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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

Graduates encouraged to use their knowledge to the benefit of SA

2017-06-28

Description: Graduation read more photo 27 June 2017 Tags: Graduation read more photo 27 June 2017

On 26 June 2017, the last day of its mid-year graduation
ceremonies, the University of the Free State conferred
388 master’s and 72 doctoral degrees.
Photo: Charl Devenish

You have the knowledge, which is a big resource, and should use it to the benefit of South Africa. This was the overwhelming message to graduates obtaining their master’s and doctoral degrees at the University of the Free State (UFS).

Their responsibility was emphasised by the likes of Justice Mahube Molemela during the ceremonies in the Callie Human Centre at the Bloemfontein Campus on 26 June 2017. Justice Molemela, Judge President of the Free State Division of the High Court and Acting Justice of the Supreme Court of South Africa, was the guest speaker at the morning and afternoon ceremonies.

The UFS conferred 388 master’s and 72 doctoral degrees on the final day of its mid-year graduation ceremonies, which was the biggest set of ceremonies in the university’s history. The doctorates came from the Faculty of Natural and Agricultural Sciences (30), Faculty of the Humanities (15), Faculty of Economic and Management Sciences (9), Faculty of Education (8), Faculty of Health Sciences (5), and Faculty of Theology (5). A total of 5 258 degrees were conferred over six days from 19 to 26 June 2017.

Future dependant on youth
Justice Molemela said the master’s and doctoral graduates have the skills to make a difference. “The future of a nation is largely dependent on its youth playing a meaningful role in creating a strong economy, culminating in a good standard of living for everyone.”

She said they should plough back into their communities and give opportunities to others. “I am certain that if each one of you thinks innovatively in your respective fields, you will find solutions which will eradicate poverty, improve service delivery, and hence our education will advance gender equity, and promote public participation.”

Dr Khotso Mokhele, UFS Chancellor, said these graduates have every reason to hold their heads high, their shoulders square, and walk with a bit of an attitude, as they have distinguished themselves.

Generation of new knowledge
According to Prof Francis Petersen, Rector and Vice-Chancellor, the UFS strives to be a university that is research led. “For me, one of the important aspects about universities which set them apart from other training and vocational institutions is the generation of new knowledge,” he said at a lunch function for PhD graduates on 26 June 2017. He feels it is critically important for them to make a contribution to the country.

Dipiloane Phutsisi, Principal and Chief Executive Officer of the Motheo TVET College in the Free State, also emphasised this. Phutsisi was the guest speaker on 23 June 2017. “Your courage and eagerness to face the future and tell the truth in the midst of this confusion, is highly desired by South Africans.”

Justice Ian van der Merwe, Judge of Appeal at the Supreme Court of Appeal and former Chair of the UFS Council, was the guest speaker at the ceremonies on 22 June 2017. He encouraged graduates from a chapter in the book War and Peace by Leo Tolstoy.

“There is no greatness where there is not simplicity, goodness, and truth (according to Tolstoy). Or maybe more modernly translated: There is no greatness where simplicity, goodness, and truth are absent.”

Click here to see a list of Deans’ and Senate medals awarded.

Graduations ceremonies:

19 June 2017:

Faculty of Education, except educational qualifications in Open and Distance Learning – South Campus
Faculty of Health Sciences, Faculty of Theology, and Faculty of Law (including the School of Financial Planning Law)

“Every one of us, is destined for greatness. In the words of Dr Martin Luther King: Everyone has the power for greatness, not for fame but greatness, because greatness is determined by service.” – Dipiloane Phutsisi (Guest speaker and Principal and Chief Executive Officer of the Motheo TVET College in the Free State)

Photo Gallery
Livestream Footage (morning session)
Livestream Footage (afternoon session)

Photo: Charl Devenish

20 June 2017:

Faculty of Natural and Agricultural Sciences: All Bachelor’s degrees
Faculty of Natural and Agricultural Sciences: All Diplomas and Bachelor Honours degrees

“Graduation marks a start of a new and wonderful journey. During the last couple of years you have not only developed your intellect, but also expanded what I call your social self,” - Prof Francis Petersen, Rector and Vice-Chancellor

Speech: Prof Francis Petersen (morning)
Speech: Prof Francis Petersen (afternoon)
Photo Gallery
Livestream Footage (morning session)
Livestream Footage (afternoon session)

Photo: Charl Devenish

21 June 2017:

Faculty of Economic and Management Sciences: All certificates, diplomas, Bachelor’s degrees, and Bachelor Honours degrees, excluding BCom degrees
Faculty of the Humanities: Social Sciences and Communication Sciences only

“Graduation is one of the most accomplished achievements one can ever experience.” – Justice Connie Mocumie (Guest speaker and Judge of Appeal at the Supreme Court of Appeal)

Photo Gallery
Livestream Footage (morning session)
Livestream Footage (afternoon session)

Photo: Charl Devenish

22 June 2017:

Faculty of Economic and Management Sciences: BCom degrees only
Faculty of the Humanities: All qualifications, except Social Sciences and Communication Sciences

“The question is not if you will make mistakes, but how do you deal with your mistakes? Do you admit them, do you learn from them, and do you grow as a person?” – Justice Ian van der Merwe (Guest speaker and Judge of Appeal at the Supreme Court of Appeal)

Photo Gallery
Livestream Footage (morning session)
Livestream Footage (afternoon session)

Photo: Johan Roux

23 June 2017:

Educational qualifications in Open and Distance Learning – South Campus

“Class of 2017, go and make your own unique contributions but remember to look into your own heart. South Africa needs your skills, your innovation, knowledge, your expertise and creativity.” – Dipiloane Phutsisi (Guest speaker and Principal and Chief Executive Officer of the Motheo TVET College in the Free State)

Photo Gallery
Livestream Footage (afternoon session)

Photo: Charl Devenish

26 June 2017:

All faculties: master’s and doctoral degrees

“Class of 2016/2017 graduates: You are critical thinkers, you can analyze, you can think independently. That is why you managed to successfully complete postgraduate degrees and diplomas.” – Justice Mahube Molemela (Judge President of the Free State Division of the High Court and Acting Justice of the Supreme Court of South Africa)

Photo Gallery
Livestream Footage (morning session)
Livestream Footage (afternoon session)

Photo: Charl Devenish

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