Hospital Histories: The many lives that began at Mowbray Maternity

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 clenched 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.

New mom Yolanda (left) with her mother and her newborn Lunathi Sitembile. (Photo: Nasief Manie / Spotlight)

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 that had slipped off.

Dr Natasha Rhoda is a neonatologist at Mowbray Maternity. (Photo: Nasief Manie / Spotlight)

Dr Natasha Rhoda attends to a small patient. (Photo: Nasief Manie / Spotlight)

An adjoining ward houses the hospital’s neonatal intensive care unit, 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 intensive care unit,  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.

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. (Photo: Nasief Manie / Spotlight)

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 the neonatal intensive care unit 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 newborns die within the first seven days of life, says Joemat. 

Discussing miscarriages and neonatal deaths, her voice softens as she elaborates on the devastating impact on families. Tragic outcomes are not entirely unexpected. She points out that they are, after all, a referral hospital dealing mostly with complicated pregnancies.

Some mothers at the hospital are referred due to health conditions including hypertension, tuberculosis or HIV/Aids. The referrals come from midwife obstetric units in False Bay, Gugulethu, Hanover Park, Mitchells 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 breast milk supply, temperature regulation and stimulation of breathing and growth, says Sister Zeenat Dalwai, who heads the hospital’s KMC ward.

Mowbray Maternity is a big proponent of KMC [Kangaroo Mother Care], which entails continuous skin-to-skin contact between mums and newborns. (Photo: Nasief Manie / Spotlight)

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, posters advertising World Prematurity Day – 17 November – show mothers in elaborate gowns holding their “preemies” in what had been a special photoshoot to mark the day last year.

Upstairs, Joemat’s office is decorated with crayon drawings by her own two daughters, aged four and seven.

For our interview, Joemat had gathered photographs and topical newspaper clippings. 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 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.

CEO of Mowbray Maternity, Janine Joemat. (Photo: Nasief Manie / Spotlight)

She relays how, each month, they have about 12 women who give birth to babies who died 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…”

The causes of these deaths are not always clear.

“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 farmland, earmarked by Jan Van Riebeeck in 1657.

Newspaper cut-outs capturing some development at Mowbray Maternity. (Photo: Nasief Manie / Spotlight)

Mowbray Maternity was originally housed in a 1916 Victorian homestead known as the Wheatfields Nursing Home. The new building was completed in 1967. (Photo: Nasief Manie / Spotlight)

During apartheid, admissions to Mowbray Maternity were mostly white patients, while Peninsula Maternity Hospital, formerly in District Six, admitted patients of all backgrounds. (Photo: Nasief Manie / Spotlight)

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 structure was completed in 1967.

During apartheid, admissions were mostly white patients, while Peninsula Maternity Hospital, formerly in District Six, admitted patients of all races.

In 1974, Mowbray Maternity made international headlines with the birth of the Rosenkowitz sextuplets, the first known surviving sextuplets in the world. 

In 1974, Mowbray Maternity made international headlines with the birth of the Rosenkowitz sextuplets, the first known surviving sextuplets in the world. (Photo: Nasief Manie / Spotlight)

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 – across the Rondebosch Common – is the renowned Red Cross War Memorial Children’s Hospital, where young patients are treated from the age of two.

When Covid struck

While Joemat wasn’t at the hospital for most of this history, she was there when Covid 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. 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, rules were slightly bent at the time. 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.

“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 before 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. 

Inside Mowbray Maternity Hospital. (Photo: Nasief Manie / Spotlight)

“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, there were complicated logistics of infected staff having to be quarantined – “halfway through April [2019] we ended up having to send 50 staff members home on quarantine” – and stacks of travel permits having to be signed, including for mothers travelling to the hospital to bring breast milk 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. DM

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.

This article was published by Spotlight – health journalism in the public interest.