Birthworks has special ties to the villages in the Peddie district of the Eastern Cape including and surrounding Hamburg village. For 6 years karen Clark and Nomvula Gxaka at the Busfare Babies Birth Centre have enabled women in the area to give birth to their babies in a safe and comfortable environment near their own villages. What we offer is not complicated. It is old fashioned comfort combined with research-based care and providing privacy and dignity to child bearing women. We have the skills, knowledge and equipment to assist women giving birth, but as important we feel, the humanity and love that is required to walk a women into motherhood.
What we offer:
Women from the area come to the Birth Centre during their pregnancies for routine check-ups and tests. Women are screened in terms of risk and only low risk women are able to give birth at the Birth Centre, high risk pregnancies are referred to the appropriate hospital.
In labour, the labouring woman is collected from her home by a vehicle from the birth centre, or will make her own way to the birth centre where she stays for her labour and birth and for several days (2-4) following the birth, until she is feeding her baby well and has recovered and able to cope with her newborn baby at home
Each laboring woman may bring with her relatives or companions of her choice to support her during her labour, and they may stay with her for the duration of her stay at the Birth Centre.
I am the only attending midwife, Nomvula and I work together to attend women in labour and Nomvula stays with the woman and her baby at the birth house for the duration of her stay, cooking for her and teaching her the basics of mothering a new baby. Having had 5 of her own children, including twins, she is very well qualified.
In the event of a complication, the labouring woman or newborn baby are transferred to the appropriate hospital for treatment using our transport as waiting for an ambulance can take several hours..
Bus Fare Babies Aims:
- To enable women to have healthy pregnancies by encouraging good diets, by careful monitoring of pregnancies and by early detection and treatment of pregnancy complications.
- To lower the levels of maternal mortality and child mortality in the first year.
- To provide good, quality care in a comfortable environment to the women of Hamburg, Bodium and Bell during their pregnancies, during the labour and birth and in the week following the birth.
- To reduce the incidence of HIV infection in the area by prevention through education, through PMTCT and by promoting safe infant feeding.
- To facilitate the screening process for HIV and to provide anti-retroviral therapy to women in labour to prevent mother to child transmission.
- To inform women about, and to encourage safe infant feeding.
- To look after women during this special time as they give birth to their babies, to make it a pleasant experience so that they can go into motherhood feeling strong, cared for and empowered after their births.
- To set up an efficient referral network between the Birth Centre and the relevant hospitals for high-risk pregnancies and complications in labour and postnatally.
- To help the government to reach millennium goals 4 (reduce child mortality), 5 (improve maternal health)and 6 (combat HIV/AIDS, malaria and other diseases)
I am Karen Clark, my Xhosa name is Nomzamo, I am 43 years old. My family comes from Cathcart, Eastern Cape, but I was born in Durban and grew up in Pietermaritzburg, Kwa Zulu Natal. I studied Nursing and Midwifery at Carinus Nursing College in Cape Town and qualified as a Nurse and Midwife in 1994, I worked in the U.K for 4 years as a nurse, worked in Khayelitsha at Michael Mapangwana MOU as a midwife and studied a further 18 months to obtain a diploma in Advanced Midwifery through Napier University in Edinburgh, Scotland. I then worked a further 2 years in London hospitals as a midwife. I have been working as an independent midwife for 12 years.
My husband, Garvey, is a coffee roaster, and we have 2 children aged 14 and 12.
The idea of building a rural Birth Centre first came to me in 1993 whilst I was working in Khayelitsha and Guguletu as a student midwife, and it has been in the planning phase ever since. Whilst working in the overcrowded informal settlement, I was struck by how many women moved to the city in order to have their babies. Many of these women came from the rural areas, were very young and had had very little antenatal care during their pregnancies and little or no support through their labours, births and as they became mothers living in overcrowded circumstances. Having worked in many different hospitals both her and in the UK I am well aware of the type of experience birth can be in an institution, I believe we can offer excellent care without excessive cost to rural women and with this purpose have started this birth centre.
We have chosen the Hamburg/Bodium/Bell area as the location for a Birth Centre as it is located a reasonable distance from East London, the roads are relatively good and transferring in an emergency situation is manageable. The Bus Fare Babies Birth Centre is at present located in the village of Hamburg, which lies at the mouth of the Keiskamma River in the South Eastern corner of Peddie district. This district comprises of 112 widely dispersed rural villages all together.
The Peddie district of Eastern Cape has approximately 100,000 people mostly living in rural villages in an area of approximately 3600 square miles. The rate of unemployment is close to 90% and majority of people live off government grants or old age pensions of grandparents. There is one hospital in the area Nompumelelo in Peddie, this is approximately 60km from where the birth centre will be.
Access to medical facilities in pregnancy and birth is severely restricted by poverty and the inability to travel to sites offering care. Although ambulances do travel to these areas, there can be a 5-6 hour wait for the ambulance to arrive. Such long waiting intervals are a danger to mother and baby at birth.
A letter from a resident of one of the Peddie villages describes why such a centre is needed:
“In 2002 I fall pregnant and I was expecting my child on the 5th of August but I had the baby on the 31st of July unexpectedly. My husband call an ambulance, early around 5 o’ clock, but the ambulance arrive at 11 o’clock.
It took me to the hospital. At the hospital there were so busy there with renovations of the old buildings, so the midwifery told me they going to sent me to East London to the referral hospital, there came the ambulance took me to the hospital, The first thing in the ambulance. There were 3 people. 1 lady and two men the lady was driving. Those two men they were drunk especial the one who was with me in the back.
Labor pains were serious and he was shouting at me not to deliver my baby. I was expecting twins, one boy and one girl.
I gave birth in the ambulance. One twin came out, the boy. I think we were not too far from the hospital. The drunk man cried very loudly and call for the lady to stop to drive to come and help me.
My baby boy was alive and he cried but later stopped, there was no oxygen in the ambulance, my boy died on the way.
When I arrived there, the girl came but I think she was tired. A sister put her in oxygen, I loose the boy I was in need of.
It was the first time for me to have a baby boy. But I loose him, I will never forget that in my whole life so we really need a safe baby birth place in our area. Because the hospital is far away.”
HIV and ARV’s
The hospital central to the district has been accredited to supply ARV’s and rollout has improved dramatically to when we first arrived in Hamburg. The ante-natal infection rate is currently 30%.
Linking with the existing government clinics and NGO’s in the area, Busfare babies encourages HIV screening for all pregnant women, encourages ARV treatment in pregnancy and appropriate treatment during labor and birth. In the post natal period, mothers and babies are referred back into the existing systems for continued ARV treatment. As their midwife, I advise and support careful and safe infant feeding choices and assist women in the first month of feeding with advise and support.With government clinics now providing ARV treatment, continued care in terms of women who have been diagnosed with HIV during their pregnancies can then be referred to these clinics for treatment postnatally.
What’s happened so far
The community of Bodium welcomed this project in their village. Their letter dated 5th September 2007 reads:
RE: Request and agreement
The community of Bodium came to an agreement to request you to please establish a maternity service in our village, which is the neighboring village, the farms around and even Hamburg village.
Reasons for this request:
1. Our village is central to the mentioned village
2. There is no such service in the entire area except the local hospital, which is 50km away.
3. It is very difficult when a woman becomes in labor especially at night there is no transport except for one teacher who in most cases visiting his wife in Grahamstown.
4. Stillbirths are not uncommon, ambulances takes five to six hours to respond.
5. Such a facility could bring relief to the community at all the villages mentioned above.
Hoping for a favorable consideration
Chair person: Mr T. Yona
Secrertary: Mrs Nokwanda Makubalo
Myself and my family moved to Hamburg in January 2008. The first year was been spent fixing up suitable accommodation for ourselves and trying to arrange a suitable site for the birth centre.
In terms of the site of the Birth Centre, we felt that a large piece of land would be suitable. The community offered land to start the project, we were however advised that in the interest of securing funding, we would have more success if the land was either leases formally for a long-term period or purchased as this would afford the project more security. We identified an appropriate site in the village. The community was been involved in the decision of location and have agreed on the proposed site as being suitable. The site is well situated in the village at a walkable distance, and close to the road and will be suitably private for laboring women.
Although the community is impatient for the project to begin.
The securing of land has been a necessary but protracted process and as mentioned earlier, we have now purchased the land
Funding and sustainability
In order to make the Birth Centre sustainable, women were asked to pay the cost of their bus fare that they would have had to pay to go to a government hospital in a large city to have their baby at the Birth Centre, hence the name Bus Fare Babies. This fee was R150, not very much but we have found that birth is not seen as having value and in order for women to be able to have choice we have chosen to drop this fee. Since 2014 the care we offer has been offered free of charge.
Our main Sponsors at the moment, apart from a few kind individuals, are the “WILD WOMEN ON THE RUN” a group of wonderful women who take it upon themselves to do a 3 day run up the wild coast, from Cintsa to Mazeppa. They have funded us for three years running and we cannot thank them enough. We hope, depite not having staff employed to fundraise, to obtain donations, both South African and overseas sources.
Bus fare Babies has approached NARM (North American Registry of Midwives) and have obtained accreditation as a clinical facility where student midwives can come for training, as well as being able to train our own rural midwives. Student midwives in the USA have great difficulty obtaining sufficient experience We would aim to also allow local women interested in midwifery to be able to train using the NARM training programme. Foreign midwives coming to work in the centre are required pay for accommodation and training and placements are a minimum of 6 months in length
The state of birth in the public sector in South Africa is far from ideal. Women are neglected, treated harshly and there is a lack of care
and compassion. The majority of women labor alone without friend or family support.
Busfare babies proposes that there is another way. That without excessive cost, women can be cared for gently and their babies welcomed into the world in a safe, soft and nurturing environment. We care for women throughout their pregnancies, as they give birth to their babies and for the early weeks following birth.
In South Africa there has been a quadruple increase in maternal mortality associated with pregnancy in 2005-2007 when compared with 2003-2005. By providing this type of care it is our belief that the statistics that are associated with maternal and child care will be greatly improved for the women that we serve. We are a small drop in the ocean of birth but it takes small drops to make a wave.