Latest News Archive

Please select Category, Year, and then Month to display items

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 to award honorary doctorate to Maria Ramos

2004-12-08

The Council of the University of the Free State (UFS) recently approved the awarding of an honorary doctorate to Ms Maria Ramos, Group Chief Executive of Transnet in April 2005. A total of five honorary doctorandi will be honored.

The other doctorandi are Proff Jan Groenewald (D Sc (hc)), Jaap Durand (D Phil (hc)), Sampie Terreblanche (C Dom (hc)) and Anthon Heyns (MD (hc)).

Me Ramos will receive an honorary doctorate in Economics (P hD (Economics) (hc)) for the large contribution she made to the establishment of a prudent fiscal and macro-economic policy in South Africa and hence, to the restoration of the financial credibility of the country in the eyes of domestic and foreign investors. Ms Ramos was the Director General of the National Treasury from 1996-2003.

She obtained the MSc-degree in Economics in 1992 from the University of London and was awarded a British Council Scholarship (Helen Suzman award) in the same year and in 1991. During the early nineties she was among others project leader of the ANC’s Macro-economic Research Group and also a member of the team that negotiated chapters on finance in the interim Constitution of South Africa. She was a research associate at the Centre for the Study of the South African Economy and International Finance at the London School of Economics and also lectured at the Universities of South Africa and the Witwatersrand.

“It is a great privilege for us to honor Ms Ramos and the other doctorandi in their different fields of expertise. This once again serves as an example of the UFS’s policy to give recognition to people who excel and make a difference,” said Prof Frederick Fourie, Rector and Vice-Chancellor of the UFS.

Prof Jan Groenewald will receive an honorary doctorate for his life-long commitment to the establishment and development of Agricultural Economics as a subject field in South Africa and in Africa and his various contributions to the UFS. During his career, Prof Groenewald received various awards among others in 1998 when he received the Stals Prize for Economics from the South African Academy for Science and Art and in 1990 when he received an honorary medal from the South African Society for Agricultural Economics.

Prof Jaap Durand will receive an honorary doctorate in Philosophy for his pioneering work on various fields in the South African society. He obtained his Masters degree in Philosophy from the UFS and contributed to almost 60 articles and collections. Prof Durand has a colourful career as academic manager: from professor in Systematic Theology and dean of the Faculty of Theology at the University of the Western Cape to Deputy Vice-Chancellor of the same university. He was the ombudsman of the University of Stellenbosch from 2002-2003.

Prof Sampie Terreblanche will receive an honorary doctorate in Economics for the important role he played, and is still playing, to keep the debate about and the need for socio-economic and socio-political reform in South Africa going. Prof Terreblanche started his career as a lecturer at the UFS. In 1992 the Stals Prize for Economics was awarded to him by the South African Academy for Science and Art. Prof Terreblanche was also a founding member of ASSET, an organisation addressing the problems of poverty, inequality and social injustice in South Africa.

Prof Anthon Heyns, Chief Executive Officer of the South African National Blood Service, will receive an honorary doctorate in Medicine. Prof Heyns is a well-known international researcher in Hematology and recently received a Centenary Medal from the UFS for his strong role and national prominence as expert and leading figure in establishing and developing Hematology at the UFS. He was the first head of the UFS’s Department of Hematology and is also co-editor of the only Afrikaans hand book of Hematology. He serves among others as a council member and member of the executive management of the South African Medical Research Council. On the international front he serves on at least five committees of the World Health Organisation based in Geneve, Switzerland. He has two honorary appointments as professor respectively at the UFS and University of the Witwatersrand.

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

Back

Economic and Management Sciences

Education

Health Sciences

The Humanities

Law

Natural and Agricultural Sciences

Theology and Religion

Open Distance Learning

Business School

We use cookies to make interactions with our websites and services easy and meaningful. To better understand how they are used, read more about the UFS cookie policy. By continuing to use this site you are giving us your consent to do this.

Accept