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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

Outstanding alumni celebrated at the Chancellor’s Distinguished Alumni Awards

2017-08-28

Description: Outstanding alumni celebrated at the Chancellor’s Distinguished Alumni Awards Tags: Outstanding alumni celebrated at the Chancellor’s Distinguished Alumni Awards

From the left: Former Miss World and UFS Medical student, Rolene Strauss; Rector and Vice-Chancellor,
Prof Francis Petersen; The Chancellor’s Distinguished Alumnus of the Year,
Vian Chinner; and Chancellor of the UFS, Dr Khotso Mokhele. Photo: Charl Devenish

Alumni Awards Photo Gallery

Alumni are the heart and soul of a university, a legacy that lives on for generations, bringing pride to the alma mater. Each year, the University of the Free State (UFS) through the Chancellor’s Distinguished Alumni Awards, celebrates its outstanding alumni, who have stood out among their peers, making waves in their careers, at home and abroad. The UFS Chancellor, Dr Khotso Mokhele, said the university plays a pivotal role in ensuring that students enjoy a life-long relationship with their alma mater. He encouraged the UFS management to create opportunities to engage students during their years of study, in order to create this mutually-beneficial relationship into the future.

The Chancellor’s Distinguished Alumnus of the Year Award, the highest honour accorded to an alumnus, recognises the distinguished national or international achievements of its recipient. The award was presented to Vian Chinner, chief executive officer at Xineoh, a performance marketing company he founded in 2014. The company, based in Bloemfontein, with offices in Cape Town, Oregon in the US, and Vancouver in Canada, specialises in applying mathematical modelling and machine learning to optimise conversion in industries including real estate, mortgage banking and e-commerce. It has generated more than $30 million in revenue for its clients.

The Young Alumnus of the Year Award acknowledges the achievements of alumni who graduated within the past decade and was presented to Leah Molatseli, founder and managing director of Lenoma Legal, who graduated with an LLB at UFS in 2010.

The Cum Laude Award is bestowed upon an alumnus in recognition of excellence in any field, whether vocational or voluntary. The awards in this category were presented to three alumni:

David Abbey, Acquisition and Leveraged Finance Deal Maker at Rand Merchant Bank. David graduated with a BCom Accounting (RU) 2007 and a BCom Hons Accounting (UFS) in 2008.

Johan Eksteen, Agricon Pelleting, graduated with an MSc in Sustainable Agriculture in 1998, and received an MBA in 2005, both at the UFS.

Zola Valashiya, Co-founder and director: Debate Afrika and Schools Projects and Campaigns Manager at Corruption Watch. He graduated with an LLB (UFS) in 2014, and Masters of Public Administration (Central European University, Hungary) in 2016. He is a Mandela Rhodes Scholar (2015) and a Young African Leadership Initiative Mandela Washington Fellow (2017) and is presently featured on the Mail & Guardian list of top 200 young South Africans.

The Executive Management Award: this service award is presented to an individual who has delivered exceptional service to the UFS and is not limited to alumni of the institution, current students and the community at large. The award was presented to Sarina Cronje, Head of Athletics at KovsieSport.

She graduated with a Bachelor of Science (UFS) in 1977 and a Postgraduate Diploma in Higher Education (UFS) in 1983. She is a mother and career woman, whose family carries the same passion and drive for sports that champions are made of.

The Kovsie Ambassador Award is bestowed upon a current student whose achievements have brought him/her distinction, benefited his/her community, and brought credit to the UFS.

Crystal-Donna Roberts graduated with a BA Drama and Theatre Arts (UFS) in 2005. She is an active television, theatre and film actress who has appeared in a multitude of theatre productions in addition to starring in Afrikaans soap opera “7de Laan, Getroud Met Rugby, Montana” and “Vallei van Sluiers” in which she won public favour. She is currently playing the lead role in the internationally acclaimed film, “Krotoa” which has won numerous awards including Best Film at the Harlem International Film Festival in New York. It also won the Award of Excellence at the International Film Festival for Women: Social Issues and Zero Discrimination, and many more.

Franco Smith, Director: Free State Rugby and Assistant Coach: Springboks. He graduated with a BA Human Movement Sciences (UFS) in 1996 and began his career in rugby in 1999 when he was selected for the Free State Under-18 Craven Week team. He became a regular on the Free State Under-20 and the UFS Shimlas teams prior to his Free State Cheetahs debut in 1992. Franco was reappointed backline coach of the Cheetahs and head coach of the Shimlas in 2015. With many accolades to his name an illustrious career in coaching and management over the years, the name Franco Smith should not be foreign to true rugby connoisseurs.

The Rector and Vice-Chancellor, Prof Francis Petersen, congratulated all the award recipients: “I applaud all alumni; you have made the city of Bloemfontein and the whole province proud.” The National Executive Alumni Chairperson, Dr Pieter du Toit, congratulated the award recipients and thanked the leadership of the university as well as the event organisers.

The awards signify the great esteem with which the UFS holds its alumni and the community that helps to drive its vision, cherish its history and pave the way for more outstanding Kovsies of the future.

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