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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 our campuses

2017-10-30

STATEMENT OF THE RECTOR AND VICE-CHANCELLOR

The protests and disruptions of academic activities by students or groups of students on the Bloemfontein and Qwaqwa Campuses of the University of the Free State (UFS) since 18 October 2017 are taking place at a critical time in the academic calendar when students are writing the end-of-year examinations.

Not only does this place strain on students preparing for examinations, it also places strain on their families, and the entire university community.

I have spent most of my time since 18 October 2017 engaging with a large number of the university’s stakeholders, including concerned parents, staff, union representatives, alumni, the media, and various interest groups to share our plans and approach towards the protests and disruptions, and to ensure our stakeholders of the executive management’s commitment towards ensuring the stability of the campuses, and the uninterrupted completion of the 2017 academic year. Similar engagements by the executive management with the Student Representative Councils (SRCs) of the Bloemfontein and Qwaqwa Campuses have also taken place, and will continue.

During the past week, the disruption of academic activities, damage to and destroying of university property, criminal behaviour, and the violation of the rights of staff and students have occurred. Such behaviour is condemned in the strongest terms by the executive management, and directly contravenes the interdict granted to the UFS by the High Court of South Africa’s Free State Division on 22 February 2017. Although the university supports peaceful protests, I appeal to student leaders and the students who are in support of the protests, to continually prioritise the completion of the exams and the academic year. The executive management will keep on supporting peaceful protests of students about matters that are important to them, and obviously important to the university. However, we do not support the kind of disruptions and protests that transpired since 18 October 2017.

Last week, we were also made aware of alleged excessive use of force and assault of students by private security companies hired by the UFS at both the Bloemfontein and Qwaqwa Campuses. These allegations are currently being investigated. The executive management condemns in the strongest terms any misuse of force by private security.

The situation on the Bloemfontein and Qwaqwa Campuses is being closely monitored, and the necessary contingency plans remain in place to ensure the safety of staff and students, and to safeguard university property.

The executive management understands and shares the concerns of academic and support service staff about the completion of the academic year. We also understand the emotional anxiety that student protests and defiance generates among staff and students. I want to thank the university community for their support, as well as members of the institutional task team for their remarkable work under difficult and trying circumstances.

There is continuity between the student protests that started last year in October and what we are facing now. The unifying theme is students’ experience of financial exclusion from higher education. A contributing factor is the fact that President Jacob Zuma has not yet released the Heher Commission’s Report on the feasibility of fee-free higher education and training, which was handed to him at the end of August 2017.

The latest developments indicate that the President might release the report by the end of the coming week. This will hopefully provide more certainty on the issue of free higher education, and could therefore contribute to the stability on campuses at South African universities. The UFS, as a collective, will actively engage with the recommendations in the report once it is available.

The executive will continue to engage with the SRC, not only to strengthen the relationship between these bodies, but to constructively address various domestic challenges on our campuses.

Prof FW Petersen
Rector and Vice-Chancellor
University of the Free State

UPDATE: 27 October 2017 at 15:03: Concession for students who experienced trauma on Friday 20 October 2017

As part of an agreement between the UFS Executive Management and the Bloemfontein Campus SRC on Monday 23 October 2017, it was agreed that there would be a process in place to allow students to write an additional exam if they experienced physical, emotional or psychological trauma relating to events that took place on the Bloemfontein and Qwaqwa Campuses on Friday 20 October 2017.

The names and student numbers of students were sent to management. In total, 1 236 student numbers were received, of which only 1 152 students were matched and qualified for an additional exam in place of the main examination that took place in the period 23 October to 28 October 2017.

Note: Only students with predicates qualify for the above concession.

Students will be notified via email by Wednesday 1 November 2017 if their applications have been successful. Should you have any enquiries regarding the notification or need to follow up on the process, you may contact the Student Academic Services Examination Division at addexam@ufs.ac.za. Lecturers will be notified via the Dean of the relevant faculty.

The students approved via this process, will also be eligible to apply for an ad hoc exam. This process will be managed by the Student Academic Services Examination Division.

Definitions:
· Main Examination: The first sitting of the final examination
· Additional Examination: The second sitting of the final examination. For the above students, this will be their first opportunity.
· Ad hoc Examination: A once-off concession for the above students, which allows them to apply for a second opportunity.
· Special Examination: A last opportunity given to students who have one module outstanding to complete their qualification. This examination is managed by the relevant ‘home’ of the outstanding module.

UPDATE: 26 October 2017 at 15:00: The exams on the campuses are continuing and no disruptions have been experienced since it started on Monday 23 October 2017.

A fire broke out on the Rag Farm of the University of the Free State’s (UFS) Bloemfontein Campus during the early hours of Thursday 26 October 2017, damaging the western side of the building. Arson is expected and the incident is being investigated by the South African Police Service (SAPS). On the same campus, two students were arrested in the early hours of Thursday morning for attempts to light a fire next to the Main Building. The incident is also being investigated by the SAPS.

On the Qwaqwa Campus, the situation is calm and no incidents were reported since yesterday morning.

The situation on the Bloemfontein and Qwaqwa Campuses is being closely monitored, and the necessary contingency plans remain in place to ensure the continuation of the exams, the safety of staff and students, and the safeguarding of university property.

UPDATE: 25 October 2017 at 14:26: Exams at the University of the Free State (UFS) are continuing today without disruptions on the campuses, after commencing on Monday 23 October 2017.

Early this morning, six students were arrested on the Qwaqwa Campus for contravening the Interdict. One of the two students who was injured and hospitalised the evening of 22 October 2017 on the Qwaqwa Campus during an incident between students, security officers, and members of the South African Police Service (SAPS) when a firearm was allegedly released, has been discharged. The second student is still in hospital and recovering well. The private security company involved in this incident has since been suspended and the incident is being investigated.

The necessary safety contingency plans remain in place on the campuses, and continued discussions/conversations between the executive management and the SRCs are taking place. Notices of intention to suspend will be issued to students who performed acts of a criminal nature or who violated the rights of staff and students.

UPDATE: 24 October 2017 at 13:36: Situation on the UFS Bloemfontein and Qwaqwa Campuses on 24 October 2017

The exams on the campuses of the University of the Free State (UFS) started yesterday (23 October 2017) without disruptions. The situation on the Bloemfontein and Qwaqwa Campuses is calm today and no disruptions have occurred at exam venues. The necessary safety contingency plans remain in place.

UPDATE: 23 October 2017 at 14:54: Agreement between the UFS executive management and the Bloemfontein Campus SRC on Monday 23 October 2017

During a meeting between the executive management of the University of the Free State (UFS) and the Bloemfontein Campus Student Representative Council (SRC) this morning, the following was agreed:

1.       Students who feel traumatised by events that took place on the Bloemfontein and Qwaqwa Campuses on Friday 20 October 2017 and do not think that they are fit to write exams, must provide their names and student numbers to the respective SRCs.

2.       In Bloemfontein, email should be sent to Asive Dlanjwa at DlanjwaA@ufs.ac.za; TyidaS@ufs.ac.za or submitted at Steve Biko House, Office 54. In Qwaqwa, email should be sent or submitted to the SRC President, Masopha Hlalele, at 2013037573@ufs4life.ac.za. These students will be excused from the exams taking place between 23 October and 28 October 2017, and will be given a chance to write additional exams. These exams will be regarded as the first opportunity.

3.       Students injured on the Bloemfontein Campus as a consequence of the events of Friday 20 October, should contact Dr WP Wahl from Student Affairs (to arrange for medical assistance).

4.       Students who wrote exams today (23 October 2017), but who feel that they have done so despite being traumatised and want to withdraw from the examination list, must indicate their names, student numbers, and the exam that they wrote. These students are also eligible for additional exams in relation to the exams set for the week of 23 October to 28 October.
5.       A window period of 48 hours (ending at 15:00 on Wednesday 25 October 2017) will be given to provide the names and details of students who experienced trauma to come forward for these arrangements to take place.

The following was also confirmed again during the meeting:

•         Students in Armentum and Beyers Naudé residences, which were singled out by the SRC as particularly affected by the events, would be offered counselling and medical assistance.

•         The 36 students jailed on Friday 20 October 2017, as well as those students residing in Armentum and Beyers Naudé who were traumatised or hurt by the events, will be starting exams a week later and will be given additional examinations for the modules they had to write during the week of 23 October to 28 October 2017.

•         Additional examination will be granted to all members of the SRC.

•         Any other student who was affected by Friday’s events and who is in need of counselling or medical attention, must indicate this to the SRC or the Office of the Dean of Students.

Please note the procedure for accessing counselling services: On the Bloemfontein Campus, students must go to the Student Counselling Offices, Health and Counselling Building (above Kovsie Health), to fill in the necessary forms and schedule emergency appointments.

UPDATE: 23 October 2017 at 07:28: Summary of events on the Bloemfontein and Qwaqwa Campuses since Wednesday 18 October 2017

Disruption of academic activities at the UFS started on the morning of Wednesday 18 October 2017 when a group of students blocked the main entrance to the Qwaqwa Campus and handed a memorandum to the campus management. Academic activities on the Qwaqwa Campus were interrupted, and resumed the next day. On the Bloemfontein Campus, disruption of some academic activities occurred after a meeting of students convened by the Student Representative Council (SRC). Members of the executive management subsequently met with the Bloemfontein Campus SRC, and a memorandum was handed to the executive management on 19 October 2017.

On the evening of 19 October 2017, seven students were arrested for arson on the Qwaqwa Campus, and four students were arrested on the Bloemfontein Campus on the morning of 20 October 2017 for contravening the Interdict. In the late afternoon of 20 October 2017, 36 students were arrested on the Bloemfontein Campus for contravening the Interdict. The arrest of this group of students occurred after the executive management responded to the memorandum of the SRC earlier in the day; the reply to the memorandum was rejected by the SRC and the students present.

Mindful of the Interdict and aware of the fact that these 36 students needed to prepare for exams, the university attempted to secure their release. This was not possible, given that the legal processing of these students by the South African Police Service (SAPS) had to continue. Students were finally released on bail on Sunday 22 October 2017 and will appear in court on Monday 23 October 2017.

Early on Saturday morning, the executive management met with the SRC and was made aware of incidents that took place at some residences, and the manner in which the private security company proceeded on Friday afternoon. The executive management explicitly stated that the approach taken by the security company was not in agreement with the UFS’s stand on student protest. At this meeting, it was agreed that the UFS would terminate its contract with the private security company and that it would initiate an independent external investigation into Friday’s events as soon as possible.

It was further agreed with the SRC that students in Armentum and Beyers Naudé, residences which were singled out by the SRC as particularly affected by the events, would be offered counselling and medical assistance.

It was finally agreed that the SRC, the 36 students jailed on Friday, as well as those students residing in Armentum and Beyers Naudé who were traumatised or hurt by the events, will be starting exams a week later and will be given special examinations for the modules they had to write during the week of 23 October 2017.

The students included in the categories indicated above, are the only students who had been granted special examinations. Any other student intending to request a special examination must follow the normal procedure.

Occurrences of fake news and miscommunication are taking place on social media – especially about the exams. The university’s official communication platforms (i.e. Newsflash, State of our campuses email, the website, Facebook, Twitter, Blackboard, SMS, and the ufs4life student email) are the only ones that carry official messages.
Exams start on all campuses on Monday 23 October 2017 at 08:00 and will continue as planned.

UPDATE: 22 October 2017 at 19:37: EXPLANATORY NOTE ON THE INTERDICT ISSUED BY THE FREE STATE HIGH COURT ON 22 FEBRUARY 2017

Since Wednesday 18 October 2017, disruptions and protests have occurred on and around the Bloemfontein and Qwaqwa Campuses of the University of the Free State (UFS), caused by students or groups of students.

On 22 February 2017, the High Court of South Africa, Free State Division, granted an Interdict against four respondents, of which the fourth respondent includes all individuals or legal persons acting in direct or indirect support of the activities to which this matter applies.

In terms of the Interdict, no registered student of the UFS, or legal persona may:

1.     Do anything which directly or indirectly obstructs, inhibits, prevents, disrupts, delays or interferes with the academic functioning of the UFS. This includes registration of students, any functions or events taking place at the UFS, tests, examinations and the processes related to academic activities, administrative services and normal student activities.
2.     Block, barricade or obstruct roads or entrances to the UFS. Similarly, roads on the UFS campus or entrances to buildings or venues on the UFS campus may not be blocked, obstructed or barricaded.
3.     Damage or destroy any property (moveable or immovable) on the UFS campus, irrespective of who the owners are.
4.     Molest, assault, threaten or intimidate UFS staff members, students, contractors and officials.
5.     Incite, taunt, instigate, prompt or encourage any other individuals or students to act in any way that violates this Interdict.

Please note that any student(s) who who contravenes the Interdict, will immediately be provisionally suspended.

The Sheriff of the Court and/or the South African Police Services are authorised to remove and expel from the UFS property and premises any student(s) who fails to comply with the provisions of the Interdict.

This Interdict is current and valid for all registered UFS students and legal persona operating at the university.

UPDATE: 22 October 2017 at 12:42: Exams will go ahead on the Bloemfontein and Qwaqwa Campuses on 23 October 2017
The exams will go ahead on the Bloemfontein and Qwaqwa Campuses on Monday 23 October 2017, as per the exam timetable. All academic and administrative activities are also continuing on both campuses tomorrow.

The situation on the two campuses is calm today, and no disruptions occurred during the course of last night.

The university crisis team – including members of the executive management and Protection Services – is on alert and has worked with the South African Police Service (SAPS) during the weekend to ensure stability on the two campuses during the exams. Security measures are in place for the exams and the situation on both campuses is monitored closely.

Occurrences of fake news and miscommunication are taking place on social media – especially about the exams. The university’s official communication platforms (i.e. Newsflash, State of our campuses email, the website, Facebook, Twitter, Blackboard, SMS, and the ufs4life student email) are the only ones that carry official messages.

Exams will proceed on the South Campus as scheduled.

UPDATE: 21 October 2017 at 12:45
The situation on the Bloemfontein and Qwaqwa Campuses of the University of the Free State (UFS) is calm today, and no disruptions occurred during the course of last night. Security measures are in place and the situation on both campuses is monitored closely.

Thirty six students were arrested on the Bloemfontein Campus yesterday at late afternoon, after a group of students clashed with members of the private security company and the South African Police Service (SAPS).

The executive management met with the Bloemfontein Campus Student Representative Council (SRC) this morning to discuss the arrest of students, as well as the disruptions of academic activities that happened on campus since Wednesday.

UPDATE: 20 October 2017 at 12:05: Situation on the Bloemfontein and Qwaqwa Campuses on 20 October 2017

Academic and administrative activities are continuing on the Bloemfontein and Qwaqwa Campuses today.

Last night, six students were arrested for arson on the Qwaqwa Campus. The South African Police Services (SAPS) and Campus Security were on the campus and are still monitoring the situation. On the Bloemfontein Campus, four students were arrested this morning for contravening the Interdict by causing disruptions at the Computer Labs and UFS Sasol Library. The SAPS is also deployed on the Bloemfontein Campus and are closely monitoring the situation, together with the university’s security team.

The executive management will meet with students on the Bloemfontein Campus at midday to provide feedback on the memorandum handed to them by the Student Representative Council (SRC) yesterday.

The safety of both staff and students remains a priority to the executive management. Staff and students on both campuses are requested to stay calm and to focus on the coming examinations and completion of the academic programme for the year. Measures are put in place to ensure that the exams will go ahead as planned. The university crisis team – including members of the executive management and Protection Services – is on alert and are working to stabilise the situation on the two campuses.

The continuation of the university’s academic programme is a serious matter to the executive management and the disruptive behaviour of some of our students will not be tolerated. Students who are identified while taking part in these incidents will be disciplined according to the university’s student disciplinary procedures.

Video recordings and/or photos of these incidents can be shared with Protection Services by contacting Noko Masalesa and Elise Saayman at masalesan@ufs.ac.za | saaymane@ufs.ac.za or +27 51 401 3436 | +27 51 401 9706.

Occurrences of fake news and miscommunication are taking place on social media – especially about the coming exams. The university’s official communication platforms (i.e. Newsflash, State of our campuses email, the website, Facebook, Twitter, Blackboard, SMS, and the ufs4life student email) are the only ones that carry official messages.

UPDATE: 19 October 2017 at 19:07: All academic activities on the UFS Bloemfontein and Qwaqwa Campuses will continue as normal on Friday 20 October 2017.

The necessary steps will be taken to ensure that outstanding classes and tests continue unhindered. Communication about the rescheduling of classes and/or tests affected by the disruptions on the Bloemfontein Campus will be sent via email tomorrow. Students on the Qwaqwa Campus must please check with the respective lecturers and/or information on Blackboard for details on rescheduled tests.

UPDATE: 19 October 2017 at 10:50: Situation on the Bloemfontein and Qwaqwa Campuses on 19 October 2017

During a meeting between the executive management of the University of the Free State (UFS) and the Student Representative Council (SRC) of the Bloemfontein Campus on 17 October 2017, a basic percentage point of 8% increase in tuition fees for 2018 was used as discussion point. Rumours on the social media of a different basic percentage point in relation to tuition fees for 2018 are untrue.

No decision has been made about the increase in tuition fees for 2018. Tuition-fee increases must be approved by the UFS Council, and therefore no decision about an increase in tuition fees for 2018 has been made yet.

Members of the executive management met with the Bloemfontein Campus SRC yesterday and it was agreed that a memorandum will be handed over today (midday); on the Qwaqwa Campus, a memorandum was handed to the campus management yesterday.

The Rector and Vice-Chancellor, Prof Francis Petersen, has subsequently been in discussion with the President of the Bloemfontein Campus Student Representative Council, Asive Dlanjwa, regarding yesterday’s disruption of academic activities on the campus. The campus management of the Qwaqwa Campus are in a similar conversation with the campus SRC, and discussions will continue today.

The situation on the Bloemfontein Campus remains under control and is being closely monitored, with academic activities on the campus continuing as normal today. The situation on the Qwaqwa Campus is calm today and academic activities, including tests, are continuing as scheduled. Staff and students on both campuses are requested to stay calm and to focus on the completion of the academic programme for the year.

Please note that the university’s official communication platforms (i.e. Newsflash, State of our campuses email, the website, Facebook, Twitter, Blackboard, SMS, and the ufs4life student email) are the only ones that carry official messages.

Released by:
Lacea Loader (Director: Communication and Brand Management)
Telephone: +27 51 401 2584 | +27 83 645 2454
Email: news@ufs.ac.za | loaderl@ufs.ac.za
Fax: +27 51 444 6393

UPDATE: Disruption of academic activities on the Bloemfontein Campus (19 October 2017 at 12:25 PM)

Disruption of academic activities on the Qwaqwa and Bloemfontein Campuses (18 October 2017)

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