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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

Number of PhD graduates a record for School of Accountancy

2017-06-27

Description: School of Accountancy PhDs Tags: School of Accountancy PhDs

From left to right: Dr Stiaan Lamprecht,
Dr Cornelie Crous, Prof Hentie van Wyk
(Programme Director: School of Accountancy),
Prof Francis Pietersen (Rector and Vice-Chancellor),
Prof Dave Lubbe (Research Fellow: School of Accountancy),
Dr Léandi Steenkamp and Dr Louis Smidt.
Photo: Charl Devenish

This year’s mid-year graduation ceremony for master’s and doctoral degrees saw the School of Accountancy honouring four alumni with PhDs in Accounting on 26 June 2017 at the Callie Human – a record for the School of Accountancy.

Professor Hentie van Wyk, Programme Director of the School of Accountancy and promoter of one of the doctoral degrees, says, “Over the past three to four decades before 2017, no more than five doctoral degrees were awarded by the School of Accountancy.”

Dr Cornelie Crous, Dr Léandi Steenkamp, and Dr Louis Smidt received their doctoral degrees with specialisation in Auditing, and Dr Stiaan Lamprecht with specialisation in Accounting.

PhD candidates’ thesis and personal profiles
Dr Crous, who was born in Bloemfontein on 30 June 1979, is currently working in the School of Accountancy as a Senior Lecturer in Auditing. Her thesis, which is titled ‘Corporate Governance in South African Higher Education Institutions’, influences the application of corporate governance principles in higher-education institutions. It provides a thorough breakdown of the application and disclosure of the application of corporate governance principles in terms of both South African and international best practices in publicly-funded universities in the country.

Dr Lamprecht’s thesis, ‘A Financial Reporting Framework for South African Listed Companies under Business Rescue’, contributes innovative knowledge and insights to the existing body of knowledge on financial reporting. According to his study, with reference to a listed company under business rescue, there is a need for an underlying financial reporting assumption that varies from the recognised going concern and liquidation assumptions. Users of the financial statements of such a company also require an accounting measurement model based on current values, as opposed to the mixed-measurements accounting model employed at present.

Dr Smidt completed both his master’s and PhD degrees at the UFS. This father of two sons is currently a lecturer at the Tshwane University of Technology. His thesis, ‘A Maturity Level Assessment on the use of Generalised Audit Software by Internal Audit Functions in the South African Banking Industry’, has already started to contribute to the internal audit profession in South Africa and globally. Due to its existing extension to internal audit functions in various industries in Canada, Columbia, Portugal, and Australia, the value has been enhanced, as it now provides an internationally correlated set of results.

Dr Steenkamp, who completed her Magister in Auditing with a distinction at the UFS in 2013, is a qualified Chartered Accountant (CA (SA)), Certified Internal Auditor (CIA), Certified Information Systems Auditor (CISA), Professional Accountant (SA), and member of all the professional bodies. Her thesis, ‘The Sectional Title Industry in South Africa: Enhancing Accounting and Auditing Practices’, makes a significant impact on the sectional title industry and the accounting profession in South Africa. The literature review gave an in-depth overview of risks associated with sectional title for various stakeholders (i.e. owners, trustees, managing agents, auditors and accountants, and EAAB-appointed inspectors).

“Indeed a special day for the School of Accountancy!” says an ecstatic Prof Van Wyk. Professor Dave Lubbe, Research Fellow in the School of Accountancy, was the promoter for three of the four doctoral degrees.

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