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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

UFS gives recognition to excellent researchers

2004-11-16

p>The University of the Free State will give recognition to excellent researchers at UFS on Tuesday 16 November 2004. “This recognition function will also serve as the first annual lecture in research excellence,” says Prof Frans Swanepoel, Director of Research Development Division at the UFS.

This is the first occasion of its kind in the UFS. It coincides with the university’s centenary celebrations. The recognition of excellent research shows the UFS’s commitment and innovative focus on research as one of its core functions,” says Prof. Swanepoel.

Recognition will be given in different categories. They are female researchers, black researchers, young researchers, C- and L-Rated researchers, researchers with significant research outputs, B-Rated researchers and distinguished professors in research.

The promotion of equity and development of research capacity of designated groups is one of the objectives of the UFS’s research strategy therefore the university is recognising the research achievements of 21 women and 16 black persons. Amongst these are Prof. Margaret Raftery (English and Classical Languages), Dr Liesl van As (Zoology and Entomology), Prof. Peter Mbati (head of the Qwaqwa campus) and Prof. Charles Ngwena (Constitutional Law and Philosophy of Law).

The UFS is also recognising nine young researchers. They must hold a doctorate and have the potential to establish themselves as researchers within a five-year period based on their performance and productivity as researchers during their doctoral studies and/or early post-doctoral careers. Amongst them are Dr Esta van Heerden (Microbial Biochemical and Food Biotechnology) and Prof. André Jooste (Agricultural Economics).

Fifty-eight established researchers with a sustained recent record of productivity are receiving recognition in the C- and L-rated researchers’ category. Amongst them were Prof. Hennie van Coller (Afrikaans, Dutch, German and French) and Prof. Gert Erasmus (Animal- and Wildlife- and Grassland Sciences).

Prof. Francois Tolmie (New Testament) and Prof. Gina Joubert (Biostatistics) are two of the twelve researchers that are receiving recognition for having excelled in research outputs during recent years.

Nine researchers are acknowledged in the B-category for the international recognition they receive from their peers for the high quality and impact of their recent research outputs. Amongst them were Prof. Johan Grobbelaar (Plant Sciences) and Prof. Hendrik Swart (Physics). Prof. Grobbelaar focused in his research on limnology, algal biotechnology, plant stress and Prof. Swart focused on solid state physics and degradation mechanisms that are responsible for the degradation of field emission and TV displays.

Seven individuals are recognised for their exceptional achievements as researchers. Prof. Frederick Fourie, Rector, but previously in the Department of Economics, is recognised for his research in two policy areas: Political Economics, Government Finance and Fiscal Policy, and Industrial Economics, in particular analysis of the South African industrial structure and competition policy, where his research contributions played a key role in reforming South Africa’s competition policy.

Prof. Lodewyk Kock (Microbial, Biochemical and Food Biotechnology) focuses in his research mainly on pure and oxidised edible oil where yeasts are used as a study model. He obtained national as well as international recognition for this research program.

The UFS is also awarding the S2A3 Bronze Medal to recognise a Master’s degree student who has delivered outstanding research in one of the sciences. Mr Pieter Taljaard and Ms Tania Venter are recognised in this category.

Media release
Issued by: Lacea Loader
Media Representative
Tel: (051) 401-2584
Cell: 083 645 2454
E-mail: loaderl.stg@mail.uovs.ac.za
16 November 2004

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