with a client will vary according to the personality of the client. Some women are easier to bond with, and become much more than just a client.
Another highlight for me is having the family of the expecting parents present at the home birth clinic. The mother is surrounded by familiar faces and the support and encouragement of family and friends are a big benefit to home birthing.
- What are your hopes and dreams for birth in SA?
I think my biggest hope and dream is that the public at large should be better informed and educated about home births. This will reduce or eliminate the misconceptions, as mentioned above, to a large extent.
I believe that women should have a choice on the kind of natal care that they receive and that they should not be forced to undergo caesarean sections, just because it is convenient for the gynaecologist to schedule the birth for a certain date and time – or just because the mother’s delivery is prolonged.
I believe that should more women opt for home births and the number of hospital births are reduced, the number of caesarean sections will reduce, which will have a direct impact on the mortality rate of mothers and babies. I further strongly believe that through choosing a home birth, the mother (and father) is more relaxed and the recovery period is reduced. There is greater bonding between both parents with the baby which reduces the possibility of post-natal depression associated with a traumatic delivery.
More relaxed environment = better bonding = more successful breastfeeding = healthier babies = happy Mommies….
Should you wish to make contact with Kathleen, you will find her at….
Kathleen’s Mother and baby clinic
221 Rondebult road, Boksburg
Home birth unit :
4 Gordonroad, Morganridge, Boksburg
Via Facebook messenger : https://www.facebook.com/KathleensMotherAndBabyClinic/
WhatsApp 0829289841; or
email : firstname.lastname@example.org