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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

Community of Qwaqwa gives Prof Petersen a warm Basotho welcome

2017-05-16

Description: Prof Petersen with Basotho hat and blanket Tags: Prof Petersen with Basotho hat and blanket

Prof Francis Petersen, Vice-Chancellor and Rector of the University of the Free State
Photo: Ian van Straaten

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Video

Various stakeholders pledged their support to the newly-appointed Vice-Chancellor and Rector of the University of the Free State (UFS), Prof Francis Petersen, during the first in a series of welcoming events that was held at the Qwaqwa Campus on Thursday 11 May 2017.

A message of support and welcome from the Paramount Queen of the Bakoena Royal Council, Mofumahadi Mathokoana Mopeli, took everybody in attendance back three decades to the time when the campus was first established.

“The Qwaqwa Campus of the then University of the North was created to swell this area and the broader Eastern Free State with intellectual capacity,” she said.

“It is with this in mind that we encourage you, Prof Petersen, to continue upholding the best of your predecessors. Search for what they could not achieve and learn from that. Traditional leadership in this area will always be a friend to the university,” she added.

Prof Petersen received a warm Basotho
welcome from Morena Thokoana Mopeli and
Paramount Queen Mofumahadi Mathokoana Mopeli of
the Bakoena Royal Council. With them is
Mrs Cheslyn Petersen.
Photo: Thabo Kessah

The Thabo Mofutsanyana Education District was represented by the Acting District Director, Lindiwe Mabaso, who expressed the district’s pride in being associated with the university.

“Our district is excelling in Mathematics and Science, and this can be attributed to the educators that we get from the Qwaqwa Campus. We are proud to say that we are number one nationally when it comes to Mathematics and Science, and this is through the support we get from the campus. Our schools will continue to be centres of excellence under the new leadership of Prof Petersen,” she said.

Staff and students weigh in

Both Nehawu and Uvpersu expressed their optimism in working with Prof Petersen.

Branch chairperson of Nehawu, Teboho Pitso, said the union appreciated the fact that Prof Petersen was taking over the leadership of the institution at a very difficult time, both institutionally and nationally.

“As workers, we are faced with a lot of challenges and we hope that none of us will be retrenched under your leadership,” he said to an appreciative audience consisting of various internal and external stakeholders.

Acting Chairperson of UVPERSU, Khethiwe Biyo, said the workers’ union was happy that Prof Petersen believed in teamwork.

“Your commitment in working with us is appreciated. We look forward to learning from you about institutional innovation,” she said.

Students were represented by the Qwaqwa Campus SRC President, Njabulo Mwali, who expressed the need for a deeper and detailed transformation process.

“Your expertise and skills have set you above all other aspirant applicants for this position, and we hope that we will learn a lot on this journey,” he said.

“We at the UFS are actively, intentionally,
and continuously engaged in promoting
diversity.”

"Ensure fairness"

In his response, Prof Petersen emphasised the importance of inclusivity and innovativeness. He said, “Staff and students at the three sites of learning must do all they can to ensure that the UFS realises its goal of being an inclusive institution, one that provides equal access and opportunities to everyone, makes a conscious effort to prevent discrimination, and ensure fairness.”

“Being committed to inclusivity means that we at the UFS are actively, intentionally, and continuously engaged in promoting diversity. This diversity is expressed through our people and through the curriculum, and in the way we work with our communities to promote awareness, empathy, and understanding of the complex ways individuals interact. As you know, our ultimate goal as a university is not only to educate young people up to the point that they graduate. What they learn during their time with us should help shape them into people who can think innovatively in order to address the challenges that face us in the 21st century,” he said.

The Qwaqwa Campus Chorale and the award-winning choir from The Beacon Secondary School in Phuthaditjhaba provided the entertainment.

Similar events will respectively be hosted on the South and Bloemfontein Campuses on 18 and 19 May 2017.

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