"decision fatigue refers to the deteriorating quality of decisions made by an individual after a long session of decision making. It is now understood as one of the causes of irrational trade-offs in decision making."
- Wikipedia
Durban is experiencing a cold front this week which has given me a perfect excuse to stay snuggled up in bed and get some much needed rest. We have just finished up a home renovation marathon and even though I haven't been doing any of the heavy lifting personally, I am definitely feeling the effects of decision fatigue. Just choosing a carpet for the nursery turned out to be quite complicated. Different colours, thicknesses and underfelts, dust retention, durability. Seriously?? Anyway, finally the nursery is done. I custom designed the furniture and chose every detail from wood to wallpaper to curtain rods with great care. I think out of all the projects I've worked on, this one had the most self-imposed pressure attached to it and it is definitely the one I am most proud of. I'll probably do a post with some pictures once I recover some energy.
Today as the dust settles on the home reno' project, I have something a little more complicated on my mind. Another decision that I've been putting off for far too long. Earlier this year, when we expected that our baby would be born in New Zealand, I had been thrilled that I would most likely have a non-medicated, natural birth experience, probably at home and preferably in water. I had always pictured that this would be the perfect scenario where I wouldn't have to go through the experience of a c-section and then the extra self-care that was required to properly heal from it. I also had read lots of articles on epidural births, induced labour and other delivery procedures that were heavy on medical intervention. In New Zealand, midwives are responsible for 4 out of 5 births as opposed to doctors. In fact, it is not uncommon to progress with the entire pregnancy, delivery and post-natal care without having had a single gynae appointment. There are obvious exceptions in situations of risk and complicated births that require emergency c-section but an elective c-section is extremely rare.
How vastly different this is to the case in SA where the rate of c-sections is twice the global average? I looked up a couple of stats online which I won't bother to reference since I haven't fact checked them to an acceptable degree but the results were quite alarming anyway and you may feel free to do some research of your own. Basically what I was able to dig up in a quick Google search showed that in 2017/18 the c-section rate in SA's private sector was 76.9%. I also scoped out that KZN had the highest rate of c-sections compared to the other provinces. As I mentioned, I have not done much credible research into the topic but I certainly hope to do so in the near future when I'm less "preggers". It's startling to say the least and has given me very little confidence that I will be able to proceed with a natural delivery at a private hospital as per my birth plan. Since I've been back and have asked around, I was unable to find anyone using a private gynae who has had a natural, vaginal delivery despite that being their original birth plan discussed and agreed upon with their gynae beforehand. It could be a coincidence. I understand that many people opt for elective c-sections here as it isn't that un-common and some of my friends had been advised by their gynaes that c-section is a preferred delivery method with greater benefits. One said to me that it was supposedly "less-stressful or traumatic" on the baby. I won't argue because I have no background and I am being very cautious to stress that this is my opinion founded only on my limited understanding of information available, but personally, I think the business side of the medical industry is disproportionately influencing the rate of c-sections in SA.
Here's the issue though, I have only been able to locate two whole midwives in KZN that appear to be reputable practitioners for natural, no-intervention, home births. This is also from an online search so pardon me if you're one of the hundreds who are out there in the shadows where my keyboard was unable to locate. TWO! After chatting to one of them at length I have some ideas as to why this is the case and I won't go into them here because what I actually want to write about in this post is the fact that because of all the people I've spoken to demonstrating an overwhelming number of gynae births and c-sections, which were all labelled as emergency procedures, there is nobody available to me who can give me a first hand account of having a natural delivery in a private hospital in Durban in 2019/20. One of the people I spoke to actually went into into natural labour and was then advised at the hospital by her gynae that since the baby was nearly 4kg's, she should have a c-section instead and she agreed. Furthermore, there is nobody I know who can advise on the safety and experience of a home delivery with the help of a midwife either.
So whereas in New Zealand, a midwife assisted birth is the norm and a c-section is extremely rare, for some reason in South Africa, if you go to a private gynae in Durban, you seem very likely to run into an emergency which requires a c-section. It may not seem like a big deal unless you're pregnant and have an attachment to your birth plan for whatever reason. In my opinion, when you enter into a relationship with a practitioner, be it a gynae or a midwife you have to have a deep level of trust in that individual. If at the eleventh hour, the gynae suggests an emergency c-section contrary to what you may have discussed and planned for, are you really in a position to stick to your guns? Let's be frank, you're not going to be keen on arguing with the professionals when it comes to the safety of your precious unborn child. Sadly, even being as skeptical as I am, I myself, would defer to the expert. The alternative is to take your chances with a midwife who is extremely undervalued and virtually un-acknowledged by the rest of the medical community here.
So here's my dilemma. I hate being forced into a situation that I don't want to be in, I also hate being manipulated and my instinct is to rebel against the system. However, at what cost? I have to now decide whether I go with the status quo and have a well-respected and highly recommended gynae deliver my baby in a hospital with access to all the drugs and interventions that are readily prescribed during delivery and accept the high likelihood that I could be urged to have a c-section or do I fulfill my heart's desire and roll the dice with the extremely experienced but under-stated midwife, completely natural, no-intervention in the comfort of my home. In NZ, midwives are all the rage but here in SA I am met with nervous stares whenever I mention considering a home birth without a gynae. In any case, this baby could decide to be breeched beyond the full term or some other complication could arise and I could end up having an actual emergency c-section anyway. Reading this back it seems like a pregnancy hormone-induced rant but I am genuinely conflicted as to what to do here.
To further complicate matters, we have just over 3 months to go and our Covid-19 cases are drastically increasing, adding to my apprehension about the hospital environment. I have also heard that it could be a possibility that Ransley will not be allowed to be in the delivery room due to the hospital's Covid regulations and to top all this off, I had a routine doctors appointment scheduled for next week and just received a call from his surgery to let me know that our gynae is in self-isolation since he's come into contact with a person infected by Covid-19 and as a result he won't be able to see me but I am welcome to resume my appointments with one of his partners until he is back.
I am at a loss at this point and I hope to get some clarity soon but this baby needs to come out one way or the other and decisions will have to made. I might update this after I un-frazzle my mind. I go back and forth and sometimes feel like maybe the delivery doesn't really matter and the most important thing after all is that she arrives here safely and in perfect health. How much of this has to do with me trying to control everything and how much is about having the right to control the most important event of my life thus far? I have to stop before I spiral. Let's see what happens.