Cape Town - While many pregnant women associate childbirth in maternity units with comfort and care, for others attending public healthcare centres this experience is not always pleasant, with many reporting clinical neglect, verbal and psychological abuse, including beatings by health workers.
The abuse of women, which is often as a result of occupational stressors on health workers, has raised the ire of UCT academics, who labelled it a “disgrace”.
In an article published in the South African Medical Journal, Simone Honikman and Ingrid Meintjes from the UCT-based Perinatal Mental Health Project, and Sue Fawcus from UCT’s Department of Obstetrics and Gynaecology, revealed that not only were these women subjected to various forms of abuse, but nurses were often so stressed and poorly trained that they failed to detect other medical issues such as antenatal and postnatal depression.
In South Africa the prevalence of antenatal and postnatal depression had been shown to be at 47 percent and 34 percent, respectively.
In the article, the academics noted that maldistribution of health workers and resources, excessive overtime demands, lack of motivation and work overload often left health staff overworked and powerless - resulting in abusive behaviour.
Lack of support structures also added to staff’s emotional burden, resulting in poor care of patients.
But all was not lost. They argued that initiatives to improve patient care and reduce adverse maternal outcomes, in which women were treated with dignity and respect, could still turn the tide of perpetuated abuse towards pregnant women.
In the Western Cape, a number of scientifically proven initiatives such as the introduction of birth companions while in labour, and training for health workers had since been implemented in a number of maternity units from last year.
The Birth Companion initiative - which allowed partners, parents and doulas to be at the labour ward during birth - not only provided women with emotional support, but some of its benefits included quicker births, and fewer complications such as instrumental delivery.
The initiative formed part of the provincial government’s Maternal Patient-Centred Care Code, aimed at addressing the mistreatment of women at maternity sections. Part of the decision to introduce the programme in August was that the infrastructure and space at facilities should be sufficient to enable privacy, comfort, and to accommodate women for observations at early and active labour, and during delivery.
But the three academics raised concerns about slow implementation of programme, arguing it was difficult to get “staff buy-in”.
Despite clear evidence for birth companions, “its implementation in public sector maternity wards is often impended by infrastructural problems such as poor security, lack of privacy and lack of enabling policies”, the academics wrote.
Health Department spokesman Mark van der Heever said the province had implemented the programme in four maternity units so far, including Michael Mapongwana in Khayelitsha, Mitchells Plain, Delft and Vanguard Community Health Centre. These maternity units served as demonstration sites to allow the province to learn from these experiences, before rolling out the programme further.
“At each of these sites the elements of the code are being implemented, and we are constantly reflecting and learning on how to do it better,” he said.
Van der Heever acknowledged that in the past some of the department’s facilities faced infrastructure challenges including lack of space, which didn’t allow space for birth companions.
“However, with the adoption of the Maternity Care Code we strive, as far possible, to accommodate birth companions in the labour ward,” he said.