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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

Change and growth at the University of the Free State

2011-07-04

Graphical representation of the High Performance Centre

“Come gather round people, wherever you roam. And admit that the waters around you have grown…”

These are the opening lines of Bob Dylan’s iconic single The times they are-a changing. They are also extremely apt words to describe the excitement about the winds of change and growth blowing across the University of the Free State, not only academically, but also physically.

Over the past few months there has been non-stop construction and growth of a physical nature, with several new buildings being erected and new sculptures rising up all over the Bloemfontein Campus.

The most visible and probably the most striking of all the new structures is the brand-new main entrance to the campus. This stunning new feature welcomes visitors to the campus in Nelson Mandela Drive, in the colours of each of the university’s seven faculties.

Once through this beautiful new gate, visitors have a choice of new and exciting features to explore on the campus.

The first is the brand new climbing wall, which is located against the West Block and Chemistry Buildings. This new addition to the campus is available for use by all enthusiasts of this exciting sport.

The Office of the Dean of Student Affairs manages the administration of the wall and students who want to climb can book at their office in the Student Centre at the Thakaneng Bridge. In order to ensure that students do not use the wall without permission, and to prevent accidents, the wall is covered by a tarpaulin, which is locked when the wall is not in use.

Next on the list of new developments is the high-performance gymnasium which is currently still under construction. With this project the university wants to create a work environment for its staff that will not only contribute to the cultivation of maximum work performance, but also to staff wellness.

The centre with its foyer and administrative offices will also consist of a health desk, university sports institute, sports sales, a spinning and aerobic centre, and dressing rooms. The total area will extend more than 2114 m².

Progress on other building projects, which commenced last year, is also very pleasing. One of the projects is a new Education Building which is being constructed opposite the UFS Sasol Library. Upon completion, this building will be used for the training of maths and science teachers in the Foundation Phase. It will include three classrooms for 100 students each and an auditorium for 225 students as well as an office block. The auditorium will also be used as a classroom. The building has been designed according to environmentally friendly principles to save water and use power effectively. Construction is going swimmingly and should be completed soon.

Planning for the construction of more student accommodation on the Bloemfontein Campus as well as the Qwaqwa Campus is also well underway. On the Qwaqwa Campus, a residence with 200 beds is being constructed. This also includes a computer laboratory. According to the planning, this residence is near completion. Furthermore, four residences will be constructed on the Bloemfontein Campus. These residences are in the planning phase.

In order to place technology within reach of Kovsie students and thereby empowering them, computer laboratories were installed at all residences. The computer laboratories will eventually make provision for approximately185 computers for student use. Proper security is also planned to safeguard the equipment.
A brand-new building for the Faculty of Health Sciences is also proceeding rapidly. This building will include a lecture hall for 200 students, five venues for 100 students each, as well as offices. Students from the School for Medicine and Occupational Therapy will make use of these facilities.

The new building for the Faculty of Economic and Management Sciences between the Flippie Groenewoud Building and the Wynand Mouton Theatre is also coming along nicely.

On the university’s Qwaqwa Campus a new Education building is being constructed. This building will include a lecturing hall with 100 seats, four 50-seat classrooms, six offices, ablution facilities, biology and science laboratory, as well as an information technology laboratory for 60 students.

In the meantime, existing buildings are being renovated on all the campuses. This includes, amongst others, improvements to the Architecture Building, the Biotechnology Building and the quarters for service workers on the Bloemfontein Campus. Other improvements that have already been completed include renovations to the Odeion’s foyer and the Callie Human Centre.

A special memorial park for women, residential accommodation within a sports environment, and a botanical garden are also among the beautiful, exciting new sites to be seen on the campus.

Coupled with all the beautiful sculptures, funded by the Lotto Sculpture project, our university’s campuses will soon be a more vibrant, beautiful attraction.

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