Giving birth at a government hospital: what to expect
More young couples and single moms are finding it difficult to afford private healthcare. So if you are giving birth in a government hospital, what can you expect?
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If you’re facing the choice of breaking open your piggy bank to pay for private care or go to a government hospital, research your options. You may be pleasantly surprised.

Why government hospitals get a bad name

Norma Bustard, registered nurse/midwife who is also the nurse manager of the Obstetric and Gynae block at the Charlotte Maxeke Johannesburg Academic Hospital in Parktown, explains why government hospitals get a bad name:

“People just don’t understand hospital protocol – especially when it comes to obstetrics,” she says. “The maternity unit has to cope with women who come to admissions in advanced labour who have not been for any antenatal care. This means that they have no medical records, and where there’s an additional language problem, it’s almost impossible to get an accurate obstetrical history. There is no time to run tests or do investigations that would otherwise improve the outcome for mother and baby. We simply have to do the best with what we have. When things go wrong, the press is quick to publish the story, often with incorrect details.”

Read: What is a birth plan?

Your first stop after confirming pregnancy

Local municipal health department

On confirming pregnancy, your first stop is your local municipal health department. Bigger centres have independent MOUs (Midwives Obstetric Units) where women are cared for during pregnancy until after the birth of baby.

When there are no anticipated (or previous) complications (and the woman is 16 years and older) her baby will be delivered at the MOU. These units are often within walking distance and are open 24 hours a day.

Antenatal clinic

Most municipal health departments have an antenatal clinic where all pregnant women can go for ante- and postnatal care.

Healthcare cards

According to Moira Van Heerden, community health nurse/midwife for Bedfordview Baby Clinic in the Ekurhuleni municipality, standard healthcare cards are issued to all women who attend these clinics.

These are filled in with every visit and become the woman’s “passport” to hospital care should there be a problem or when she goes into labour.

What you need to do to register for antenatal care

Phone your local municipality for details about the clinic, times and dates for antenatal care.

Take with you:

  • A referral letter from your doctor (this is not essential)
  • Your barcoded ID 
  • Most recent light and water account to verify your address
  • A small notebook to record any instructions and appointments

All women with uncomplicated pregnancies may go to these clinics.

More about: Preparation during the 3 trimesters

Admittance to hospital, antenatal care units and academic hospitals

Hospital and antenatal care

Teenagers 15 years and younger, women having their first babies at 35 or older, multiple pregnancies or any other complications are referred directly to the hospital for antenatal care.

Academic hospital

Should there be a serious problem the woman is then further referred to an academic hospital. These hospitals are attached to universities which may imply frequent appointments, tests and monitoring, but it also means that all women have access to the best possible healthcare.

Difference between an uncomplicated pregnancy and a "high risk" pregnancy

Registered nurse/midwife Elaine Hennessy who is the clinical assistant manager at the Johannesburg Academic Hospital antenatal clinic, explains the difference between an uncomplicated pregnancy where babies can be delivered by private midwives at home or at a MOU, and “high risk” pregnancies.

“Academic hospitals have the equipment for specialised tests and procedures and bed space is kept for problem pregnancies,” she explains.

Uncomplicated pregnancy

“Women with no medical or surgical problems or detected complications during the pregnancy, who do not need scans or other specialised tests, can give birth at the local hospital. She must go to the hospital within her residential area which may limit her options.

Moderate risk pregnancy

Moderate risks include problems with previous pregnancies or moderate problems that may occur during the pregnancy.

High risk pregnancy

High risk includes hypertension (high blood pressure), diabetes, multiple pregnancy, more than three miscarriages and congenital abnormalities”.

All about: High risk pregnancies

Booking your hospital bed

Book your hospital bed early – preferably at about 8 weeks into your pregnancy. Take your antenatal card (or referral letter from your doctor), ID, proof of residence, an employment certificate or other proof of income. If you are not working you need 3 consecutive current bank statements.

You will then receive a hospital appointment card along with your registration number and payment classification.

What you can expect from a government hospital

South Africa has 216 private hospitals with 28 000 beds and 342 public hospitals with about 100 000 beds.

Government hospitals do supply food and linen

Registered nurse and midwife, Nomonde Makhudu reassures women that government hospitals do supply linen and feed their patients!

“Of course you may bring your own pyjamas or night gowns, slippers and dressing gown, bath towels (if you prefer) and even your own pillows,” she says. “All patients are given a list of essentials that they must bring and these include clothes for the baby, blankets to take your baby home in, disposable nappies, cotton wool and surgical spirits as well as your own sanitary pads.”

The standard of cleanliness

The standard of cleanliness and the atmosphere of each maternity unit is dependant on the unit manager. Even in circumstances of poverty, many of these units are clean and orderly and there is a feeling of security and contentment amongst patients and staff alike.

In a “baby-friendly” environment, posters encourage breastfeeding, and midwives are helpful, offering support and breastfeeding advice. What the bathrooms lack in luxury is made up for in cleanliness and most importantly, the nursery is spotless despite the lack of lace and frills. Where you are satisfied with the service and nursing care, take the trouble to thank the staff (a box of chocolates says it all!) and do tell hospital management in writing.

If you have a valid complaint

If you have a valid complaint, it’s best to speak to the nurse manager. Keep in mind that government hospitals are busy places where the sickest are seen to first. You may find that if you don’t have any problems, you will have to look after your own baby (good preparation for going home) and be responsible for yourself. Your hospital stay may be as short as 4 to 24 hours or as long as weeks if there are complications.

Also read: 10 suggestions for writing your birth plan

Taking responsibility

Norma encourages all pregnant women to take responsibility for their health. “A pregnant woman needs to understand that if she has been referred to a specific hospital for follow-up, it is her responsibility to do so,” she says.

“There have been unnecessary, tragic incidents when women did not fully understand the implications of their conditions and failed to follow through at an academic hospital until it was too late.”

The importance of giving correct details

Norma also stresses the importance of giving correct detailssuch as ID number, street address and family contacts. “The clinic card is a legal document – these should not be changed or tampered with in any way,” she points out.

Women are also encouraged to stay with one antenatal clinic and not “clinic-hop”, miss appointments, change or swap appointments because this complicates administration – particularly when there are long queues.

Norma advises single women about NGOs and support groups and organisations available to help them. “We will help in any way we can, we can make arrangements to help the pregnant mom and her baby during her pregnancy so that she does not have to feel desperate enough after the birth to abandon her baby at the hospital.”

Special requests

Caesareans are done only when necessary

There is no need to document a “birth plan” because every midwife at a government hospital wants the best for you and your baby. “Natural birth” comes first and caesareans are done only when absolutely necessary.

Epidurals need to be discussed beforehand

Although pain relief is given when necessary, alternatives such as heat, massage, water and movement will be offered first. Epidurals should be discussed ahead of time because they are generally not standard.

Birth partner

All women are entitled to respect and privacy at all times. One birth partner may stay with you, and they may have to be your “spokesperson” (this also applies to private care).

Interesting read: Is your pelvis big enough for labour?

Basic rights as a patient of the hospital

Don’t presume that because the hospital is government- run, you will get inferior treatment. Many women praise government hospitals. According to Batho Pele, you have the right to:

  • Consultation: you should be given a choice about the services offered.
  • Service standards: insist that promises are kept.
  • Access: one and all should get their fair share.
  • Courtesy: don’t accept insensitive treatment, you should be treated with courtesy and consideration.
  • Information: you are entitled to the full particulars at all times.
  • Openness and transparency: you should understand how national and provincial departments are run.
  • Redress: your complaints must spark positive action.
  • Value for money: public services should be provided economically and very efficiently.

If, like many South Africans, you cannot afford private healthcare, you are more than entitled to government health care. Who knows? You and many others may be pleasantly surprised by the excellent quality of service.

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