The motivation behind my academic journey

It all started in Amsterdam in a student advisor’s office at the university. I didn’t get a place to study medicine after trying three years in a row. At the end of self and clueless what to study, she asked me if I ever thought about midwifery?

Up to today I am grateful for that suggestion. It led me to Belgium, Gent, where I did my basic degree in midwifery and back to the Netherlands to get my first work experience as a midwife. Born and raised in South Africa, the African in me never left. Curious to find out if there is something for me in my country of birth, the waves and people of Jeffrey’s bay lured me in and I re-located to South Africa.

It has been a humbling journey. Most people didn’t have a clue what a ‘midwife’ was and I had to explain myself. After registration with the Nursing Council I got green batches to put on my uniform. When I started to work in the local hospital the nursing sisters were kind of looking down on me, you are ‘just a midwife…?’ What do they mean ‘just a midwife’? I am a highly qualified and valued health care provider?’ Slowly but surely I started to understand what was going on in the ‘midwife world’ in South Africa.

I got involved in the community and was the co-founder of The Healthy Mom and Baby Clinic . On the side I started to work as a Private Midwife. Out of curiosity and because it is the degree to have as a midwife in South Africa, I enrolled for the post basic degree ‘Advanced Midwifery and Neonatal Nursing Science’ at the Nelson Mandela Metropolitan University. And my picture of the ‘midwife world’ became even clearer. In order to obtain my degree, I had to do a research. I was stunned by the high cesarean section rate in the private sector and decided to look at the factors influencing the mode of delivery in the private sector. My take home point was the absence of midwives in the low-risk population. It was shocking. My supervisor decided to publish my article and all of a sudden I saw the value of my research: now I have a voice. When she suggested doing my Masters Research, it didn’t take much convincing. This time I looked at collaboration between midwives and obstetricians. Because that’s the only way a midwife can work; if she collaborates with the doctors. An article was published again I took home, we need more and better midwives.

The midwives…!

Again, not much motivation needed to agree with my professor’s suggestion to do a PhD. I took a year ‘break’ of studies and carried on. This time I want to go big. I want to do something for the midwives in South Africa! The profession needs to be strengthened. The majority of midwives are working in public sector and I was done with private sector, so this time I was going to focus on public sector. What are the midwives saying? What is going on? I am still in the process of finding that out and I need your voice to be heard!

If you are a midwife working in the public sector of South Africa with more than three years experience in maternal health, please take some time to do my survey!

Start survey 

 

 

Breath in, breathe out…one wave at a time!

First pregnancy – Home birth

When one of my friends (in her mid twenties) mentioned that she was going to do a home birth, I must admit, I thought she was crazy or just naïve. It was her first baby, why take such a risk? This was two years ago, and oh, how my view has changed during this past year, as I journeyed through my own first pregnancy. I work with children and mothers with complications after birth and I always thought that the “safest” way for a baby to be born is in hospital. All the necessary equipment and trained personal are there; ready to help in the case of an emergency and the NICU and theater is just down the passage.

After working closely with premature babies over the past 3 years, I have come to realize that there are a lot of factors that can affect the baby during pregnancy, during labour and after the delivery, which has a direct or indirect impact on their development. I learnt what a massive roll oxytocin (the “love” hormone) and cortisol (the stress hormone) plays in our bodies. I learnt that if a woman is stressed during her pregnancy and delivery, this might have an effect on her labour and even affect how baby is born (this is just my opinion).

I realized that I knew very little about birthing a baby and what a mother needs during her labour process. My husband and I did an extensive 8-week ante-natal class (with extra sessions afterwards to desensitize my husband as he battled to deal with the thought of the whole birthing process). I did a lot of extra research, reading and speaking to professionals as well as mothers. What I found was that our modern day practices in hospital are still quite structured in such a way to make it comfortable for the healthcare practitioners and their preferences so that they can do their jobs well. When questioning certain protocols, I was told that unfortunately they couldn’t change the way they do certain things in hospital. This was odd to me, seeing that everyone seems to be pro-natural birth, but all I heard was the “what-if-something-goes-wrong” or “just-in-case-something-goes-wrong”.

This made me look into the possibility of a home birth. There were a few things that I wanted in place on my labour day and delivering at home would allow this to be a possibility.

One thing that was very important to me was that I did not want to be in a scenario where my baby or myself were at risk. We met with an advanced midwife, and asked her many, very direct questions to determine the “possible risks” of delivering at home. She answered all our questions and did not flower up the idea of a homebirth. After that, I knew that home births are safe for moms who are well informed with a low risk pregnancy and a strong support system. She made it very clear that it is no walk in the park, and that there is a 50% possibility that I would be transferred to hospital, seeing that she does not take any chances with mothers at home.

After my 37-week check-up, my Gynecologist reassured me that I was a good case for home delivery. My pregnancy was still low risk and she was happy to be the backup doctor on the day.

My water broke on the Friday evening around 7pm (at 38weeks and 2 days). I did not have any contractions at the time. After informing my midwife, she gave me 24h to go into labour, otherwise she advised that we go to hospital.   The next morning around 04h30, my contractions started! I waited till about 6am before I phoned my Doula (also a midwife) to inform her. She arrived about 20-30 min later and examined me. At that stage, I was 2cm dilated and in the early stages of labour.

I decided that I did not want to make use of any pain medication. I used various means of pain relief during the day. Initially, I was able to get through the contractions with focused breathing and movement, leaning on the kitchen counter and swaying side to side.

It took my husband quite a while to wrap his head around the fact that things are HAPPENING! We still laugh about the fact that he asked me if he could put up some shelving (whilst I am rocking through contractions). I had to very calmly tell him: “I don’t think we will get to put up shelving today”. I think it was his way to cope and keep busy

Back to the contractions…When movement was not that effective any more, I combined the breathing with TENS treatment to assist me during contractions. That helped quite a lot, until I went into active labour around 11am. After that, I wanted downward pressure on my lower back during every contraction, with every breath I breathed out. My midwife was notified when I transitioned into active labour and she arrived around midday. At that stage I was 6cm dilated. I also made use of a gym ball during active labour to help take the edge off from the contractions. Between the two midwives and my husband, they worked very hard to help and coach me through each contraction. We were such a great team and I am extremely grateful to them!

When my contractions got really strong, they suggested that I tried sitting in the birth pool. The warm water was really relaxing between contractions, but did not assist with any pain relief during contractions. The only thing that helped was rhythmical and focused breathing as well as the downward pressure with every breath I breathed out during contractions. I still recall my Doula saying to us at our anti-natal classes that labour contractions are like waves, and you need to try stay on top of the wave. Towards the end, music (I set up a playlist with music a week before I went into labour) was very helpful to break the silence and had a subconscious calming effect, which also assisted with dealing with the pain. I cannot recall actively listening to the music, but I do recall the relief before the pushing phase.

I reached the transition stage of labour in the birth pool. The pain is something that you do not want to re-imagine. Instead of being fearful of the next contraction, I focused on tackling each one as they got stronger, something that athletics (running hurdles) and surfing taught me. Not to fear the hurdle/wave, but to push forward instead of backing down. With that said, when it got quite bad, I recall thinking to myself: “This is our first and last baby. I am not doing this EVER again!” The pain was like nothing I have ever experienced in my life. I recall my Doula saying to me at some stage: “Not long to go”, and thinking to myself: “She better not be lying to me!” I had to constantly decide to fully trust the midwives and followed their instructions as best I could.

When they saw I was ready to push, they helped me out the pool and on to a birth stool. My husband sat behind me and assisted with the downward pressure on my back during contractions.

The pushing phase was once again a different type of pain, unlike anything I have ever experienced. During the pushing phase, my midwife asked me if I wanted to look “down there” using a mirror. When I looked, I saw nothing, even though it felt like her head should already be visible! Everything in me did not want to push, because it felt like I am going to fracture my pelvis by pushing, but I realized that there was no turning back at that point.   I closed my eyes and re-focused. With the coaching of the ladies, it took about three contractions (that I can recall) and our healthy baby girl was born.

My husband’s favourite moment was looking over my shoulder and seeing our little girl being born, spit out the amniotic fluid and taking her first breath. After crying for a bit, she started making sucking movements with her mouth. I completely missed this part as I still had my eyes tightly shut at that stage. She was handed to me straight away and as I sat back against my husband with our baby in my arms, he burst out crying and then I realized we did it, and I burst out into tears. At that moment my placenta spontaneously came out as well. I was so grateful, as I did not want any artificial hormones injected. Time of birth 13h50 (for baby and the placenta)! Weight 2.84kg, 49cm long.

I was assisted to my bed, where I lay skin-to-skin with my baby, while the midwives cleaned up. During that time, our baby started to bob her head and wiggle around. She found my breast within minutes and started suckling all by herself. That was such an amazing moment for me as this was one of my biggest desires, for my baby to be born un-medicated and given an opportunity to initiate breastfeeding within the first moments of her life, which she did! I am so proud of her!

Afterwards we all sat on the bed reflecting on the day and my midwife prayed, thanking Jesus for His tangible presence throughout the day and the birth of our precious little girl.

The Lord provided in every little detail. A few days later reading through my “birth plan” where I wrote down my desires for the birth, I felt like I received the biggest undeserved gift ever. I could tick off every box! Looking back at the day, I could not have asked for a more beautiful, ‘peaceful’, unmediated home birth to welcome our precious girl into this world.

Just dropping in…

My mom once told me that you give birth in a similar way your mom did, and since my mom had quite easy labour experiences, I was never concerned about the whole process. My midwife and friend, Margreet, said during an ante natal class that for a first pregnancy, it can take up to six hours for your baby to finally greet the world, from when you are about five centimeters dilated….so I was super relaxed.

We live in Jeffreys Bay, about an hours drive to hospital, and my husband works up to three hours drive away from home, but with six hours to kill, that would give him enough time to get home, have a shower and get us to hospital in time to meet our new baby, or that’s what I thought.

Another friend of mine asked me after her son’s birth (about three years ago), what I thought contractions felt like, and we both agreed that it must be quite an intense tightening sensation around your abdomen, as the movies always portray. And she then said that she experienced it as rather gentle cramps (in the beginning though). We had this discussion again in my last week of pregnancy, and I remember feeling rather excited about the birthing process when I went to bed that night.

I woke up around 03:30 am, feeling gentle cramps, and started timing them while I messaged my sister in law in New Zealand (since she has three boys and would be awake this time of day), trying to find out whether this was Braxton hicks or the real deal. An hour later, we figured I am still okay and that I probably might be needing my rest. The contractions were about 4 – 6 minutes apart, lasting about 90 seconds. But I was rather chilled, because it wasn’t painful at all, so I went back to sleep again.

We were also advised in our antenatal class to find something to distract you from labour once it starts, like bake a cake, or go for a walk. Well, my husband read an article on superfoods eirlier the week, so my distraction was making superfood-cookies for him to take to work. (This ended up being my breastfeeding snacks a week later.) By 11:30 I finally finished the cookies, and was rather exhausted, with the odd gentle cramp as I discribed earlier. So I had a lie down on the couch, once again keeping tract of my contractions and its intensity.

An hour later, I asked Margreet whether she would be able to come see me around 13:00. I felt rather relaxed and wanted to have lunch first. In the meantime, my contractions were getting more intense, and getting to an uncomfortable state. By 12:45, just before Margreet arrived, I told my husband: ‘I think this is it, we should probably start heading to hospital sometime soon’. When Margreet arrived, she was more interested in our dog (her very cool surf buddy) and our new house (which we moved into only two weeks before), since I seemed way too chilled for someone in labour. On examination, I was already 5 centimeters dilated. In a very relaxed manner, Margreet tried to tell me to maybe start heading towards the hospital, and that she will notify the labour ward that we are on our way. To my husband she said quietly ‘Get to hospital NOW!’.

We arrived in the labour ward at around 14:00. Then it was documentation time, and checking my contractions and baby’s heartbeat, but both mommy and baby were super relaxed. By 15:00 I was 7cms dilated and the hospital nurse called for a delivery cart to be prepared. I found it quite comfortable bouncing on a big exercise ball, and ‘blewing my contractions away’ as Margreet told me to do. The contractions weren’t nearly as painful as I expected it to be. It was definitely uncomfortable though, to such an extent that I had to pause my sentences and blow the contraction away first. The hospital midwife showed me a position to try out, by standing with my elbows resting on the bed, and my back bent forward, knees slightly bent and hip width apart. So I tried it, and that’s when my water broke. Immediately I felt an intense pressure, and that was pretty much when I realized again what exactly was happening here. Why I was in hospital, because for a very short period of time, I sort of forgot exactly what I was in for.

I was asked to get onto the bed for the birthing process, but with the pressure I felt, i couldn’t imagine it being comfortable at all sitting down, and the bed was still very high. I managed to get onto the bed on my hands and knees. As I tried to find a way to lay down, I had two more contractions. I was still standing on my knees hugging my husband who was standing on the opposite side of the bed, when my baby ‘fell out’. The midwife barely had enough time to put her gloves on, that’s how quickly it happened. Our baby girl was born at 15:45. To me, giving birth was really easy, and a rather pleasant experience. I would definitely do it again, but next time, I might have to skip the baking…

 

First time ZAMBIA

Just back from a week of Zambia with my dear friend, housie and fellow mission hearted medical person: Mari.  If I don’t use this moment to write some impressions down, life is going to carry on quickly and the writing will not happen.  There is something about going somewhere for the very first time, you can only experience the first time once… I love it so much.  This trip was a bid of a surprise that has come my way and I did not have any chance to ponder too much upon it and do some research about the country. So it was a true empty canvas for me.  The first impression was from the air, the beautiful Zambezi finding it’s way through the african planes.  Then Livingstone, a clean beautiful settlement where the people have the biggest smiles.  Even though I came with little expectations, I was quite surprised to see the beautiful houses, the tarred roads and way too many South African franchises, they seem to import everything…!  Yet the shocking realization that the Kwacha is stronger than our Rand…! And so does my first impressions carry on.  The purpose of the visit determines what kind of impressions one gets and I could not have asked for better exposure to this beautiful place.
We were blessed to be hosted by a beautiful Zambian family.  I met this couple when they were expecting their third child in our clinic in J-Bay, about two years ago.  That pregnancy and birth birthed a vision in their heart to see a Healthy Mom and Baby Clinic become a reality in Zambia.  After a couple of emails and meetings in J-bay, I seemed it fit to go visit.  This couple are leaders of an organization called Elijah Mission International.  Their Mission is ‘to confront injustice and empower individuals to be agent of change in their communities’ and their vision ‘see communities where God’s dream is realized for every individual’. They are involved in different projects to empower youth through arts and music and run different programs, to be honest I am not too sure what they all do as I was connected to Anne, who heads up the clinic’s work.
Anna, a beautiful woman that has learned to allow God to be the centre of her life and tapped into His big heart for the world.  A nurse by trade, a wife of a Zambian doctor, a daughter of an American family. She caught on to Elijah’s Ministries vision and stepped in to make it a reality.  We met the team, did some home visits, school visits and prayed.  But more than everything, we could be there to walk alongside another woman for a week, to cheer her on, to look with her and see where it is going.  What a privilege.
Saturday tourist day, yes I can do the tourist thing too.  We couldn’t have asked for a better touring guide than Bruce himself, an intelligent, well travelled Zambian that could tell us so many ins and outs we would never get from the Lonely Planet guides.  Victoria Falls were magnificent and seeing the sun go down over the mighty Zambezi just made the day complete.
Mighty waters.... Majestic
Mighty waters…. Majestic
The Sunday we visited Overland Missions, a dream come true for me.  I have been following this organization for a while.  Walking on their base, seeing some salty sold out people that live out the great commission, travel the roads no one else would and reaching people groups of which governments say they don’t exist… I was moved to the core.
A F R I C A  my heart beats for you.

Laughing All the Way to the Labour Ward

A woman walks down a harshly lit corridor of a small provincial hospital in a smaller Eastern Cape agricultural town. She’s heavily pregnant, four days overdue if her scans are to be believed. Not that she’s taken much stock of ‘due dates’, knowing that the baby will come when he’s good and ready. She stops beside her husband to let another contraction pass, barrelling through with the force of a freight train.

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SOMSA: Midwives Changing South Africa One Family at a Time

Finding myself a quiet spot in this beautiful place called East London, of course it is in the dunes close to the beach. Nahoon Reef. I just attended the 12th annual Society of Midwives of South Africa (SOMSA) congress and what a week it was! Need to reflect and process, need to use this moment and write things down. Being a midwife and South Africa and not part of a midwife association has bothered me for a while so this year I decided to register and become a member, go to their congress to find out what they are about. As always it is better to find out for yourself and not go on other peoples opinions. To make it worth my while, I decided to submit the abstract of my research and got a slot to speak. And was it worth it…!

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The Natural Birth Experience: Ruling over the Pain to Bring forth the Joy

Just after midnight on December 12th 2013, in a tiny town somewhere in the Eastern Cape in beautiful South Africa, my second son Reuben Finlay Williams was born, completely naturally, without any drugs or pain relief used whatsoever. I felt like a champion. I felt like I’d just conquered the world. I felt amazing, like I had just climbed Everest and reached the top all by myself! The sense of God given achievement and joy was a moment I basked in. It was dark outside but it felt as though the sun shone around me in that little delivery room in the Clinic in Uitenhage. This birth was what I had hoped for, dreamed of and up until then could only imagine. A moment perhaps only another mother might know. But of course I did not do it all by myself, I had my beloved husband with me and one of my closest and most trusted friends pulling me through the whole labour. Had it not been for both but, I know my husband won’t mind me saying, especially for Shauna, I don’t believe the experience would have been quite what is was.

Having another woman with Isy3me during labour who I was close to and trusted and who was already a mother of four herself, was one of the best things about my birth experience. She had already been to that place of pain and fear, uncertainty and exhaustion four times and come through it, therefore I considered her presence wise counsel and a great encouragement and that’s exactly what she was. She kept count of my contractions and timed them for me so that I knew where I was as the different stages of my labour progressed. She played restful music for me and calmly reminded me with a broad and loving smile when I was anxious that I was made for this and my body knew exactly what to do every step of the way.

Isy2Whilst resting on the back of a chair, I sat upright on a big, balance ball for my entire labour which kept my whole body, and in particular my pelvis, mobile, flexible and in the optimum position for my baby’s head to bear down upon my cervix to help it to contract more efficiently and quickly. In fact, the only time I lay down during my labour was when I had to move to the bed for a brief internal examination to see how many centimetres dilated I was and when I did lie down, I immediately found that I couldn’t stand the discomfort of such a passive position. I was compelled to get up, stand up, stretch, bounce gently on my ball again and keep, quite literally, ‘on-top’ of my pain. For my second time around in labour, remaining upright and mobile during the full intensity of the strongest contractions made me feel in control and able to cope right the way through to birthing little Reuben. I breathed steadily and rhythmically with each wave of pain and one by one, as each contraction washed over me and then gradually faded away, I reminded myself I was moving ever closer to receiving this precious gift from God I so wanted, my second little son. As a result of adopting this position of authority over my own body, I felt a sense of dominance over the pain. I was in charge, I could move with my body and do whatever I felt I needed to bring this baby boy into the world.

Several weeks prior to labour and birth, I spent time every day reading through the stages of labour and what to expect so that I could also take authority over my mind. I was determined this time around not to fear the pain or allow it to rule over me. This was my strategy for achieving the birth experience I so hoped for; completely natural, unassisted labour and delivery. I equipped myself with the knowledge of what my body was going to do throughout labour and birth in order to be well prepared to handle it. I made sure I understood the process thoroughly. I took time to visualize my body relaxing and my cervix contracting in order to bring forth the very thing I desired most of all, another beloved baby boy. I discovered that in doing all this I was actually able to accept peacefully without any fear, the inevitability of the pain I was going to face once again. The fear I had was gone. This became an extremely powerful if not the determining factor in shaping the birth experience I had with Reuben and I’m convinced that it came down to the fact that before labour had even begun, mentally I had mastered the pain which in turn enabled me to ‘own’ this birth experience.

I have realized that as a woman aIsy1nd a mother, in the process of labor and giving birth, the engagement and intentional focus of the mind in order to overcome the pain and fear and to enjoy the experience, is as significant if not more so then the engagement of the physical body alone. At the ordained time, of course we have no choice but to birth our baby or babies, once labour begins there is no turning back! The wonderful thing is that if we are ready in our minds, with an assurance that we were made by God to withstand, go through and rule over the pain of birthing our children we can come out the other side on top. Not only
come out on top with our little bundles of joy but also with the very great and valuable sense of triumph and achievement that as a woman and a mother, only we were pre-destined to know.

What a privilege it is to have been created a woman, to be able to do this incredible thing that brings forth life and fruit into all the earth. When I look at my two precious sons, Jacob and Reuben, I realize what an honour it is to be a mother, created with a God given mandate; to birth and raise the next generation.

by Isy Williams

What is a midwife?

“Being a midwife is not just what a caregiver does. It is who this person is. A midwife stands at the crossing-point of generations, embodying fundamental values in societies across the globe.” – Sheila Kitzingen.

I have come to know that not everyone knows what a midwife is. Some think it is an old-school thing, others think it is some sort of alternative medicine and only hippies make use of midwives. Yes, it is one of the oldest professions recorded, dating back to the two Hebrew midwives in the book of Exodus, called Shiphrah and Puah. But it is also a well known modern day profession. Countries such as the Netherlands, Sweden and New Zealand, which have the best birth outcome statistics in the world, use midwives as their main maternity providers.

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About Margreet, The Midwife

MIDWIFERY & ACADEMIC STUDIES

She has just completed her Masters Research in Midwifery and soon to start her Doctorate. Her passion for the ocean is intertwined with her love for people and her desire to look after the people behind the waves.

Margreet has been nominated for various midwifery awards and academically, her Masters studies on women’s delivery method choice in South African private sector has been published and cited by peers both locally and internationally. She was featured in the British Journal of Midwifery, as well as local publications and newspapers such as The Herald, and has also presented her findings at the International Nursing and Midwifery Conference 2014 hosted by Stellenbosch University.

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