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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

Wildlife researcher in ground-breaking global research on giraffes

2017-10-20

Dr Deacon from the Department of Animal, Wildlife and Grassland
Sciences at the University of the Free State (UFS),
lead a multispecialist research group to catch
and collar giraffe to collect data that will
contribute to the conservation of these animals.
Photo: Prof Nico Smith

Capturing 51 giraffes without any injuries or mortalities to collect data that will contribute to the conservation of these animals is not for everyone. Capturing a giraffe with minimum risk to the animal and the people involved, requires extraordinary skill, planning, and teamwork. “This exercise is a dangerous task, since a well-placed kick from these large and extremely powerful animals can cause serious injuries. Early in October was the first time that giraffes were captured on such a large scale,” said wildlife researcher Dr Francois Deacon.

Dr Deacon from the Department of Animal, Wildlife and Grassland Sciences at the University of the Free State (UFS), led a multispecialist research group of over 30 people from 10 different countries to collect information about these little-known animals.

UFS first to collar giraffe
Taking a global approach, the team responsible for this intricate process consisted of wildlife biologists, conservationists, interdisciplinary scientists and five specialist veterinarians who are experienced in catching and working with wild animals. Specialised drugs sponsored by Dr Kobus Raath from Wildlife Pharmaceuticals, tested for the first time and administered with a dart gun were used to tranquillise the giraffe, which then allowed for the GPS collars to be fitted. These collars, sponsored by Africa Wildlife Tracking, enable the researchers to record the location of individual giraffe for up to two years, give 24/7 readings, irrespective of weather conditions. In this cost-effective manner, data can be gathered on climatic factors, giraffe communication, social behaviour, home ranges, seasonal movements, human and giraffe interaction zones, as well as migration routes and the duration of the migration process. The collars will effectively be used to locate individuals to collect faecal samples for hormonal cycles, stress hormones, nutrient deficiencies based on diet and also internal parasites.

“This knowledge we gain is the key to all keys in saving this iconic animal from becoming extinct,” said Dr Deacon.

Six years ago, during a pilot study, Dr Deacon was the first researcher to fit giraffes with a GPS collar. Collaring is less invasive and allows researchers to collect detailed samples. Not only was extensive knowledge and experience gained during the process, but he also initiated interest from the filmmaker and conservationist, Ashley Scott Davison, executive producer of Iniosante Inc.

Getting to tell the story
Davison, who was doing research for a film on giraffe learnt about the silent extinction of the species. In a great number of countries giraffe numbers have been declining by as much as 40% over only a few years since 2000. Today West Africa has between 400 to 600 giraffe left while four out of five giraffes were lost in East Africa since 2000. This is a considerable decline in numbers and poses a real threat to the survival of the species in the longer term. At the end of 2016, the giraffe was classified as vulnerable on the International Union for Conservation of Nature Red Data list.

According to Davison, children in school learn about the destruction caused by ivory poaching and habitat loss. But in Africa today, there are six times as many elephants as there are giraffes.

In the process to find out more about this majestic species Davison learnt of Dr Deacon’s work. After being introduced to and spending time with Dr Deacon, Davison not only describes the UFS as the leader in the conservation of giraffes but he returned to the university, three times to help build a dedicated research team to address unanswered research questions within various disciplines.

Flowing from the affiliation with the UFS is Iniosante’s award-winning production of a documentary, “Last of the Longnecks”. The film has received several awards, including official selection at the 2017 Global Peace Film Festival, the Wildlife Conservation Film Festival and the Environmental Film Festival in the US capital.

The film team accompanied the multispecialist research team last week to gather footage for a follow-up documentary, “Catching Giants”. This film is expected to air in middle 2018.

Video clip of the event: https://www.dropbox.com/s/d3kv9we690bwwto/giraffe_UFS_revision-01a.mp4?dl=0

Video clip of the event: RooistoelTV

Former articles on this topic:

18 Nov 2016: http://www.ufs.ac.za/templates/news-archive-item?news=7964
23 August 2016: http://www.ufs.ac.za/templates/news-archive-item?news=7856
9 March 2016:Giraffe research broadcast on National Geographic channel
18 Sept 2015 Researchers reach out across continents in giraffe research
29 May 2015: Researchers international leaders in satellite tracking in the wildlife environment

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