Birthing in South Africa

Zinzile Seepie, the Zulu Doula, shares her insights and experiences with birth in in South Africa

"I don't know if I would say having an unassisted birth was a decision. The more I learned about birth and the more I reflected on my first birth the more I realized that, even though it was this amazing experience, I was not free. It was a gorgeous birth, but the more I learned about birth and the more I grew in the birth world, the more I remembered my own experience as a child in rural KZN (KwaZulu-Natal), the brighter the discrepancies were in what I understood in terms of how free I was in that birth."

Zinzile and her two sons, Jedi and Langa

Birth in South Africa's First and Second Economies

​I had seen women birth unassisted growing up, so I knew that it could be done. It's very different though, especially in the second economy. Let me give you some background. In South Africa, we've got two very distinct economies. There is the first economy which is rich people or people with money and then there is your new second economy which is varying levels of poverty. With my work with Amnesty International and with Human Rights in Childbirth, I have had the opportunity to hear of stories, particularly in the second economy, of really poor women giving birth by themselves on sidewalks or on rural roads because there’s no transportation to take women to hospitals or birth center facilities.

In 2014, Amnesty International released a paper speaking to the degree of poverty within rural regions in South Africa where women would have to put three to six months salary away in preparation for their birth. And I'm not even talking about the people or the medical team that would assist them. That is just transportation to access a hospital. When we speak about unassisted birth in South Africa it's not a glamorous thing. It's something that happens to women who are in really horrible situations. It's only in the first economy where women have the power and the consciousness to make those decisions for themselves. The greater majority of women are just trying to access any type of medical assistance. That is the aim: Can I just get some help? Can someone assist me.

That was something I also had to take into my consideration. Having an unassisted birth wasn't a decision I made lightly because I did understand that not all women die, but in cases where there is abject poverty there are a number of other factors that are in play. Unassisted birth doesn't always end well, so I had to be conscious of that. Also being a doula and having seen women birth, I think sometimes in the birth world we oversimplify birth. It's not something you can just do by yourself at home one day, unless you are inspired by something bigger than yourself. Those are the things I took into my confidence and I took into serious consideration. I live in a country where I'm so fortunate that this is a choice that I could make for myself. 

Prior to my unassisted birth, I had the opportunity to meet a number of women who'd had an unassisted birth. One in particular is a good friend of mine. She's had five or six unassisted home births. I'd watched a few of the home videos that her husband had made of her birthing their children.  At first I thought she was crazy, but i also knew she was an incredibly spiritual person. And i recognized even then that that was not something she had done of her own human capacity or reasoning that she had. You have to be inspired and I definitely recognized that she was inspired by something than herself to make that decision.

Zinzile's First Birth

The birth of my first son was a beautiful water birth in a very well-to-do birth center. It was majestic. There was a huge king size bed, a huge birthing bath, and candle light. It was dim. It was everything that you would want. It was the perfect environment - almost romantic. And I was so fortunate to have an amazing midwife. She was young and African. I remember getting to the hospital at night. There are flowers on the bed there was candlelight. It was dim. It was dark. It was beautiful.

While I had a water birth in a birth tub, I didn't have freedom of movement. My midwife instructed me lovingly and kindly about the position I should get into. When I struggled with that position she suggested one more and then said that didn't work for me either at that point. So she said I should get back into the first position that I had been in, which was uncomfortable. So it was uncomfortable. The water was hot and she had advised me that the temperature was the best temperature for the baby. So I remember being in this position that felt really uncomfortable, in water that felt really uncomfortable.

At that time, of course, I was so appreciative and grateful and thankful and I still am. There are so many wonderful things that my midwife had done. For example, she had allowed me, and I say again, she allowed me to birth my baby relatively unassisted even there and even in that situation. So when I felt his head come out and I felt his body moving down she said, “You should bring him out now… probably in the next push he's going to come out, so be prepared to bring him out.” And I thank her for that. 

I realized that I had birthed him. I birthed him. With their instruction and their guidance, I birthed. I did it. And he did it. We did it. So that was my turning point. I realized this was the best that South Africa had to give me. Did I feel empowered? Yeah, I did. I felt like someone had given me power. I felt like my midwife had given me the power to birth my child. I felt like the facility, which I paid an astronomical amount of money to birth at, had given power. And I felt birthing a child in dignity, in power, and in love should not cost that much. And with the knowledge I had learned afterwards, I thought, “Ok... so if I do this again, how would I do it differently?”

This was my thought process. I want freedom to move how ever I want to move. I want to get into whatever position I want. I want to choose. And most importantly, I didn't want to drive somewhere when I was in labor. I knew I didn't want to do that. I didn't want to say, “Oh, I'm leaving home now to go and have this baby.” There's so much that happens in a woman, particularly a conscious woman, in her process and in her preparation as she is laboring where I thought just a change in environment threw me off. At the time, I chose my birth environment for the sake of my partner and my family. I wanted them to feel comfortable in the environment. I thought to myself, “Next time, I don't want to be thinking about other people. I want to be thinking about me and this human being I’m bringing into this world. And I want to make sure that we have everything we need. 

Preparing for a Second Birth

​Once Jedi was about two years old, I started thinking, “This is what I'd like to have and this is what it should look like. This is what it should feel like. "And then I started thinking it would be nice to do this thing with just me and maybe a witness. That's what I wanted. I knew wanted a doula, because I knew I would never birth without a doula. So I actually valued the doula more than the midwife. I know it sounds a bit weird but, given that I'm a healthy woman who's strong and I worked out throughout my pregnancy. I’m a very active human being and I'm not sickly in any way. I had to own that knowledge.   

I asked myself, “Who are you? Let’s devise a birth plan, a birth environment, and a birth vision which is completely designed for you, Zee, and your baby and specific to you. Once I put all of that into my knowing and allowed it to sit in my knowing. I knew I wasn’t birthing outside of my home. I knew I wasn’t birthing with five hundred people around. I knew that it had to be in my own power, in my own wisdom, and in my own knowing. And I did believe. I believed that I could do it without the assistance of anyone but God. Birth is such a spiritual thing. And I wanted to have a spiritual birth experience not a medical one. I didn't want any of that and I believed that it was possible. 

I had a lot of medical interventions with my first son, Jedi. The midwife ruptured my waters and gave me some medication, so there was a little bit of feeling really out of it, but in it. There were needles. I think a lot of it had to do with it being a first birth and me just trusting the medical realm. That transition from the second economy to the first economy is like going from one extreme to another. With Langa, it was so different. I did so much listening to my body... experiencing all of me and breathing deeply... feeling where there were blockages in my body… seeking them out inside of me. I asked myself, “Body where are there blockages? Body, what you need? Body, how can i serve you?” I focused on really respecting my body and the work that it was doing. I allowed myself to feel myself... to heal myself... to hear myself. ∎

Zinzile Seepie is the founder of Nana Wethu Doulas, and the national coordinator of Human Rights in Childbirth in South Africa. She is a political activist for reform of birth in state hospitals and reform of how society treats women at all facets of their lives, but particularly in birth. Zinzile finds the balance in honoring her heritage as a Zulu woman, while challenging toxic cultural norms.​