worlds apart

[lalilu]

I'm a doula in South Africa & find this forum very rivetting. It just makes me very sad when i compare what 's happening around pregnancy & birth here to what's available where you are. For example;
If a woman is of the financial means she may request a cesarean without a medical reason for it!
Only 4% of women give birth with independant midwives!
The csection rate in our private healthcare sector ranges btwn 70%-90%!!
There is no direct entry midwifery qualification/course available
Saddest of all it seems that women here just do not take responsibility for their own health & just go along blindly with what their gynea tells them. The fact that every other post on mumsnet is from someone at least considering a homebirth is phenominal -in the city where I live, there are only 2 obstetricians that will provide back up to the midwives who do homebirths!
Well done you ladies!

Out of interest, what proportion of women in RSA use private health providers? What healthcare is provided for women outside the private system, and outside cities?

Lalilu - I don't think that's at all typical. Not many women give birth with independent midwives here - a tiny part of 1%, I would think. Home births are only something like 2-3% nationally although there are pockets where the rate is higher.

I think the majority of us still use the NHS. Caesarean rates are now somewhere between 25-33% of all births, although maybe higher for those wanting private health care.I don't know what the private situation is generally, although I have seen comments on MN to the effect that 'if you want a CS go private'.

Possibly we question a little more, but I wouldn't really be sure of that.

Most make use of the public health system where mothers will be seen/cared for by midwives (who are also nurses) but the treatment they receive in this 'sausage -factory" system is bordeline criminal. The cs rate in the province where I live is around 23% in public health sector - which is reasonably good considering our hiv prevalence.
I guess my gripe with it all is that healthy women with a normal pregnancy are being "cared for" by obstetricians (in the pvt sector) who have absolutely no faith in naturala birth & the dr's justify the cs rate by implying that they're less likely to face litigation for a cs than vag birth!!
It's also not uncommon for an individual gynae to decide thatthe hospital he/she works in will not allow independant midwives use the facility!!!

In the UK, the rate of c section in the private sector is far far higher than NHS as health insurance will ordinarily only pay out for complications of pregnancy which medically require a c section - therefore the group of patients delivering privately are by definition much mire likely to have a CS. And here you can pay for a private CS without medical need too.

lalilu My husband is South African, but has been in the UK for 12 years. His family are still over there. You have confirmed exactly what I suspected.

I am expecting DC 4, which our SA relatives are shocked at to say the least. My husband sister has one DC. When she was expecting from the minute she found out she was pregnant she was having a planned CS, there was never any question. I have my children at home and this was/is completely alien to our family over there. They seem to treat pregnancy as an illness and something to be "treated" rather than enjoyed.

I wondered if it was due to the medical aid system and a way to make money??? The medical system over there is very different from our, I would say "sledge hammers to crack nuts". Even when we have taken the children to the doctors in South Africa we seem to come out with a large amount of medication, over here you have to just about beg for an antibiotic .

Its very interesting to me, I would love for my SIL to see how different it is over here as she is currently trying for her second child.

lalilu, I see exactly the same difference in care where I live in Costa Rica. I had my DS in the UK nearly 3 years ago, so know both systems. People of here pay to have C-sections and doctors decisions are never questioned. The majority of doctors dont even explain their actions as there is such blind trust in them they dont need to. Home birth is illegal (!) and if you have your baby in hospital under the public health care system then epidurals are NOT available. (not that I am a fan, but this seems harsh to me for people who want them) this forces even more people to take a loan, go private and get a c-section. Crazy crazy system.