Tuesday, 19 August 2014

To C or not to C.

I have gone to a huge amount of effort (and money) to TRY and avoid a C-section in South Africa, and I certainly never dreamed it would be so hard. I am wondering now if I should even have bothered, considering that if the baby is breach or there is another issue, I will have to have one anyway, which would actually save me a lot of money. Maybe I should have surrendered to the C all along.

In the UK the NHS (being free) keeps C-sections to minimum - emergencies and complications only. The care is midwife led. I remember thinking back when I lived there that natural birth seemed terrifying and that I should aim to come back to SA for having kids so that I could have a C-section.

Then I came back to SA and started to actually research what giving birth is like. I remember sitting in my tiny room in Johannesburg coming close to a panic attack as I read about natural birth. Then I remember reading about C-sections - and I realised that as terrified as I was of natural, I was more terrified of C-sections. I have had a very minor operation before, and it was terrible. I hated recovery, I was miserable for weeks. C-sections are not minor. I don't really want to have major surgery and then have to look after a baby. I am sure most women are not such wusses about operations, but I AM! I hate them. Let's not mention the weird reactions I had to the anaesthetic.

So I decided to go the natural route. Little did I know in SA and in Cape Town in particular, this is almost impossible in the private sector. I knew that SA private hospitals have a high rate of C-sections, actually it must be one of the highest in the world, because it is much higher than the US. What I did not know is that most doctors here actively discourage natural birth. Apparently in Cape Town many doctors refuse to do natural birth at all. Or they pretend they will allow it, but then tell you that you need a C-section for various reasons. Basically they lie to you and tell you your baby is too big or your baby will die. Now in some cases, obviously those things are true. My midwife told me their C-section rate is 20% - so they deem 20% of women need a C-section for those reasons.

My hospital up the road has a 90% C-section rate. Apparently 90% of women interviewed for a survey at that hospital hoped for a natural birth. But 90% of women who go there get a C-section (I can't find the link to these stats. I may be remembering them incorrectly. I know it involved two 90%s). Which means a whole lot of people are being told they need a C-section when they don't. I kept reading miserable stories of  women being told their babies are too big, having a C-section and the baby weighs a perfectly normal amount. The reasons are payment (doctors get paid a lot more for C-sections), safety (some doctors think C-sections are safer, although the statistics do not back this up!), convenience (the day can be scheduled, and it can take an hour, whereas labour can be days), and these days, just inexperience.

I have no issue with elective C-sections, if a woman wants one. But if a woman wants a natural birth and is being forced into a C-section, then yes I have a problem with that.

According to the interwebs my only hope of having a natural birth in Cape Town was ditching the doctors and hiring a private midwife. So that is what I have done. They have back up doctors that cover them in emergencies. There is only one hospital in Cape Town that allows them to practice. This hospital is not only my list of hospitals for the medical aid coverage that I chose. And they do not cover both the doctor and the midwife. So I am going to have to pay extra for the midwife and extra for the hospital. This baby is going to cost a LOT of money. If I had stayed in the UK, the whole thing would have been free, and the natural birth would have been default. At least I know with the midwife that if I am told I need a C-section that I am not being lied to and I can trust their advice.

All I can say after all this effort, I better not need a damn C-section after all! Funny, what an effort it took for the privilege of squeezing a baby out of a vagina. Which is still the (second) most terrifying thought to me. Let's just block that thought out for now.


Louisa said...

It's kind of terrifying when you're headed that way...but whatever way your baby arrives is perfect when you get to hold them for the first time.

I was also aiming for natural, but since my mom had complications in childbirth I told my doc that anything over 3.5 was going to be via sunroof. N had long that's one of the measurements they base weight on. They told me she'd be well over 4kg.

When she was born she didn't even clock 3kg haha. The doc felt so bad that he negotiated half off for me on all the fees without me even asking. Which was great since I had to pay for everything myself (didn't have MA when I fell pregnant). In 2009 it costed about R35 000 all included!

It doesn't get much cheaper once baby arrives either. With daycare, formula and nappies plus all the extras like another dependant on new MA it was about R5 000 per month. That's still more or less the same.

Next year school fees go down a bit, but I'm guessing lunch box packing will eat up that money and all things balance more or less again.

I actually don't know how people do it who earn less than that a month, and they tend to have MORE children...there is no bulk discount, I checked.

po said...

Wow, Louisa, what a great doctor you had to do that for you! You can tell that he was genuine and not forcing you into anything. It seems that there are better options in Pretoria and Johannesburg than here in Cape Town for those who want C-sections or natural. I have heard many bad stories here of women being coerced into what they do not want. That being said, other people say it is possible to have a natural birth at hospital x of the C-sections, but you just have to be really strong and fight for it. I know myself - if a doctor is telling me I need an emergency C-section or my baby will die/I will die, there is no way I am going to argue. So I want to be able to trust that my doc is not going to lie for convenience sake, so that if they say I need a C-section then I really need one. I am not strong enough to just ignore medical advice! It's nice to have option, right?

I am terrified at the cost of children, Cape Town is incredibly expensive. We live in a flat and even the tiniest houses(smaller than our flat) cost about R1.5 million in this neighbourhood. And even the government schools are very expensive. I won't be working at first because I am currently studying now, so daycare costs will not be an issue, but from what I can see, we lose much more money from me not working than we would if I was working and had a child in daycare :P And nappies!! I am checking out cloth nappies to save money, but they seem like quite an effort.

My hospital bills are going to be painful, but we are using our savings from our work in the UK. I just wish I had known the situation better in advance, and would have tried to get better medical aid or just seen a pro-natural doc, so I would have save a load of money. Hindsight!

Louisa said...

I bought all the cloth nappies...N got hysterical each time I put one on her. Eventually I just gave them to my cousin. I'm guessing they had the same problem because I never saw her son wear one.

Whatever you do, just don't go to a government hospital. A friend of mine ended up going that a storage closet after being made to wait in a qeue for 4 or 5 hours! (In CT)

Well, I'm sure everything will turn out as it should. Don't panic...and if you need to bend someone's ear you are welcome to call or mail me, even if you just want to vent. Send me a mail and I'll give you my number if you want.

It can be a bit overwhelming sometimes.

Ps! Not sure how close you are to D-day, but please be aware that baby blues hits on more or less day 3. So don't do anything drastic if you feel that wave coming. I spent the whole of that day crying for no good reason. Somehow I missed that chapter in What To Expect. ;-)

Louise Corrans said...
This comment has been removed by the author.
po said...

Thanks Louisa! I am feeling that I am a prime candidate for the baby blues! I supposed you can just be aware, right? As far as giving birth goes, we have the extra money to pay for what the medical aid won't cover, but it is so expensive and frustrating, cos if I surrendered to the C-section I would not pay extra, or if I had chosen a better medical aid option I would not pay extra, I just did not know that most hopsitals in CT were not natural friendly.

There is actually a really good gove hospital just down the road from me, Mowbray maternity. It has an excellent reputation. Also it has a birthing centre that was semi private that you could use with a midwife but the midwives I use are not allowed to practice there any more. Not sure why. There is nothing like the excellent birthing centres that you have in Joburg or Pretoria here. If I could not afforc to pay the extra, I would feel fairly comfortable going to Mowbrat maternity, but no other gove hospital here!! That is for sure. The rest are sketchy at best. But I will pay for the private because we can!

The cloth nappy thing is a bit dubious to me. The ladies who do it seem very passionate about it, like it is more a hobby than just a practical money saving thing. I am not sure I can muster that much passion about nappies lol. I am thinking of buying one or two to try. If it does not work out they can be cloths or something right Ha.

Thanks so much for all your advice, it always helps to hear how things worked out for other people!

po said...

Ugh and excuse the typos.

Helen said...

There is a clinic in Joburg that specialises in natural birth - they will only do a C-section in an emergency. Over the last 2 years I have known 6 people who gave birth there, and all of them ended up having massive complications because the emergency C-sections weren't very good (saving the horror stories, you don't need those). I think specialist places can be very dangerous if something unforseen happens as they lack the capabilities to adapt. Everyone I know who has gone the private midwife route (I know a lot of reproducers these days) has been much happier.

I was never sure which route I preferred until my cousin who is a doctor fell pregnant and refused to even consider natural birth. Kind of felt like a C-endorsement to me. Plus you get to lie on your back for 3 days while the nurses teach you to look after the baby, and none of those heavy-breathing classes. Recovery time is the only minus, but I think the scheduling makes up for that. Although admittedly my surgery last year had 4 keyholes into my stomach and that was insanely painful for a few weeks afterwards.

Blergh, why am I thinking about these things, I have my hands more than full taking care of P1 as is, not planning on going either route for a long long time!

po said...

Helen I have heard of the place called Genesis in Joburg - to be honest if I lived in the area I would be going there! They say on the website that they do have practicing doctors at the place to do C-sections if needed. The funny thing is, although their C-section rate is low for SA (private sector) it is actually still really high compared to the rest of the world! Same with my midwives. 20% C-section rate is actually considered really high! But for SA it is about as low as it gets. I had not heard bad stories about C-sections at Genesis but you never know, it could be an issue.

I know you may not be thinking about actually having a kid now, or even ever, but it really does not hurt to think and know about these things for the future. I ignored this subject until a month before I tried to get pregnant, which hence led to me realising my medical aid was not great, I was only insured for Caesar Palace type hospitals, had no gap cover etc etc. Sigh. So I think you are on the right track! I think natural birth is actually going through a bit of a revival in the SA middle class, LOL but if someone prefers a C-section and does not have the fear of operation that I have, then I fully support that!

Champs Whiskey said...

Not to be off topic, but I am going to be, ...

Congratulations!!!! How wonderful! It was great to discover all these posts last night. Even if you seem a bit bewildered by it (man, I would be! And am, and that's why I am single and not with child... ).

That's all I've got. I wouldn't have the first clue on advice or ideas on this.

And great to see you blogging!


po said...

Hey Champs, long time no hear! Sounds like there is some catching up to do on your new blog! Are you still in Aus? I will head over there soon.

Champs Whiskey said...

I'm still based in Oz but actually, right now, I'm high on Jo'burg morning air and jetlag :D In town for a few weeks. Definitely give me a shout when you head to Aus -hopefully to Melbs?