Protea Midwifery Birth Unit & Services


Frequently Asked Questions

Antenatal care

As soon as you get the positive pregnancy test, let us know! We will help to guide you by giving you a pregnancy planner which lays out all the important appointments you need to make and when to see the necessary healthcare providers. We work closely with a colleague from Disa Clinic, Dr Elna Mcintosh, who specializes in first trimester scans and care. We refer you to her up until 16 weeks and then we take over your antenatal care from then. 

There are 4 routine tests that we do at the beginning of pregnancy, these are, your blood group, syphilis, HIV and your iron (Hb) levels. There are some additional tests that we can do such as a full blood count, hepatitis B and Rubella. There are additional tests that we recommend if we pick up an abnormality, but those tests are not routinely done. 

A midwife is a registered and qualified health care professional who is trained in caring for and managing patients during their pregnancy, birth and postpartum period. Registered midwives have studied a 4-year nursing degree at a University, we achieve 4000 practical hours in hospitals and clinics throughout the course of our degree. 

The South African Nursing Council requires us to have completed certain competencies as well as worked a minimum of 1000 hours in maternity wards. After we have graduated, we decide in which area we would like to practice as Registered nurses and midwives. Those wanting to pursue midwifery would then complete a year of work in a government facility in the maternity wards. 

Midwife-led care is woman-centred and means that a midwife will be the lead healthcare professional that is responsible for the woman’s care from the first antenatal booking right through to the postnatal period with their newborn. Midwives focus on providing individualized education, counselling, antenatal care, continuous care during labour, birth and the immediate postpartum period as well as ongoing support during the postnatal period. Midwives promote birth as a normal physiological process and advocates for minimum interventions. 

Yes, we have a list of OBGYNs that we would recommend our patients see, however, we are happy to work with any OBGYN that is willing to support us. All our patients on medical aid require a backup up OBGYN that they would see at 28 weeks and 36 weeks. Our patients that are paying cash would use government facilities as backup, but we highly encourage them to still see an OBGYN at 28 weeks and 36 weeks.

Absolutely, during our consultations we will have discussions regarding the birth and your specific birthing plan so many of our patients feel comfortable in knowing that we will adhere to their plan. However, if you feel more at ease to type and print out a copy of your birthing plan then we will happily accept and adhere to it unless the mom or baby are in immediate danger.

We are not contracted to a specific medical aid, but we are registered with the Board of Healthcare Funders. This allows our patients to pay us cash and claim back from their medical aid with the invoice we send that includes all the necessary ICD10 procedure codes. 

We charge a global birth fee and will not be sending an itemised bill after the birth that will exceed the agreed upon fee. Our fee includes the use of the facility, stock, equipment, medication and the two midwives present at the birth. The only additional invoice you can expect is from the laboratory to process the blood tests that we routinely do at birth. These blood tests will be checking your baby’s blood group and thyroid function. The laboratory will send that invoice to you as they are a third party.

It will depend on the reason why your pregnancy is now high risk. With certain conditions, it no longer falls under our scope of practice therefore, we are legally required to hand your care over to your back up OBGYN. If the OBGYN has assessed you and is comfortable for us to continue your care then we are happy to do so but if you need to continue to see the OBGYN then they will take over your care for the rest of your pregnancy.

If we pick up an irregularity during our consultations, we will provide you with a referral letter and recommendations of an OBGYN to see to do further investigations. The OBGYN will determine the plan forward and will inform you if they are happy for you to continue your care with us or if you should rather do follow ups with them. Pregnancy, labour and birth do not always go to plan and therefore we are flexible to plans changing. We will be in constant communication with you and your OBGYN should that happen.

labour & birth

Labour can either start with contractions first or your waters breaking first. If you are ever uncertain about what you are feeling, give us a call and we will ask a few questions and advise on the next thing for you to do. If you think you are feeling contractions, we always advise to first take two Panados, a warm bath and to lie down for a bit. If the pain persists then chances are high that you are in early labour. 

We do not recommend timing the contractions at this point because they can still be fairly irregular, and it will only serve to frustrate you. If you must pause and really breath through the contractions, then you can start timing them. We highly encourage our moms to continue to eat and drink during early labour and to try and go about your normal day (even as excited as you may be). We will be in constant communication with you to let you know when we think it is time to come through to us. 

If your waters break first, let us know immediately and we will also ask a few questions about the colour of the water, how much it was and how baby is moving. Your waters breaking is also known as rupture of membranes. It can take up to 24 hours for your body to start with contractions after your water has broken. We will start you on antibiotics after 12 hours of your waters having been broken to protect you and your little one from any infections. If labour has not started within 24 hours of the waters breaking, then we would have to start inducing your labour because our guidelines state that a woman should not go a prolonged period with the waters broken.

We would be in constant communication with you when you go into labour and will let you know when the best time is to come in because every moms’ labour is different and can progress at different rates. 

We use a portable, waterproof doppler to monitor the baby’s heart rate during labour. We find that the doppler is less invasive and we can use it as often as needed. We do also have a Cardiotocography (CTG) machine which is commonly used in hospital to give a tracing of the baby’s heart rate and contractions, however, we only utilize the machine if needed. We can also use the machine to do a non-stress test if you are concerned over your baby’s movements, have started to go past 41 weeks or during an induction of labour.

During our consultations, we will discuss our backup plans. We like to plan for the worst but hope for the best. All the moms that deliver with us must have a backup hospital for in case you need care that is out of our scope of practice. We are trained and equipped to identify problems before they become dire emergencies. We will then stabilize both mom and baby to ensure we have sufficient time to transfer you to hospital for further care.

We will phone a private ambulance to come and collect you, we will also phone all the necessary doctors to meet us at the backup hospital to manage you as you arrive. In our experience, the time it takes from when we say you need to be transferred to you being in theatre is approximately 1 to 1½ hours. 

Due to the financial cost of a private ambulance and private hospital, we utilise government facilities in an emergency,  unless you let us know beforehand otherwise. We phone a government ambulance and ensure that we have completed all the documents that you will require. We then complete a referral letter and give you all your antenatal documents. Unfortunately, due to Covid-19, government facilities do not allow us or any family members inside. The government facility will then take over the care of mom and baby until discharge.

There could be a multitude of reasons for us to have to transfer you from our care. If your pregnancy becomes high risk and you require regular care from a gynecologist then we will make recommendations on fantastic gynecologists that we work with. We would then provide you with all your antenatal documents and a referral letter for them to continue your care. In most cases, we will phone the gyneacologist to inform her of your history and reasons for further care. 

Unfortunately, if we need to transfer your care to a government hospital, you will be treated by the gyneacologist who is on call that day. We will still provide you with all the documentation that you will need for referral. 

We primarily use natural pain relief methods for our moms. These methods include labouring actively, effective breathing techniques, HypnoBirthing, water submersion, massage and aromatherapy. 

We also have the option of using drugs, we use Buscopan and Hydroxizine injections to help take the edge off. Both drugs work on the smooth muscles of the uterus to help relax it. We do not use Pethidine or Entonox (laughing gas) as we find the risks of the side effects outweigh the benefits of its pain relief, especially in a home birthing facility. 

An epidural must be done by an anesthesiologist in a hospital setting because it requires constant monitoring of you and your baby. It is not often that our moms need an epidural as many of them manage incredibly well using natural techniques. Should you require the use of an epidural we will transfer into a hospital setting.

We also highly recommend the parents investigate using a Doula, they are fantastic in helping you manage and cope with labour.

Absolutely. Doula’s can be an amazing addition to your birthing team. We are happy to work with any qualified doula that you choose. We are also happy to make some recommendations on some incredible doulas and photographers. We will happily welcome your photographer to capture your birth memories.

It is not common for us to have two of our moms in labour at the same time. However, if it does happen, often one mom will be in early labour and our other mom will be close to birthing. We will finish attending to our mom who is close to birthing and then go and attend to our other mom who is in early labour. If both moms are in a similar stage of labour, then myself and Sr Ashley will each be with a mom and phone a colleague to come and assist. 

Your due date is not an expiry date to us. We allow our moms to go 10 days over their due date before starting any pharmacological interventions, as per the maternity protocols of South Africa. Once you are 40 weeks, we would encourage you to start using natural inductions techniques such as reflexology, eating dates, having sex, bouncing on an exercise ball, curb walking and long walks. We also have the option of doing a stretch and sweep after 40 weeks, but that is only if you feel comfortable with that procedure. We would begin to monitor you more closely once you surpass 40 weeks just to ensure that you and your baby are still healthy. 

postnatal care

Yes, it is our standard procedure to initiate immediate skin-to-skin and allow delayed cord clamping to take place. The only time that this will not be possible is if there is an emergency situation and we need to tend to mom or baby immediately. 

We are qualified to do the first examination of the baby after birth. Should we discover anything that would require further management by a paediatrician (other healthcare specialty) then we would provide you with a referral letter and recommendations on a paediatrician to use. If there is nothing of concern, then baby will be checked by the baby clinic sister at the 6 -week checkup.

We encourage both parents to do as much skin to skin with baby as possible. We will assist with breastfeeding and ensure that baby is latching well. We will also assess your perineum and do any suturing that is necessary. We will monitor mom and baby for 4 – 6 hours after the birth to ensure that no complications take place. 

Once you and baby are cleared to go home, we will do follow up postnatal clinic visits within 3 to 5 days of the birth to ensure that everyone is doing well and to answer any questions. We generally do 2 postnatal visits after birth, but should you require more assistance, then you can make an appointment.

We do give the baby a routine Vitamin K (Konakion) injection at birth to prevent bleeding, but we do not give the baby the BCG vaccination. This is because the BCG vial can vaccinate 10 babies and once mixed can only be used for 6 hours then needs to be discarded. We feel that we will be wasting the vaccine, should we have to open a new vial at every birth to only vaccinate one baby. We do provide you with contact details for baby clinics in your area to take your baby to, that usually keep government stock.

After the birth, we will give you the home affairs proof of birth form, maternity certificate and baby’s clinic card. We have an arrangement with Genesis Maternity Clinic that allows our parents to utilise their system to apply for their birth certificates. Genesis Maternity Clinic has a home affairs official who collects the application forms and returns with the birth certificate about a week later. You can go to Genesis Maternity Clinic with your proof of birth form, certified copies of both parent’s ID’s and marriage certificate, complete the application form (in black pen only) and they will SMS you when the birth certificate is at Genesis Maternity Clinic for collection.