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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

UFS Odeion School of Music (OSM) launched

2011-09-15

The University of the Free State’s (UFS) Odeion School of Music will be launched at the first Dean’s Concert in the Odeion on the Bloemfontein Campus on Friday, 16 September 2011.

The former Department of Music, in the Faculty of Humanities, has been transformed and will henceforth be known as the Odeion School of Music (OSM). This follows in the path of the corporate transition currently taking place at the university, which aims to reflect the progressive and dynamic striving towards excellence, as endorsed by the UFS Vice-Chancellor and Rector, Prof. Jonathan Jansen, and his management group.

Two years ago the faculty formulated a new mission with the aim to become an international faculty of excellence. An important component of it has been to create a pro-active marketing strategy and policy towards internationalisation and curriculum development.

The name Odeion School of Music portrays not only an excellent asset in the Free State, but also nationally and internationally. The school’s new name bears the respected Odeion brand and a number of successful and respected ensembles operate under this brand. These include the acclaimed residential Odeion String Quartet, as well as the Music Department’s student ensembles, the Junior Odeion String Quartet, the Odeion Sinfonia, and the Odeion Choir.

According to Prof. Nicol Viljoen, the Chairperson of the OSM, the name change was motivated by the following objectives:

The idea of a school within the Faculty of Humanities not only reflects an academic profile that does justice to the intention of the Department to reposition itself, but also simulates the current identity of the unit. This encompasses diverse thematic entities not only from an academic perspective, but also from a community and cultural perspective. The unit does this through providing services, which include arts entertainment, the provision of facilities, as well as a strong emphasis on community development.
With regard to an international perspective, it provides attractive possibilities not only from the perspective of a marketing and publicity profile, but also with regard to the identity of the unit.
Hypothetically the new name allows more flexibility to complement the profile with reference to newly anticipated developments. These include the application of prestigious international experts as artistic fellows, membership to progressive European, jointly developed degree programmes and curriculum development initiatives, the founding of a chair in Orchestra Conducting, a master’s degree in Arts Management, as well as the incorporation of bio-kinetics in the teaching methodologies of performance practice, to name but a few.
From a management perspective it could also consolidate the perspective of scarce skill specialisation.
To give momentum to the establishment of the OSM, Mr Marius Coetzee was appointed as Innovation Manager. He is a former Project Manager of the European Degree in International Music Management – a joint degree initiative between three Universities from Norway, the Netherlands and Finland, funded by the EU in Brussels. His aim will be to develop and investigate aspects such as internationalisation, marketing, pro-active recruitment strategies, curriculum development and innovative teaching methodologies.

Mr Coetzee said music conservatories, from both European and American perspectives are managed and maintained as highly successful and substantial brands. From the European perspective some examples include the Sibelius Academy in Helsinki (Finland), the Liszt Academy in Budapest (Hungary), the Grieg Academy in Bergen (Norway) and the former Sweelinck Academy in Amsterdam (Netherlands). Similar to the South African milieu, the majority of music conservatories in the USA and Canada are resident within an academic university.

However, unlike the South African reality, the majority of these institutions have a value-added identity portrayed by a specific name. Such an example is the renowned Peabody Conservatory of the University of Baltimore or the Jacobs School of Music at the Indiana University Bloomington, to name but a few.

The Dean’s Concert will highlight performances of students in the school. The concert will probably become a regular event in future Spring Music Festivals.

Media Release
15 September 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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