A smoother transfer of patients between specialists and midwives could enhance the health system in South Africa, improving outcomes and making maternity care more cost-effective. “Mothers and babies could see better outcomes if our healthcare system was structured to give midwives a greater role in pregnancy management and birth,” says The Birthing Team’s Dr Howard Manyonga.
A new study in the United States, published in scientific journal Plos One, has shown that states that give midwives hospital access and professional decision-making power perform better on measures of maternal and neonatal health. It echoes a review in Lancet which concluded that integrating midwives into healthcare systems could prevent more than 80% of maternal and new-born deaths worldwide.
“Midwives must be better integrated into our health system, particularly in the private sector where currently they are positioned as assistants to obstetricians. Making midwives the primary practitioners in non-complex pregnancies will increase access and make private care more affordable for more women, including those not on medical schemes” says Manyonga, who is an obstetrician and gynaecologist with a background in health systems management.
In most medical settings in South Africa, midwives and obstetricians are paid separately and as a result are often in direct competition for patients. This means that if a complication presents during birth, there is a financial disincentive for midwives to refer the patient on to a specialist.
“Typically, midwives only refer patients on to obstetricians if a serious complication arises, sometimes this happens too late. As a result, specialists have generally developed a falsely negative view of midwives’ skills and aptitude because they only come in at a crisis point,” says Manyonga. For expectant mothers, such a referral on also entails high, unexpected fees.
Better integration of midwives also incentivises prenatal care by making it more affordable, “Quality prenatal care is the best determinant of a healthy delivery – with this in mind, at The Birthing Team, we created a set fee for complete care by a team of midwives and obstetricians, allowing women to access all necessary prenatal care at no risk of a co-payment,” says Manyonga.
The Birthing Team programme is restructuring how South African midwives and obstetricians interact. It applies an integrated care model to maternity care, which emphasises collaboration, team fees, rigorous prenatal care and a community-based approach. There is no additional fee for the patient if the obstetrician is consulted during antenatal care or called in for delivery, and the midwives who have overseen the pregnancy will still earn. “Ultimately, the best outcome for mother and baby is performed and risks are reduced,” says Manyonga.
The Birthing Team is currently operational in Berea, Johannesburg at the Netcare Rand Clinic and Durban at the JMH city hospital. “A well-managed pregnancy with care from a team of midwives, in consultation with obstetricians, produces the best outcomes. Obstetricians train for years to be experts on complex births – they should be freed up to focus on these cases,” says Manyonga.
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Head of Birthing Team: Dr Howard Manyonga