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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

B. Iur. programme in Occupational Risk Law first of its kind in the country

2010-11-26

The University of the Free State (UFS) will offer a B.Iur. degree programme in Occupational Risk Law from 2011.

This programme of the Faculty of Law is the first of its kind to be offered in South Africa and positions the UFS in the forefront of this field of study.

The programme is designed to develop and qualify professionals, knowledgeable in the field of occupational risk law as prescribed by South African legislation and international best practices. It further offers a qualification based on a well-researched basis of applicable legal principles, combined with safety, health, environmental and quality risk management principles applicable to employers and employees in a specialised industry.

The B.Iur. (Occupational Risk Law) has been developed by experts within the parameters of international comparability, according to research-based identification of career demands and requirements in the fields mentioned.

By introducing this programmesignificant progress will be made towards achieving the nationally stated objective of legal safety, health and environmental quality assurance in the workplace and within the broader community. The programme will also encompass the values and standards prescribed by the Institute of Safety Managers. This will provide them with a further step towards the regulation of the professional en ethical standards in the field of legal safety, health and environmental quality assurance.

With the programme, the UFS not only creates a unique opportunity for stakeholders and learners to add meaningful value to their careers, but also exerts a meaningful influence on the industry and society in terms of the acquisition of a most appropriate type of qualification. The B.Iur. (Occupational Risk Law)degree therefore offers a meaningful contribution towards the industry through addressing the increasing demand for career opportunities in the field of legal safety, health and environmental quality compliance.

The new programme is the result of an agreement between the faculty and its partner, IRCA Global. The university officially launched its partnership with IRCA Global, an international supplier of risk management solutions pertaining to safety, health, the environment and quality in 2008. As part of the agreement, the UFS will offer short learning programme, a diploma and a degree in Risk Management.

IRCA Global is a South African company in the international risk control and SHEQ environments with filials in Africa, Australia, India, Eastern Europe, and South America.

In the interim IRCA Global has continued with the marketing of the programme, with the result that hundreds of potential students are waiting for the launching of the programme. The faculty is geared towards offering the programme in e-learning. New modules will also be offered with the help of IRCA’s trained and skilled facilitators. The faculty also utilises the partnerships entered into with IRCA to appoint practising specialists as part-time lecturers for the occupational risk law component of the programme as well as to develop a new specialist component amongst the permanent staff.

The programme is already active and students can register for the first semester 2011 (study code 3324, programme code M3000). Direct your enquiries to Cora-Mari de Vos at 051 401 3532 or devosc@ufs.ac.za.

The programme consists of fundamental modules of the LL.B. and B.Iur., as well as short learning programmes in the Faculty of Law and specially developed core modules in occupational risk law. The B.Iur.in Occupational Risk Law enables successful candidates to enrol for applicable Post Graduate Diplomas or a cognate Honours Degree. Obtaining one of these qualifications provides the platform to articulate to Magister degrees. Horizontal articulation possibilities exist with the accredited Baccalaureus of Law (LL.B.) which is presented by several institutions in the country.

Media Release
Issued by: Lacea Loader
Director: Strategic Communication (actg)
Tel: 051 401 2584
Cell: 083 645 2454
E-mail: loaderl@ufs.ac.za
26 November 2010

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