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Why midwifery should be in the hands of trained midwives

20 December 2021 | Story Elsabé Brits

Dr Elgonda Bekker, from the University of the Free State (UFS), completed her doctoral degree in nursing in 2020, with a practical, transformative thesis to improve the education of midwives in the country.

Midwives who are properly trained and acknowledged for their skill and experience do not only save lives but make a huge contribution to maternal health in South Africa. However, there is a dire need for professional midwives and competent educators.

Dr Elgonda Bekker, from the University of the Free State (UFS), completed her doctoral degree in nursing in 2020, with the title: Competencies of South African midwifery educators: a transformative framework. It is a practical, transformative thesis to improve the education of midwives in the country. Sadly, just months after she received her degree she passed away. Yet, her colleagues at the School of Nursing at the UFS continue to build on the foundation she laid.

Too much too soon, too little too late

The World Health Organisation (WHO) states that 10-15% of births may need intervention through caesarean section. A recent analysis, however, found that private hospitals had a caesarean section rate of 73.6%, compared to 26% in the public sector.

Although the public sector rate is higher than the WHO target, the private sector rate is not justifiable, Bekker writes. The case fatality rate for mothers who died after a caesarean section had been performed showed an increase. That is one of the statements indicating that not all medical interventions are of benefit to mothers.

A focus on too much too soon or too little too late in the Lancet series on midwifery of 2014 indicated the need for better-quality care. In South Africa both manifest because of the disparity between private and public healthcare. According to Bekker’s research, the high caesarean section rate in the private sector is a classic example of over-medicalisation of obstetric care, whereas the public healthcare system follows a midwifery-led model of care.

“Midwives are a vital solution to correct this disparity. Competent midwives, educated to standards, can prevent interventions without indication, provide service in rural settings and advocate for the rights of the childbearing family,” she wrote.

Midwifery is a disempowered profession

Winnie Moroa Motlolometsi, a midwifery educator, explains that professional nurses in the country have a dual registration with the South African Nursing Council as a nurse-midwife. This leads to many qualified midwives not necessarily practising as midwives. It is therefore very difficult to calculate the number of practising midwives.

Furthermore, the conflation of nursing and midwifery requires training as a generalist practitioner. Depending on the institution where they are trained, professional nurses may or may not comply with the International Confederation of Midwives’ Global Standards for education and regulation of the midwifery profession.

Nevertheless, according to Dr Bekker’s research, midwifery is a disempowered profession, because the global guiding documents are neither considered by the regulatory authority nor the National Department of Health. There is a triple gap for competencies, coverage, and access:

Insufficient numbers of competent midwives
.. who can cover maternal health services

…who render services that address the needs of women

There is a dire need for competent midwives in the country, but the predicament is that whilst midwifery educators are qualified, they are not necessarily clinical specialists, which ultimately jeopardises the quality of maternal healthcare.

What was also clear from Bekker’s research is that although South Africa has a progressive constitution, gender equality has not materialised on grassroots level. Violence is ever present. Women are viewed as weaker, vulnerable, and less suited for the workplace. Nonconformity to sexual gender norms, based on cultural or religious bias, creates conflict for some women.

Dr Deidre van Jaarsveldt, senior lecturer in the School of Nursing at the UFS, said Bekker’s study highlighted that feminism is a strengthening agency for women. In this study it was important to frame the context of midwifery as a disempowered, woman-led profession, caring for women who are still finding themselves in a society where there is gender inequality.

The research indicated that there were many challenges:

Lack of autonomy for midwives
Non-compliance with the global midwifery standards
Conflation of nursing and midwifery
Midwifery regulated by non-midwives
Lack of direct entry into midwifery education in the country

High litigation in maternal and child healthcare – there is fearfulness among practitioners and reluctance to work within the midwifery profession

In practice it is difficult to distinguish midwifery specialists from nurses who are practising as generalists and are expected to offer maternal healthcare services. If something goes wrong, the midwifery profession is held accountable, but practising midwives were not necessarily involved.

Reproductive, Maternal, Newborn and Child Health Hub

There is a dire need for midwifery to become an autonomous profession guided by global standards. Membership should be based on advanced qualifications, which strengthen midwifery as a speciality. This can only be attained through education and maintained by a regulatory body, as well as the de-conflation of midwifery from nursing. When this happens, midwives will know who the actual midwives are and be able to hold one another accountable, Motlolometsi adds.

Dr Bekker advocated for the “decolonising” of midwifery, which means restoring the knowledge to the profession. To allow midwives to receive quality education, midwifery should become an independent profession that is guided by global standards and regulated by midwives.

Van Jaarsveldt says the School of Nursing at the UFS endeavours to offer quality midwifery education. Students learn in a high-tech simulated learning environment where they can become competent before working with actual mothers and babies. The educators are clinical experts, supported by a team of midwifery practitioners who act as preceptors for the students.

Before her untimely death, Dr Bekker started establishing a Reproductive, Maternal, Newborn and Child Health Hub in the Faculty of Health Sciences, which is continuing under the leadership of Dr Cynthia Spies, supported by a team of interprofessional experts.

“Through research and continuous improvement of education and practice, this group of professionals envisions optimising and strengthening reproductive, maternal, newborn, and child health competencies so that current maternal and child morbidity and mortality trends can improve resulting in surviving and thriving childrearing families.

“The goal is to develop partnerships and opportunities for collaboration and research with colleagues in healthcare disciplines and to extend beyond healthcare to include innovative interdisciplinary partnerships,” says Spies. The objectives include:

Practice development with implementation of evidence-based practice and positive experience of the childbirth and child health continuum;
Clinical competency development through training and the development of short learning programmes;
Clinical research that addresses the current reproductive, maternal, neonatal and child health mortality, morbidity and health issues in central South Africa.

News Archive

UFS researchers receive awards from the NSTF

2008-06-04

The recipients of the two awards are, from the left: Prof. Jan van der Westhuizen, UFS Department of Chemistry, Dr Susan Bonnet, UFS Department of Chemistry, Prof. Thinus van der Merwe, FARMOVS-PAREXEL, Prof. Maryke Labuschagne, UFS Department of Plant Sciences, and Prof. Ken Swart, FARMOVS-PAREXEL.
Photo: Lacea Loader

UFS researchers receive awards from the NSTF

The University of the Free State (UFS) last week received two prestigious awards from the National Science and Technology Forum (NSTF) during its tenth gala-awards ceremony held in Kempton Park.

Prof. Maryke Labuschagne from the Department of Plant Sciences at the UFS was the female recipient of the research capacity-development award over the last ten years. She received the award for her successful mentoring of black researchers and students. The award, sponsored by Eskom, includes a prize of R100 000 which will be used for research purposes.

A team consisting of Prof. Jan van der Westhuizen and Dr Susan Bonnet from the Department of Chemistry at the UFS and Prof. Kenneth Swart and Prof. Thinus van der Merwe from FARMOVS–PAREXEL received the innovation award for an outstanding contribution to science, engineering and technology from either an individual or a team over the last ten years.

Prof. Labuschagne, an expert in the field of plant breeding and food security in Africa, received the award for her contribution to the training and development of black students and researchers in this field. Various black students successfully completed their postgraduate studies under her guidance at the UFS during the past ten years, with positive results.

Research by her South African students has led to a firmly entrenched research relationship between the Agricultural Research Council (ARC) and the UFS, while research by her local and international students has culminated in no less than 82 publications over the last decade.

It has also led to the establishment of collaboration agreements with universities and research institutes in Malawi, Kenya, Uganda and Tanzania – among others with the University of Malawi where Prof. Labuschagne and her students are involved in the International Programme in the Chemical Sciences (IPICS) of the Uppsala University in Sweden. The project focuses on the study of genetics and chemistry of tropical roots and tuber crops in Malawi. This has led to collaboration with international research organisations and has generated overseas funding.

The combined team from FARMOVS–PAREXEL and the UFS won an award for the synthesis of drug analogues used as reference products during the analysis of the drug concentration in blood, from existing and new drugs registered nationally and internationally.

The project resulted in capacity building in synthetic organic chemistry, mass spectrometry and chromatography: Five master’s degrees were completed, seven are in progress, and six postgraduate students commenced with Ph.D.’s.

The skills transferred during this project are already being applied to examine the properties of indigenous medicinal plants as part of the recently established UFS novel drugs and bioactive compound cluster.

Applied Biosystems, the Canadian manufacturer of mass spectrometers, donated equipment to the value of more than R10 million for this project. As a result the UFS is one of the few universities in the world that can offer postgraduate training in bioanalytical chemistry.

Prof. Hendrik Swart, head of the Department of Physics at the UFS, and Dr Martin Ntwaeaborwa, senior lecturer at the Department of Physics were finalist in the research- capacity developer and black-researcher categories respectively.
The NSTF awards gives recognition to the outstanding contributions of individuals and groups to science, engineering and technology. This includes all practising scientists, engineers and technologists across the system of innovation, including, for example, teachers and students in mathematics, science and technology. The NSTF represents government, science councils, professional bodies, higher education, business and civil society.

Altogether nine individuals and three organisations were presented with the NSTF Awards trophy by the Minister of Science and Technology, Mr Mosibudi Mangena.

Media Release
Issued by: Lacea Loader
Assistant Director: Media Liaison
Tel: 051 401 2584
Cell: 083 645 2454
E-mail: loaderl.stg@ufs.ac.za
4 June 2008

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