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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

Faculty of Law establishes unique panel of advisors

2005-11-11

Photo: Stephen Collett

Some of the panel members who attended the Collegium Iurisprudentium of the Faculty of Law at the UFS were from the left His Honorable Judge of Appeal Lex Mpati (Vice-President of the Supreme Court of Appeal), His Honorable Judge of Appeal Joos Hefer (former Chief Justice of South Africa), His Honorable Judge of Appeal Frits Brand (Supreme Court of Appeal) and Mrs Alet Ellis (lecturer at the UFS Faculty of Law).

At the back from left were Prof Johan Henning (Dean: Faculty of Law at the UFS), His Honorable Judge Faan Hancke (High Court of the Free State and chairperson of the UFS Council) and Adv Jannie Lubbe Sc.

The Faculty of Law at the University of the Free State (UFS) has established a panel of advisors comprising of all the honorary and extraordinary professors of the faculty.

“The faculty has been known for its excellent practice-orientated training as well as the involvement of law practitioners in the training of LL B-students,” said Prof Johan Henning, Dean of the Faculty of Law at the UFS.

“The faculty was greatly dependent on the services of advocate lecturers, full-time members of the Bar and Side Bar who lectured on a part-time basis at the faculty. For this reason lecturing in the faculty was mainly done after-hours to part-time students,” said Prof Henning.

With the shift in emphasis to full-time lecturing and the appointment of full-time lecturers, especially because of the increasing student numbers, the full-time LL B-programme and the increasing pressure on students for quality research inputs, a greater need for meaningful contributions of judges and senior law practitioners to the faculty was experienced.

“To comply with this urgent need, three honorary professors and nine extraordinary professors were appointed. This group of experts deliver an indispensable contribution to the practice orientation of the faculty by means of formal lectures, public inaugural lectures and guest lectures, direct lectures to graduate and post-graduate students, participation in research projects and the constant evaluation of lecturers, modules and the content of modules and learning material. The international exposure of students and lecturers is also promoted by their contribution,” said Prof Henning.
“A need to have the involvement of this special class of professors structured in a more organised way was identified and a decision was made to establish an advisory panel called Collegium Iurisprudentium. It is a privilege to us that all the honorary and extraordinary professors accepted the invitation,” said Prof Henning.

The panel will provide the faculty with continuous, distinguished, practice- orientated capability and capacity as well as international expertise, not only for direct inputs to students but also to advise lecturers about the curriculum, the compilation of the content of the LL B and M module, learning material and others, as well as to strengthen the research capacity of the faculty.

“The panel will also deliver a decisive contribution to the faculty’s preparation for the constitutional audit of the Higher Education Quality Committee (HEQC) of the Council for Higher Education (CHE) that will take place in October 2006,” said Prof Henning.

The Collegium Iurisprudentium, which has been formally constituted, comprises of:

Appeal Court Judge J J F Hefer,
Appeal Court Judge L Mpati
Appeal Court Judge F D J Brand
Appeal Court Judge I G Farlam
Prof B A K Rider
Judge S P B Hancke
Judge A Kruger
Judge D H van Zyl
Adv S J Naudé
Adv J Lubbe Sc
Prof M M Katz
Prof R J Cook
Mr S van de Merwe
Mr W van der Westhuizen
Mr D C M Gihwala

Media release
Issued by:Lacea Loader
Media Representative
Tel: (051) 401-2584
Cell: 083 645 2454
E-mail: loaderl.stg@mail.uovs.ac.za
11 November 2005

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