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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

Ms Oprah Winfrey to receive an honorary doctorate in Education from our university

2011-06-10

Ms Oprah Winfrey

Invitation to the public (PDF document)

Invitation to UFS staff and students (PDF document)

Media accreditation (PDF document)

Street closures on 23 and 24 June 2011 (Bloemfontein Campus)

Map from the Bloemfontein Airport to the UFS (PDF document)

Map of the UFS (PDF document)

For more information, please contact:
Tel: 051 401 3000
E-mail: info@ufs.ac.za

Staff and students from our Qwaqwa Campus, please contact:
Dr Elias Malete's office

Our university will be awarding an honorary doctorate in Education to the global media icon, philanthropist and public educator, Ms Oprah Winfrey, on its Bloemfontein Campus on Friday, 24 June 2011.

Both the Council and Senate of our university gave strong support to awarding the honorary doctorate to Ms Winfrey.

By awarding the honorary doctorate, we want to recognise Ms Winfrey’s accomplishments and unparalleled work as a global media leader, as well as a philanthropist with vision and foresight in the field of education and development.

“It is a great privilege for us to be the first South African university to honour Ms Winfrey in this way and to be able to recognise a global icon of her stature,” says Prof. Jonathan Jansen, Vice-Chancellor and Rector of our university.

Ms Winfrey already holds honorary doctorates from Princeton University as well as Duke University in the United States, among others.

Reaching millions of viewers in more than 150 countries with her award-winning programme, “The Oprah Winfrey Show,” she has brought genuine change into the lives of ordinary people during its 25-year run.

Capitalising on the power of the media and her standing as a global icon, Ms Oprah Winfrey has brought a range of critical social and educational matters to the attention of her viewers. In 2000, she expanded her media reach through the successful creation of O, The Oprah Magazine, which then debuted in South Africa in 2002. Earlier this year, she extended her media influence through the launch of a US cable channel, OWN: Oprah Winfrey Network.

Her Book Club has had a dramatic and profound impact on the reading habits of America and those of people in other parts of the world, while her public charity, Oprah’s Angel Network, collected approximately $80 million over a period of twelve years in aid of building schools, women’s shelters and youth centres across the globe.

Through her private charity, The Oprah Winfrey Foundation, hundreds of grants have been awarded in support of empowering women, children and families, and The Oprah Winfrey Scholars Program, supports hundreds of university students, in the United States and elsewhere, who are committed to giving back and making a difference in their communities and country.

During a December 2000 visit to former president Nelson Mandela, Ms Winfrey pledged to build a school for girls in South Africa. This gift was to become the Oprah Winfrey Leadership Academy for Girls, which opened in 2007.

The Academy embodies her strong belief in the power of education to change the future. The Academy provides a unique educational opportunity to over 400 young girls, in Grades 7 through 12, from all over South Africa. These young women come from small rural towns and the big cities, but they share a common background in that they all come from poor families.

Ms Winfrey believes that the Academy can contribute to the development of a new generation of women leaders, deeply imbued with a sense of public service. The Academy stands as a beacon of hope in the educational landscape of this country.

More recently, Ms Winfrey has turned her attention to the failing public-school system in the United States and has brought the impact thereof on the lives of many people in America to the attention of the American public and policy-makers. Even more profoundly, she has highlighted how poor education entrenches poverty and social exclusion. In this sense, Ms Winfrey demonstrates the interconnection between education struggles in the USA and South Africa in powerful ways.

Both the Interim Director of our university’s International Institute for Studies in Race, Reconciliation and Social Justice, Mr John Samuel, and Prof. Jansen have worked for and with Ms Winfrey on matters of education at her school in Johannesburg, and in South Africa more broadly.

The South African public is invited to share in this occasion, and attend the award ceremony. A limited number of tickets will be available to the public from Wednesday, 15 June 2011 to Wednesday, 22 June 2011, and can be purchased from Computicket at an administrative cost of R10 a ticket.

Media Release
11 June 2011
Issued by: Lacea Loader
Director: Strategic Communication
Tel: 051 401 2584
Cell: 083 645 2454
E-mail: news@ufs.ac.za

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