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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

State-of-the-art physics equipment and investment in students result in academic success

2017-09-26

At the recent nanotechnology facility tour at the UFS,
were, from the left, Dr Mthuthuzeli Zamxaka, SAASTA;
Prof Hendrik Swart, Sarchi Chair in the Department of Physics;
and Xolani Makhoba, Department of Science and Technology.
Photo: Leonie Bolleurs

Nanoscience, which is revealing new properties of very small arrangements of atoms, called nanoparticles, is opening a new world of possibilities. The Department of Physics at the University of the Free State is undertaking fundamental research with potential commercial applications. Its equipment and expertise is giving solid state physics research the edge in South Africa.

The UFS team of researchers and students are passionate about studying planets and atoms, all under one roof. Recently, the department, in collaboration with the South African Agency for Science and Technology Advancement (SAASTA), hosted a nanotechnology facility tour to give the public, learners and the media the opportunity to familiarise themselves with the science of nanotechnology, its origins, potential applications and risks.

Successes of the department
According to Prof Hendrik Swart, Senior Professor in the Department of Physics, the increase in resources since 2008 is playing a big role in the success rate of its research outputs. The Sarchi Chair awarded to Prof Swart in 2012 (bringing with it funding for equipment and bursaries) also contributed to the successes in the department.

The UFS Directorate Research Development also availed funding that was used for bursaries. These bursaries made it possible for the department to appoint 10 post-doctoral fellows, not one of them originally from South Africa.

The investment in people and equipment resulted in researchers and students publishing some 80 articles in 2016. Their work was also cited more than 900 times by other researchers in that year.

Another highlight in terms of the department’s growth in the past 10 years is the new wing of the Physics Building. Physics at the UFS is the only place in sub-Saharan Africa where state-of-the art equipment is found under one roof.

Antonie Fourie, Junior Lecturer in the UFS Department of
Physics, explained to a group of delegates and
members of the media the workings of an electron beam
evaporation system.
Photo: Leonie Bolleurs

Application of research
The department is a unique research facility with equipment that includes the X-ray Photoelectron Spectrometer (for the study of atoms), the Scanning Auger Microscope, as well as the Ion Time-of-Flight Secondary Ion Mass Spectrometer (revealing the chemical bonds in a sample, and drawing maps of the positions of atoms).

One of the areas on which the department is focusing its research, is phosphors. Researchers are exploring light emitting diodes (LEDs) which use less energy, are brighter and provide a wider viewing field. They are also looking into LED displays (LCDs) which are used in flat screens – the phosphors create the different colours and backlighting.

The research on solar cells reveals that phosphors can increase their efficiency by increasing the range of light frequencies which can be converted into electricity. Glow-in-the-dark coatings absorb light in the day and emit it later so cells can charge at night. As glow-in-the-dark phosphors become cheaper and more effective, they can be used as a lighting substitute on the walls of houses, street numbers and stop signs.

Video production of the Department of Physics research and equipment

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