Today’s guest is Katrina Meek who lives in Johannesburg, South Africa. The cesarean rates are extremely high in many parts of South Africa, similar to in Brazil but Katrina knew she wanted a natural birth. After having her first child at a birth center, she decided to plan a homebirth with her second. She faced a great deal of resistance from friends and acquaintances regarding her decision but she ultimately knew it was the perfect birth experience for her. Katrina is also a doula who is working to educate women in South Africa about their options when it comes to childbirth. Connect with her on Instagram.
Birth Story in South Africa
Here’s a little sneak peek into her story but be sure to listen to the full episode to hear her tell her story:
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Transcript Episode 74 – Giving Birth in South Africa, Katrina Meek
[Voice 1] Uh, I think my water just broke!
[Voice 2] I think that things really intensified..
[Voice 3] She was right there, and she was coming…
[Voice 4 It was…it was an amazing feeling.
[Voice 5] I could cry just thinking about it. I could FEEL her HEAD!
[Voice 6] (choking up) We heard her cry. We were holding hands and she was SCREAMING (chuckles)!
I’m Bryn Huntpalmer and you’re listening to The Birth Hour. This podcast is designed as a safe place for women to come together to share their childbirth stories. Stick around to hear informative and empowering birth journeys from women all over the world.
[Bryn] Today’s guest is Katrina who is a mom to two and a doula who is living in South Africa. She talks about the maternity care system in South Africa and how natural birth is extremely rare there. They have one of the highest c-section rates in the world, which I didn’t know about. I knew that Brazil’s rate is really high because we talked to a Brazilian mom in episode 47, but in South Africa it’s also extremely high. In Cape Town it’s over ninety percent in a lot of the hospitals. So when she decided to have both a birth center birth with her first and a home birth with her second, she faced a lot of resistance and it was really uncommon. So, she talks about that experience as well as the maternity care system in South Africa in general, and then shares her birth story.
[Bryn] Hi Katrina, welcome to The Birth Hour, thank you so much for being here today.
[Katrina] Thank you for having me.
[B] Can you tell the audience a little bit about you and your family?
[K] Sure, no problem. My name is Katrina and I live in beautiful, sunny South Africa. I live in Johannesburg where I’m sitting freezing at the moment since we’re in winter. I’m a mom now of two. I’ve got a wonderful husband, I’ve got a beautiful two-year-old and I just had Maya Mae three weeks ago today. I’m also a doula as well, so very pro-natural and very into the pregnancy, very into birthing. It’s an absolute passion for me, so to fall pregnant throughout this whole process was just absolutely exquisite.
[B] So did you become a doula after having your first?
[K] Yes, actually what inspired me to be a doula was that when I fell pregnant with my first — my first daughter Neetha — my OB-GYN here in South Africa — the second you get pregnant you go see an OB-GYN, there’s no midwives, there’s not many choices on child-birthing options. So I went to go see an OB-GYN and she literally told me during one of my first appointments, “Oh, you know, you are quite a small girl and you’ll never be able to carry a natural birth, let’s book a Caesarean. She is a December baby and you don’t want her to arrive near Christmas time…” And it was only when I really started doing my research, because I was really really pro-natural, that I thought, “I don’t want to have a Caesarean. I really want to do this naturally.” My mom had three babies naturally, so why should I be denied that option just because I’m told that my hips are too small?
[B] And you mentioned that the Caesarean rate was really high in South Africa?
[K] We actually have the highest Caesarean rate. I think it’s probably one in twenty that have natural births. It’s actually quite shocking. It’s quite sad actually because I think that every woman deserves to have a chance at natural birth. You know, for medical reasons I understand why Caesareans are necessary, but if you are a perfectly healthy woman and you don’t have the options to have a natural childbirth, why should you have to be put through a Caesarean? And that’s actually why wanted to become a doula, because I went through the natural way with my daughter. I had her at 39 weeks and five days, my water broke at half past four in the morning, and she was born literally an hour and a half later, a perfectly beautiful, natural birth. I thought, “I have to inspire people, I need to educate people. I need to be involved in natural birthing.” And I decided to do my doula certification. So I started to be a doula, and a year later I was a qualified doula. I had about 30 or 40 births to my name, and I’m so grateful for that. I’m so grateful that one OB-GYN told me “no,” because it inspired me to become a doula and to have a natural birth myself.
[B] So are the majority of your doula clients trying to have a natural birth?
[K] Actually, a lot of my clients are VBACS.
[B] OK, so they seek out that help after having a Caesarean?
[K] Exactly, and I think they know how sometimes traumatic a Caesarean can be. And especially with second children, it’s difficult to be able to pick up a toddler with a fresh Caesarean scar and look after them. If I had to have a Caesarean, I’d be looking after a two-year-old, and we all know how wonderful two-year-olds can be. They get quite dependent on mom, they want to go “uppies” and they want to be held because they’re feeling a little bit left out. I don’t understand how women can do that while having a fresh Caesarean scar. It must be incredibly painful.
[B] Mm-hm. And your most recent birth was a home birth, right?
[K] It was a home birth. The rate for home births is probably one percent. It was something that I’d been dreaming to have. After having such a beautiful and such a quick birth with my first, I thought, “I have to do this and I have to push myself and get my mind right to do this.” And I had the support of my incredible midwife and my husband. I’ve got the two most amazing moms: my mother and my mother-in-law. They were all here. Again, my water broke at half past four in the morning, which is quite strange. It was almost the same time, to the minute (laughs). And, she was born an hour later! It was beautiful, it was in my own home, it was upstairs in my tub. It was just before seven in the morning, so the sun had just risen, as it was winter here in beautiful sunny South Africa. So, it was my ultimate birth. It was incredible.
[B] Was it difficult to find a home birth midwife in your area?
[K] Yes, it was. Even my midwife, she was quite skeptical about giving me a home birth. It took a little bit of arm twisting. But, I think with my knowledge of being a doula, and her trusting me and me trusting her one hundred percent — I think, as a team, we decided, “Cool, let’s give it a try.” I’m quite fortunate that my local hospital is only about a three-minute drive from my house, so God forbid if anything did go wrong, you know it was a quick drive up to the hospital. So I think that kind of also played a part in the decision. But, yes, midwives are quite skeptical, but there is a majority of them that do it. Unfortunately, not many women want to have a natural birth in South Africa, which is which is heart wrenching. I wish every woman got to experience what I experienced.
[B] What do you think the reasons are for that? We had a guest on from Brazil where the Caesarean rate is also very high, and she mentioned that a lot of it is due to cosmetic reasons and that women are told that their body will never be the same if they have a vaginal birth.
[K] Absolutely, it’s exactly the same. You know, there’s a lot of the old wive’s tales of, you know, your body will never look the same and your women’s regions will never function the same. Of course, in certain circumstances where things do not go as planned, I understand that concern, but I was up and about within 45 minutes of giving natural birth, running around playing with my toddler. I just wish people had the knowledge that natural birth is very, very, very possible.
[B] What was your prenatal care like with the home birth?
[K] So, I had a midwife that saw me once a month up until I was 34 weeks, and then it was every two weeks. Once I hit 37 weeks she saw me once a week.
[B] Did you go to an office for that or did she come to your home?
[K] She came to my home, which was amazing, you know, as far as feeling comfortable…
[B] With the toddler?
[K] Exactly, there’s nothing worse than bringing a toddler and sitting in a doctor’s room. Because i had a midwife, I didn’t have any sonar scans or anything like that, so and my husband and I wished to spoil ourselves every 12 weeks. We would go for a 4D scan, there is quite a nice facility in our area that accommodates 4D scans. We got to look at her, just to check her measurements. But, otherwise it was in the house, very relaxed. We got to listen to the baby’s heartbeat, which was nice because my husband was here sitting on the sofa with us, my toddler was running around, you know, it really worked for us to have something at home.
[B] And was your husband excited about the home birth as well?
[K] Umm… yes and no. I think he knew how headstrong I was about having the home birth. I think he actually knew how passionate I was about it, so when my water broke and it was “go time” as we call it, he was incredibly supportive. All the chores and all the little checklists were all done before I even had my first contraction so he kind of sat there a bit bored, asking “What else can I do?” I think it was a bit daunting for him, but i think he he felt comfortable enough since my midwife had already delivered our first daughter and because we had such a beautiful, smooth birth with my first daughter. We expected — and i’m so glad that it did happen — that we had a beautiful birth with our second.
[B] And did you get opinions from friends and families since home birth is so unusual?
[K] Goodness, I remember actually speaking to an acquaintance, and the first thing she asked me was, “Who’s your OB-GYN?” And I said, “Well, actually I don’t have one, I’ve got a midwife.” And she said, “Well, what hospital are you doing your Caesarean in?” I said, “No, I’m doing natural birth.” She says, “OK, well, which hospital?” and I said, “No, I’m actually having a home birth.” And she actually asked me if I have medical savings — we call it “medical aid” here in South Africa, everyone has to have a medical aid. She actually thought I was poor, because I was having a home birth. She didn’t think I had the correct medical savings to be able to go have my baby in a hospital, which I think was quite a an eye-opener for me. I was taken aback that because I wanted to have a home birth, I was considered not into “the 21st century way” of giving birth. It was quite a surreal thing, she really thought I was poor, to put it bluntly.
[B] And were you able to kind of explain to her the reasonings and what it was like to have a home birth?
[K] Yeah, it took me a couple of minutes because I was actually quite surprised by her reaction. She asked, “Why aren’t you having a Caesarean? Why aren’t you having you baby in a hospital? How can you put your baby’s health at risk by having her at home? How can you not want to have her in a hospital, where there are doctors who can keep her safe?” Which was a bit difficult to answer because I didn’t really have an answer for her. For me, it was: I trust my body and I’ve done this before, so I trust my body so much that I believe that everything will be fine. A lot of people have preconceived perspectives of home birth, people don’t think that it is the right choice, because we are putting our babies at risk. But, I mean, if you look at the percentages of things that go wrong in hospitals and things that go wrong at home, there really are no risks.
[B] It’s an interesting topic about the cost, because in the United States, often home births aren’t covered by insurance. So you often have to be more affluent to afford a home birth because your insurance will cover your c-section at the hospital but it won’t cover your home birth that costs a fraction of the total amount.
[K] It is exactly the same. When I phoned my insurance and I said to them that I’d like to have a home birth, I think they covered me — if I work out the ratio — it works out to be about eleven percent. That’s all they’ll cover for me, compared to a hundred percent of the c-section and three days in the hospital. It’s actually mind-boggling.
[K] Absolutely mind-boggling. I had no drugs, no materials, I had absolutely nothing while having my home birth, compared to a Caesarean, which would have included an anesthesiologist, nurses, doctors, OB-GYNs, and three to five days in a hospital. And they would have covered that one hundred percent, but would not cover my home birth one hundred percent.
[B] Do women typically take childbirth classes in South Africa?
[K] A lot of people don’t do it. A lot of the midwives offer antenatal classes. I took antenatal classes with my midwife for my first daughter, and they were lovely. I actually made one of my best friends through antenatal class. I think it’s quite important and it’s beautiful to be able to bond with people that are going through the same kind of thing — not sleeping at night and constantly going to the toilet — and going through your mood swings together. I loved my antenatal classes, I think they are so important. They really are.
[B] Do the women who choose to give birth with a gynecologist have childbirth classes, or do they just say, “Oh, I’ll have a c-section so I don’t need a class?”
[K] Well, basically, if you’re going to have a c-section, you have to get outside classes. With midwives, we always have classes with our midwives, but if you have a Caesarean I think your doctor doesn’t offer those classes so you actually have to go to a private place to get those classes done. Which, again, is more expenses, and I think at the moment people don’t want to spend extra money to to do these classes. With our midwives it comes with our packages.
[B] How is your postpartum period?
[K] It’s been three weeks, and I do have a toddler, so I haven’t had much time to think about postpartum at the moment.
[B] Yeah, you’re definitely still in the thick of it.
[K} Absolutely, we still trying to make routines and we’re still trying to get the sleeping patterns right. But, second children are a lot easier than the first. Women: there is hope, the second kids are a lot easier! I can absolutely preach for that. With my daughter, I remember the postpartum period was like, every three hours you have to wake her up, let’s put her on the boob, and I don’t think she’s had enough, and have I burped her enough? I think with the second, you kind of just go with the flow and, you know, things happen whenever they’re going to happen. For example, the baby goes an hour and a half between feeds instead of three hours. So I am a lot more relaxed with having my second child, and I see it with my new daughter Maya. She is so relaxed and so chilled, she goes with the flow. She constantly has her sister’s hands in her mouth or in her ear, or in the eye, or she’s pulling her hair. It’s quite sweet to look at, actually.
[B] Yeah, I noticed that with my second as well. Is breastfeeding common in South Africa?
[K] (Sigh.) That’s another quite strong debate that we have here. You know, a lot of women feel the need to have to breastfeed in toilets, and to have to breastfeed in their cars, which now I have a big problem with. I absolutely love to breastfeed both my daughters. I remember with my first daughter, I did breastfeed her in toilets because I was a little bit nervous. You often don’t see it here, which is devastating. We do have some nursing rooms, as they’re called, in some of the restaurants, but why would anyone want to breastfeed their child in a toilet, in a restaurant? It absolutely baffles me now. I’ve got the confidence now to be able to breastfeed in public, but I think it’s only because of my studies and being a mom of two. I don’t have time to go to the toilet because I actually have to look after my toddler. So, yes, breastfeeding is a bit of a debate here. I wish it was normalized. I wish that people saw it as a beautiful thing, not as a sexual thing. It’s beautiful, your child needs it, and I just wish there was a little bit more education about it as well.
[B] Yeah. Well, what resources do you recommend to the mothers that you work with? Are there any resources specific to South Africa that you point people to? Or is it the Ina May books and things like that that we all read over here?
[K] Well, we’ve all got the Ina May books. A lot of our resources for doulas are based on books like that. It’s basically just to know your options. I didn’t know my options in the beginning and I’m so glad i actually researched it. I wish people would know that c-sections aren’t the only way sometimes. There are beautiful, natural birthing places. There are birthing centers that people don’t know about. You don’t have to go through an OB-GYN throughout your whole pregnancy. There are incredible midwives here. They are absolutely phenomenal. There are doulas, and a lot of the doulas that I work with, they became doulas because they didn’t realize they had the option of doing the natural birth. They didn’t realize they had the options of midwives and doulas, and natural birth, and VBACs, and all of that. We’ve got quite a nice South Africa VBAC group on Facebook which grows every day. I think people now realize, sometimes Caesareans aren’t the only way, it’s not the only option here. There are so many other options, there is the natural option, there is the midwife option, there’s doulas. There really are a lot more options than what the OB-GYNs are giving, which is basically: let’s book as Caesarean date.
[B] We’ll definitely link to that Facebook group from the show notes page. Can you also share where listeners can connect with you online?
[K] Definitely. So, we have a beautiful doula group called “Wombs South Africa.” There are a whole bunch of doulas in South Africa. We’re quite a tight knit community. There’s “The Doulas of South Africa” as well, which is also a beautiful group. You know, we just want to spread the word that there is natural birth available in this country, it doesn’t have to be Caesarean. Because that’s all that we get told and it’s so disheartening. Even as doulas, we go through these journeys with these beautiful ladies with their OB-GYNs, and come 36 weeks, their OB-GYN will tell them, “Oh dear, the cord is wrapped around the neck, you have to have a Caesarean.” And, we all know as doulas, and as natural birthing people, that you can still have a natural birth if the cord is wrapped around the neck, or even a breech baby. I know the most amazing midwives who have delivered breech babies all the time. But one of the most common phrases with the OB-GYNs here is, “Oh, looks like your baby’s a little bit too big.” So these women are birthing babies who are…. we work in kilograms, so please excuse me, I’m not too sure of that the ratio with pounds and kilograms. But a friend of mine was told that her baby was going to be far too big for her to give birth naturally, and she actually delivered only a 2.6 kilogram baby, which is tiny — she was so tiny. She could have had the opportunity to have a natural birth but it turns out the guy needed to go on holiday, and would have liked to have his clients booked in before he went away.
[B] Yeah, that’s five and a half pounds for us, which is a preemie, usually.
[K] Yes, exactly, and these are the problems that we face, which is totally heart wrenching. But, we as doulas, we are not medical doctors, we can never ever protest against what an OB-GYN’s word is, or what his diagnosis is. And then we see these tiny little babies being cut out, and we’re thinking oh just two more weeks of you baking, little one, and you could have been beautiful, healthy and strong and not spend your first 10 days of life in in the NICU.
[B] So you can’t give any kind of contradictory medical advice, but do you urge your moms to ask more questions or is that even an option there?
[K] We do, we always say that if you are a little bit unsure about what the OB-GYN is saying, maybe go get a second opinion. Or, if you do want to go natural, you could maybe consider going with another guy that is quite pro natural. But I think at that stage of anyone’s pregnancy to change an OB-GYN that far along is quite daunting, and I understand the mom’s point of view. So, it does get quite difficult.
[B] Mm-hm. Well, thank you so much for sharing a little bit about your birth and also a lot of really great information about birth and pregnancy in South Africa.
[K] No problem, thank you so much for having me.
[B] Thank you again so much, Katrina, for reaching out to me on Instagram and coming on the show to share your birth stories. If you want to connect with Katrina, you can leave a comment on her show notes page at thebirthhour.com and you can find me on Instagram @thebirthhour. Thanks so much for listening. If you enjoyed today’s show, head to thebirthhour.com to sign up for our newsletter, and if you really liked the show please subscribe and leave a review in itunes. I’m Bryn Huntpalmer and you’ve been listening to another episode of The Birth Hour. Thanks again, and see you next week.