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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

During 2011: Sport

2011-12-01

Our sports stars set their gaols high and with hard work, dedication a good measure of determination they show that they will not give up until these goals are met. A place in the national team or a medal or award in hand is enough proof that our Kovsie sportsmen and women are serious about their successes on the sports field.

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Some of our stars this year were:

Athletics:

Thuso Mpuang, our Kovsie Sportsman of the year, represented South Africa during the World Athletic Championships in Deague, Korea. He obtained the silver medal in the 200m during the World Student Games in Shenzhen, China and a gold medal as a member of the 4 x 100m relay team.

Janette Siebert represented South Africa during the Southern Africa Championships in Maputo, Mozambique.

Boy Soke represented South Africa during the Africa Cross Country Championships in Cape Town. He also represented South Africa during the World Cross Country Championships in China.

Cricket:

The 21-year-old former Kovsie, Obus Pienaar, who was still playing cricket for our university club until the end of the season (end of March), has been playing abroad for the Irish cricket club Waringstown from the end of April 2011.
We are proud of Obus’ achievements, in particular his contribution to the match against the CIYMS. During this game, Obus hit the highest score ever in the Northern Cricket Unions when he scored 244 runs in only 114 balls. This included 22 sixes and 13 fours. During his innings in this match, Obus also broke the July 2004 record of his compatriot, AB de Villiers of the Proteas.

Hockey:

Lesley Ann George represented the Protea Women’s Hockey Team during the series against China, Belgium and Azerbaijan. She was also a member of the Protea Women’s Hockey Team during the Champs Challenge in Ireland. The team finished fifth.

Nicole de Vries represented the Protea Women’s Hockey Team during the series against China, Belgium and Azerbaijan. She was also a member of the Protea Women’s Hockey Team during the Africa Cup in Bulawayo. The team obtained a gold medal.

Hettie Oosthuizen represented the Protea Women’s Hockey Team during the series against China, Belgium and Azerbaijan.

Izelle Lategan represented the Protea Women’s Hockey Team during the series against China, Belgium and Azerbaijan.

Nicole Kemp was a member of the Protea Women’s Hockey Team during the Africa Cup in Bulawayo. The team obtained a gold medal.

Karate:

Elsabe le Roux was a member of the Protea JKA Shotokan Karate Team that participated in the Africa Zone 6 Championships in Maputo where she obtained a gold and silver medal.

Bruno Schwalbach was a member of the Protea JKA Shotokan Karate Team that participated in the Africa Zone 6 Championships in Maputo where he obtained two gold medals. He was also a member of the Protea JKA Shotokan Karate Team that participated in the Common Wealth Karate Championship in Australia where he obtained one silver and two bronze medals. He was a member of the Protea JKA Shotokan Karate Team that participated in the All Africa Games in Maputo Mozambique where he obtained a bronze medal.

Balungile Nchofe was a member of the Protea JKA Shotokan Karate Team that participated in the Africa Zone 6 Championship in Maputo, where he obtained a gold medal.

Netball:

Kovsies’ netball team has performed well over the past year with, amongst others, the inclusion of players in the SA Universities World-cup Group.

Karla Mostert and Maryka Holtzhausen participated during the World Cup in Singapore in the SPAR SA Protea team.

We are also proud of the eight players who have been included in the SA team. They are Zimari Smit, Sheri Duimpies, Ane Botha, Danique du Toit, Nieke Loubser, Karla Mostert, Fikile Mkhuzangwe and Lauren-lee Christians.

At the SA tournament, Ane Botha was named as the centre-court player of the tournament, whilst Karla Mostert was named as the best defending player. Karla has also been included in the SPAR SA Protea team to the All African Games, which start in Mozambique at the end of August.

Rugby:

Boom Prinsloo and Robert Ebershohn are representing the Springboks in the HSBC Sevens World Series.

Soccer:

Gabisile Hlumbane, our Kovsie Sportswomanof the year, is a member of the Banyana Banyana National Soccer Team. The team obtained a bronze medal at the African Women’s Championships during October 2010, a gold medal at the Unity Cup Hosted during December 2010, a silver medal at the COSAFA Women’s Championship hosted during July 2011 and qualified for the London Olympics in 2012.

Squash:

Paul Rodrigues represented the South African U/ 23 team at the All Africa Squash Championships in Johannesburg.

Triathlon:

Nelmaré Loubser represented the SA Elite Team during the World Championships in Spain.

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