When Millie Muthoni was planning for the birth of her first child, a doula was at the top of her list. She also enrolled for Lamaze classes with a midwife instructor.
Taking a crash course for Lamaze, she spent a discounted Sh5,000 for each of the two, three-hour sessions, as they were two couples in the class.
“I took on a doula because I did not feel like I could trust the doctors to take me through delivery without insisting on a Caesarian Section,” she says.
Her Doula who attended to her through the crucial hours of the birthing process charged her Sh10,000 for the service.
A doula is a trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during and just after birth; or who provides emotional and practical support during the postpartum period.
Ms Muthoni is one of the many middle class parents who are taking no chances, and not sparing a cent, in preparation for a smooth delivery of their babies.
On top of the Lamaze classes and birthing coach she spent a total of Sh140,000 at Nairobi Hospital and private clinics, two years-ago.
Similarly, Francisca Wambui was taking no chances with her first child. In her late twenties, birthing classes and a doula were a must for her.
“I weighed my options between a private doctor and a doula. A doula was more readily available,” she says. Her choice of doula like most women was the woman who took her through her birthing class.
New mothers are taking Lamaze classes and other forms of birthing classes to prepare them for their young ones. To add on the cost are the different packages private hospitals offer.
Lucy Muchiri, proprietor of Eve’s Mama, a midwife led service, has been offering home births, doula services as well as birthing classes.
Starting off her private business in 2009, the former nurse has seen a steady increase in the spending of the middle class families on maternal services.
In a month, she takes on five to six mothers-to-be classes, which are done on an individual or group basis interchangeably each month. The classes offer the parents’ insights of the birthing process and how to deal with the first month after delivery.
Like Ms Wambui, some mothers prefer to take the classes in the comfort of their homes for the added privacy and attention. These classes can cost from Sh8,000 onwards, with private and crash courses fetching a higher fee.
The demand for these services is because women in urban areas, especially the middle class, are living separated from their families, their mothers or aunties who traditionally took the role of caring for pregnant women are either busy or too far away, which results in the women paying for the classes, says Ms Muchiri.
“I had no family with medical background to be a point of reference during the birth of my daughter, so I sought out an alternative to prepare me and get me through the process,” explains Ms Muthoni.
Birthing classes cost between Sh7,000 and Sh20,000, price varying on whether they are group or individual whereas Lamaze costs from Sh8,000 upwards depending on who is offering the class.
A new trend emerging among the middle class and wealthy, driven by improved infrastructure and better healthcare is the option of home births.
Discarded in the 1960s as a practice for the poor or those in the village, homebirths lost popularity among women in urban areas as they opted for hospitals.
Times have changed and influence from the western world, and the internet offering a wide range of information some women are opting to stay home, surrounded by professional help.
When Ms Muchiri started offering a home birthing option, in 2009, the demand was not high – one every two or three months. Today, she delivers two home births every month.
“The growth is still slow because of fear of complications,” she says.
Going ahead the cost of birthing will only go up with private hospitals increasing their delivery fees. This year rates went up by an average of 10 per cent.
These hospitals include Guru Nanak, Aga Khan, Nairobi, Eldoret hospital and Avenue Healthcare is some of the private hospitals that raised fees for inpatient and outpatient services.
There is also the option of water births that some women are turning to. Aga Khan offers the option for Sh6,100 for the birth pool, and between Sh15,000 and Sh60,000 for either a private or hospital doula.
Water birth is the process whereby a mother chooses to labour and deliver her baby under a tub of warm water or she can decide to labour in the water and get out for a normal delivery under the watchful eye of several nurses.
The theory behind underwater birth is quite simple. Since the baby has been in the amniotic fluid for nine months, being born in similar environment becomes natural for the baby and less stressful for the mother.
The cost is determined by the package offered by the doula who can offer care before, during and after the birth or before or during or just after.
Not all hospitals have high charges for delivery, there are various options in the market to suit ones pockets including public hospitals where delivery is free as per a government directive.
Church based hospitals such as St Mary’s are also considered to be more affordable compared to other private ones such as Aga Khan, Karen and Nairobi Hospital.
These packages are usually determined by the type of delivery, whether it a natural birth or a c-section, and in the case of a natural birth whether it is by a midwife or by an obstetrician.
Aga Khan University Hospital’s antenatal package costs Sh22,000 and includes eight visits – an initial blood test, one scan and iron supplements.
For normal delivery, including a three day stay in a general ward bed, the rate is Sh99,000 while a caesarian section, with a four day stay, is Sh215,300.
According to hospital representatives, the packages offer financial predictability and flexibility as one can pay in installments between 28 weeks and 37 weeks or the full amount on admission.
Nairobi Hospital offers a maternity package for Sh95,000 from natural delivery. The rate is inclusive of six antenatal visits, a postnatal visit by the doctor, laboratory tests and one ultrasound, iron supplements, pre and post natal standard drugs and midwife charges.
The caesarean package includes the maternity package and the other additions which include the doctors’ fee, two post natal visits by the doctor, anesthetist fee, theatre fee and antibiotics among other things.
At Avenue Hospital, the charges are much lower with the normal delivery package, excluding obstetrician, midwife, and pediatrician and induction fee, costing Sh20, 000.
The normal delivery package with an obstetrician will coat Sh45,000 while a caesarean package costs between Sh125,000 and Sh135,000 depending on whether it is elective or an emergency case.
Natural birth at Mater Hospital, costs Sh60,000, after you have been assessed by the resident doctor to see if the package is suitable for you.
In addition to the general package, Karen Hospital offers a private room packages for Sh100,000 for a natural birth and Sh180,000 for a c-section.
During delivery, a doula and birthing partner are allowed to be present. During labour, the nurse to patient ratio is one to one while postnatal care is one is to three.
Natural delivery by a doctor rather than a midwife will usually increase the rate by anywhere between Sh10,000 and Sh30,000 depending on the hospital.
At Nairobi Women’s Hospital, a delivery with an obstetrician will cost an additional Sh24,000. Other costs that are usually not included in the packages are induction, vacuum delivery, medicines and supplements other than iron, extra visits by the doctor, other specialist care, and incubator care among other costs.
However, even with the packages, there are some elective courses of action requested by patients that are not catered for in the special rate.
Kenyan women are also using epidural anesthesia during childbirth an option that numbs away the pain during labour. The injection is offered in private hospitals including Aga Khan Hospital and Nairobi Hospital, on request, for about Sh40,000.
“The middle class look at the hospital they visit as a statement, with some very keen on what society has to say about where they had their baby,” explains Muchiri.
The medical care offered at public and private hospitals is more or less the same, however the comforts accorded at private hospitals hold more allure for the patients.
The nurse to patient ratio for these hospitals also holds appeal for prospective mothers.
Edina Mullumba says at AKUH, the nurse to patient ratio in labor ward is one to one in active labor, one to six in postnatal, one to four in room nursing.
For those not wishing to stay in the general wards, which usually sleep four people, these hospitals offer private and executive rooms, some complete with a lounge for visitors and kitchenettes. These rooms do however come at an additional cost.
A standard room at the Princess Zahra Pavilion, the executive wing at the Aga Khan, you will spend Sh29,000, while an executive room in the same will cost Sh42,000.
An executive room at Karen hospital will cost you between Sh26,300 and Sh29,350 a day depending on whether it is deluxe or not.
The Nairobi Hospital charges are at Sh19,000 a day in the South Wing which is the executive wing and Sh27,100 in the North wing, which is the VIP section.
Technology has seen the introduction of 3D scans which cost more than a normal one. These allow expectant parent see all the features.
In addition, to the hospital cost the middle class family is quick to invest in all kinds of gear, furniture and safety equipment. These range from trendy car seats to prams, safety equipment, bed mobiles and baby monitors.