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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

Fundraising campaign launched to help feed hungry students

2012-03-28

From the left is Dr. Carin Buys (Patron of NSH), Ms. Nicky Abdinor (guest speaker), Mrs. Grace Jansen (patron of NSH) and Redi Tlhabi (master of ceremonies).
Photo: Johan Roux
28 March 2012

Video clip (YouTube)

The University of the Free State (UFS) received over R200 000 for its No Student Hungry (NSH) Programme at the NSH launch dinner on Friday 23 March 2012 in Bloemfontein.

Prof. Jonathan Jansen, Vice-Chancellor and Rector of the UFS as well as founder of the NSH Programme donated R100 000 from the proceeds of his book We Need to Talk to this programme. Standard Bank also donated R30 000.

An additional amount of about R90 000 was raised by means of pledges made by guests and the auctioning of several items. These items were donated by local companies and university staff.

The No Student Hungry Programme (NSH) aims to raise funds to provide modest food bursaries for needy students and give them daily access to a balanced meal.
Prof. Jansen started the NSH programme in 2011 with the proceeds of his book, We Need to Talk.

The NSH funds more than 100 students in the hope of helping them to excel in their academic endeavours and, ultimately, to obtain their degrees.

In 2011, Prof. Jansen discovered that a significant number of students were studying without eating on a regular basis. These were often students with strong academic records but without adequate funding to sustain themselves with regular meals.

The project was established in January 2011 when the NSH Team started to develop the structure and processes of the programme. The first 100 students who were awarded the food bursaries started using their student cards for daily meals on campus on 1 April 2011.

“The No Student Hungry Campaign is not only about creating a university campus that cares. It is about creating a country where being human matters. Our students on the NSH project are amazing young people. They struggle to get by, but they have great potential and achieve good marks," Prof. Jansen said on Friday.

Prof. Jansen’s wife, Grace, and Dr Carin Buys, wife of Mr Rudi Buys, Dean of Student Affairs, volunteered to drive the programme and raise funds to address the problem. They are supported by various divisions within the university.

Students apply for the bursaries and are selected on the basis of their financial needs, good academic results, active participation in student life programmes and commitment to give something back to the community.

The raising of funds is a continuous process involving awareness campaigns, seeking of partnerships with companies and institutions and support from the general public, staff and individuals.

An agreement has been made with several food outlets/restaurants on campus who offer healthy, balanced meals to NSH students when they swipe their student cards that are funded by the programme.

At the end of the year the process is reviewed and students who still qualify are reinstated on the programme, whilst those whose circumstances have changed or are no longer in need of the bursaries, make way for new applications.

The NSH Team meets with students on a regular basis with the purpose of offering training, motivation and opportunities for personal growth and career development. Students are also expected to become involved in projects as a way of ploughing back into the community.

The goal is to expand the project annually as support for it grows.
Ms Nicky Abdinor, a clinical psychologist from Cape Town, who was born without arms and with shortened legs, provided an entertaining motivational speech at the launch. Ms Abdinor, founder of the Nicky's Drive organisation, also visited the UFS’ Unit for Students with disabilities where she delivered a talk on independence for people living with disabilities.

To become involved with the NSH Programme, please contact Mrs René Pelser on +27(0)51 4019087 or e-mail pelserr@ufs.ac.za.

Media Release
28 March 2012
Issued by: Lacea Loader
Director: Strategic Communication
Tel: +27(0)51 401 2584
Cell: +27(0)83 645 2454
E-mail: news@ufs.ac.za

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