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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

SRC elections of our Bloemfontein Campus

2011-07-26

The Student Council elections of our university at the Bloemfontein Campus will take place on 29 and 30 August 2011. These official election dates were announced by Mr Rudi Buys, Dean: Student Affairs, on 25 July 2011.

Nominations open on Wednesday, 27 July 2011 and the elections, which are constituted according to the SRC Constitution, shall be handled by the Independent Electoral Agency, which shall be instituted by the SRC Constitution with this in view.

“The elections introduce a new era in student leadership and governance, because student representation will now constituted in such a way that affords the majority of students the opportunity to vote directly for their representatives. Senior leadership structures are extended in the new Constitution, in order to allow more students to hold senior positions,” states Mr Buys.

The SRC elections follow on the approval of a new Constitution that was accepted by our Council on 3 June 2011.

The Constitution was drafted over a period of eight months by the Broad Student Transformation Forum (BSTF), consisting of students, in order to design a new dispensation in student structures. The BSTF, which decided on new models of student representation in collaboration with independent facilitators, consists of more than 70 student organisations and residences. The changes to the Constitution were decided on and accepted by the BSTF, after recommendations from four student study groups, which investigated student leadership and governance in depth, at national as well as international level, were taken into account. The study groups visited nine (9) other SA universities, as well as investigated student representation at internationally renowned universities like Cornell, Yale and Stanford in the United States of America.

Ms Modieyi Motholo, Chairperson of the Interim Student Committee, says that she is very proud of what the students have achieved with the new Constitution. “I wish to accord recognition to all the students who lead the process for all their hard work. Constitutional revision is a strenuous process and it is nothing short of a miracle that the students could not only reconstruct the Constitution, but also have it accepted in less than a year.”

The important changes include, amongst others:

Candidates no longer stand on behalf of parties in the elections, but as independent candidates for 10 predetermined portfolios for which students can vote directly;
Students also directly vote for a President and a Vice-President;
Nine (9) SRC members serve ex-officio as SRC members by virtue of being chairpersons of nine additional student councils established by the Constitution. Amongst others, the councils include a postgraduate student council, an international student council, a student media council and a student academic affairs council;
More stringent eligibility requirements are set for candidates, namely that students who wish to run in the elections has to, amongst others, sustain an academic average of more than 60%, and hold proven student leadership experience (which could be verified by the Independent Electoral Agency).

“With the SRC elections, students have the opportunity to firmly entrench the changes in student governance on which they have decided on by themselves firmly, as a sustainable model for democracy at our Bloemfontein Campus. It speaks volumes that the number of leadership positions for which candidates can make themselves available, in essence has been increased by the number of additional student sub-councils from 21 to 67, because it brings about much more direct representation for different students across the campus,” says Mr Buys.

“I firmly believe that the upcoming student council elections will be a success,” says Motholo. “I wish the students, who are prepared to sacrifice a year of their lives in service of the student community as a member of the SRC, all of the best.”

The Qwaqwa Campus’ election schedule shall be announced within the next week, as well as the date of the institution of the Central Student Council (CSC).

Media Release
26 July 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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