Weighing little more than three bricks of butter, baby Lunathi Sitembile is pressed against mum Yolanda's bare chest, a thin tube entering her nostril and another taped to her tiny clutched fist. Born premature at 31 weeks (between 37 and 42 weeks are 'full term') Lunathi initially struggled to breathe, but after a week inside an incubator with oxygen airflow administered through a nasal cannula, her little lungs have strengthened.
Wrapped in a grey robe, Yolanda's relaxed features belie the rigours of being a new mother. She says Lunathi has taken to breastfeeding well. Grandma Christina looks on, nodding.
We're inside a high care ward at Mowbray Maternity Hospital where the sound of shrill beeps - heart, temperature, and oxygen monitors - cut through the dim light. Beside us a nurse pauses next to an incubator, a hand gently reaching past the transparent box-like structure to readjust a baby's knitted cap which had slipped off.
An adjoining ward houses the hospital's neonatal intensive care unit [NICU], where critically ill and underweight babies are treated. Visible behind a glass window, neonatologist Dr Natasha Rhoda and student doctors are huddled around a small patient dwarfed by blinking equipment.
"In the NICU, it's hour by hour, not day by day. Every small victory counts," says the hospital's CEO Janine Joemat, who is guiding Spotlight around the premises.
Inside an angular face brick building overlooking the railway line near Mowbray train station, Mowbray Maternity is South Africa's largest dedicated maternity hospital with 73 neonatal beds - including six in NICU and 16 for lodger mums - and 132 obstetric beds, including a stillbirth delivery room.
Under the watch of 45 doctors and 227 nurses around 900 babies are born here each month; about half of which are natural births. Additional staff include pharmacists, social workers, physiotherapists, dieticians, and radiography specialists.
Out of the almost thousand births at the facility, between two and eight newborn babies pass away within the first seven days of life, says Joemat. Discussing miscarriages and neonatal deaths, her voice softens as she imparts the devastating impact on families. However, this is a good outcome, she says, as they are a referral hospital dealing mostly in complicated pregnancies.
Some mothers at the hospital hail from the local drainage area while others are referred due to other health conditions including hypertension, Tuberculosis (TB), or HIV/AIDS, from Midwife Obstetric Units [MOUs] in False Bay, Guguletu, Hanover Park, Mitchell's Plain, and Retreat.
Kangaroo Mother Care
Mowbray Maternity is a big proponent of KMC [Kangaroo Mother Care], which entails continuous skin-to-skin contact between mums and newborns, with benefits including bonding, increased breastmilk supply, temperature regulation and stimulation of breathing and growth, says Sister Zeenat Dalwai, who heads the hospital's KMC ward.
Presently, Yolanda is accommodated at the KMC ward which provides her with easy access to Lunathi, a short walk away. Here, against a corridor wall, placards advocate for World Prematurity Day - November 17 - showing mothers in elaborate gowns holding their "preemies" in what had been a special photoshoot to mark the day last year.
Upstairs, Joemat's office bears crayon drawings by her own two daughters, aged four and seven years old.
For our interview, Joemat had gathered photographs and topical newspaper cut-outs. One photograph shows Joemat beside Western Cape Health MEC Nomafrench Mbombo and former Premier Helen Zille at the hospital's centenary celebration in 2016.
At the centenary event, an emotional Zille visited the hospital bed where she gave birth to her first son, Paul. In a speech at the time, she praised the hospital's nursing staff, saying they helped her through trauma and post-partum depression.
Zille details giving birth at Mowbray Maternity in her 2016 autobiography Not Without a Fight: The Autobiography. "We had a perfectly healthy little boy, but it came close to turning out differently," she writes. "Without going into all the details, after 14 hours of heavy labour and minimal dilation, the medical team overruled my determination to have a natural birth. 'This is the twentieth century, you know,' the labour ward sister said archly, as the epidural was administered..."
At a small boardroom table, Joemat speaks openly about the hospital she has steered for the past nine years.
She relays how, each month, they have about twelve mums who give birth to babies who passed away in the womb.
"And so these mums come in knowing that their baby's got no heartbeat, and it's a very different delivery because you have this very heavy sadness," she says.
"We allow the family into the delivery room, the mum can have anybody there that she wants. And then also for these mums, we give a little keepsake. They get a little quilt to mark the pregnancy. There was also this project where people would take old wedding gowns and make these little white dresses; so they'd put it on these babies for photographs. Often they just look like they're sleeping. I mean, it's still your baby, even if you're not leaving with that baby, and you do want a memory..."
Sometimes the causes of these demises are unclear. "Sometimes it's an infection or sometimes the mom has had a bleed... Sometimes we just don't know. Science cannot tell us why," says Joemat. "One of the things we try to do is send the placenta away for analysis in the labs. So we try to give the mom a reason because the not-knowing is so hard."
Aside from the Western Cape Health Department's Patient-Centred Maternity Care Code, Joemat says their standard is simply whether an outcome is acceptable for themselves.
"I'm a mom," she says, "and most of our team are mothers. And so our standard is this: Would we accept this for ourselves? Would this be good enough?"
A long history
The five-storey maternity hospital sits on a swathe of Cape Town's earliest contested colonial farm land, earmarked by Jan Van Riebeeck in 1657.
Originally housed in a 1916 Victorian homestead known as the Wheatfields Nursing Home, the Government of the Union of South Africa bought the facility for £35 000 in 1948, renaming it Mowbray Maternity Hospital. The Victorian homestead was demolished and the present modernist structure was completed in 1967.
During apartheid segregation, admissions were mostly white patients, while Peninsula Maternity Hospital, formerly in District Six, admitted patients of all backgrounds.
In 1974, Mowbray Maternity made international headlines with the birth of the Rosenkowitz sextuplets, the first known surviving sextuplets in the world. By 1985, the hospital offered private and public care to both "white and coloured" patients; and in 1992 Mowbray Maternity and Peninsula Maternity Hospital amalgamated at the Mowbray facility, since then without private services.
Two kilometres away from the maternity hospital - across the Rondebosch Common - is the renowned Red Cross War Memorial Children's Hospital, where young patients are treated from two years and older.
When COVID-19 struck
While Joemat wasn't at the hospital for most of this history, she was there when COVID-19 struck in 2020. Measures taken in this time, she says, were tough. "We couldn't have birth partners in the hospital because of the social distancing. And it was traumatic for us as management and for our staff to implement. Because our philosophy around birth practices and respectful care is that every woman has a right to a birth companion of her choice. In our setting, we normally allow two birth companions. And then COVID came around and we couldn't."
Leaning toward compassion, at the time rules were slightly bent. The hospital would come to allow fathers to enter the hospital to say goodbye to severely ill babies. They also allowed teenage mothers a birth companion.
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"Normally if a baby deteriorates and we see the baby isn't responding to care, we will start preparing the family for that loss. We will start counselling the family. This is the current condition of your baby, this is what we have provided so far, your baby isn't responding, and so on. In those circumstances prior to COVID, we would allow the granny and the grandpa or a sibling to come in, to spend time with the baby in our family room. And you know, they take a little footprint of the baby, a keepsake. We also give them a little quilt. Little keepsakes that make the pregnancy tangible. So during COVID, one of the things we said when we knew a baby was probably going to demise; we would then allow the dad in. Because that was a complaint that we received - from a father who had lost a baby, and he hadn't actually seen the baby."
She recalls staff traumatised by losses in their own families and having to remain empathetic and caring to patients. Also, the logistics of infected staff having to be quarantined - "halfway through April [2019] we ended up having to send fifty staff members home on quarantine" - and stacks of travel permits having to be signed, including for mothers traveling to the hospital to bring breastmilk for their premature babies on long-term treatment.
Walking around the hospital premises, Joemat greets each staff member and patient; all the while dispelling a string of anecdotes and facts. While lamenting infrastructure shortcomings - torn laminated floors and peeling paint - she points out the hospital's "phenomenal results" despite limited resources. For this, she is quick to credit her team. And indeed, around us, as surely was the case half a century ago, there is a quiet buzz of activity as healthcare workers do their best for the mothers and babies in their care.
*This article is part of a Spotlight special series on the history and ongoing relevance of several old hospitals in South Africa. Not only do we find the stories of these places fascinating, we think they provide valuable cultural and historical context for healthcare services today.
