NINO ( Neuroscience for Improved Neonatal Outcomes).
Cape Town, March 2013.
Dear friends,
Thank you all for your letters of support for our application for a licence to establish a NINO Clinic in
Cape Town - and for your other expressions of affirmation.
Regrettably the Minister of Health, Theuns Botha, has dismissed our appeal, and thereby confirmed
the rejection of our application.
We are deeply disappointed, particularly as the reasons he has given (transcribed below) are so
unsatisfactory …
2.1 There is no need for this kind of facility as there are other health care facilities in the
relevant sub-district and in the rest of the Cape Metropole that render similar services. There
is an indication that these facilities are underutilised, Furthermore, according to expert
opinion there are ample maternity and neonatal units that cater for private sector in the
Western Cape Peninsula.
2.2 I am concerned about patient safety. According to expert advice, as such a standalone
unit, in cases of patients with complications, unnecessary responsibility will be placed on the
midwife managing the patient if she has to wait for an anaesthetist, paediatrician and
obstetrician to arrive from their respective private practices. The expert opinion also
indicates that the best practice is for a midwife-led birthing unit to be attached to a hospital
where 24 hour emergency specialist care is available.
2.3 The need for 3 major theatres and neonatal ICU beds seems superfluous since your aim
is to cater for the low risk pregnancies and natural births managed by midwives.
2.4 I doubt that your statement that the choice of natural birth does not exist in private
hospitals is correct. Surely a patient has a choice in deciding whether to undergo a caesarean
section or to have a natural birth.
2.5 The Department’s concern that neonatal intensive care unit staff, a scarce resource,
might be recruited for provincial and private hospitals is valid.
When we discussed the NINO Clinic concept with the Minister a year ago, he acknowledged that
there is no place that renders “similar services”, and that a place which provides a choice for natural
birth rather than a coerced Caesarean (with rates between 70 and 90% in Cape Town’s private
hospitals) is a real need. The absence of a private “midwife-led birthing unit” (part 2.2) in Cape Town
contradicts his earlier statement that “similar services” (2.1) exist in Cape Town. The concern that he
now expresses for “patient safety” fails to recognise that half of Cape Town’s mothers already
deliver in MOUs, where they do so very safely. We can state this with absolute confidence because
as Medical Superintendent of Mowbray Maternity Hospital and the Peninsula MOU’s, Nils was
directly responsible for this safety. Furthermore in our application the NINO Clinic is presented as a
‘hospital’ with respect to theatres and NICU, and the application clearly states that “24 hour
emergency specialist care” is included. The NINO application is for a 40 bed hospital with specialists
on site, specifically not only for “low risk pregnancies managed by midwives”.
We do not believe that a single one of the Minister’s reasons justifies the denial to us of a licence,
because each one had been addressed in detail in the motivation. The detailed scientific rationale
and letters of support were not acknowledged; and the Minister’s answers suggest that they may
not even have been read.
We remain convinced that the NINO Clinic remains the best way to address a very major problem in
health care delivery, in the Cape and beyond. Now, particularly in Cape Town, most mothers in
private birthing facilities will continue to be denied the choice of a natural birth. Our anticipation is
that private hospitals and health systems will continue those practices which protect their profits at
the expense of the best interests of mothers and newborns. The science and the evidence for better
practices was documented in the application for NINO - Neuroscience for Improved Neonatal
Outcomes.
We have the benefit of a growing support team, and we are determined to continue our efforts to
promote change – locally, nationally and internationally. We obviously need more than a good, well
researched clinic proposal – and we are looking at different options.
One of these could be an extensive media campaign, which would include raising our public profile.
This would inform the general public and ethical health practitioners about recent research findings
and the deleterious effects of some current practices - and indicate how action can be taken at
multiple points in the system to promote the creation of improved neonatal outcomes.
If you would like to be kept informed and to help facilitate the campaign among your own contacts
please let us know. Your ideas and testimonies of your experiences would also be very welcome.
Please -mail us - jill@kangaroomothercare.com
Do join with us to muster the forces of change!
Yours sincerely,
Nils and Jill Bergman
www.ninobirth.org
www.skintoskincontact.com
www.kangaroomothercare.com