Bioethics Blogs

Critical interventions in birth in the first 1000 days by Jennifer Rogerson

Choice and the assigning of value in the practices and crafting of life-giving work

In healthy birthing initiatives described by, among others, the World Health Organization, emphasis has been placed on the importance of ‘the golden trio’: vaginal birth, breastfeeding and immediate skin to skin contact after birth. These three experiences are said to seed a baby’s immune system with good bacteria, preventing diseases from allergies through to diabetes and obesity, and facilitating neuroplasticity and brain development. In resource-poor countries, these are cheap and effective public health interventions. Despite these benefits, South Africa’s middle class caesarean section rate is extremely high.

My research is part of the University of Cape Town’s First 1000 days research cohort led by Fiona Ross and focuses on midwife assisted birth. While the WHO recommends that a country should not have a caesarean-section rate higher than 10-15% of all births, South Africa has extremely high rates of c-section birth, largely testament to the highly medicalized private health care system enjoyed by the rich. In some private sector hospitals, particularly in metro centers, the rates vary between 70% and 95%, despite a strong push by the state for so-called ‘natural delivery’ (vaginal birth). Given the prevalence of c-sections in the private sector, and that sector’s broad refusal of midwife attended (rather than obs/gynae attended) birth, middle class women who want a vaginal birth find it difficult to have the ‘natural birth of their dreams’. Private midwife consultation is one of the few options available to them. With a powerful rhetoric encouraging c-sections in the South African context (obstetricians have extremely high medical malpractice insurance fees with increasing legal suits, convenience for doctor and patient in choosing a birth date and the perception that c-sections are safer), women who chose vaginal birth with a midwife are making important medical choices that they understand in political terms.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.