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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

Research project gives insight into the world of the deaf

2005-11-30

Mr Akach in conversation (using sign language) with his assistant Ms Emily Matabane. Photo: Lacea Loader

UFS research project gives insight into the world of the deaf

The Sign Language Division of the University of the Free State’s (UFS) Department of Afro-Asiatic Studies and Language Practice and Sign Language has signed a bilateral research project with the universities of Ghent and Brussels to write a book on sign language.

“We want to compare the Belgium and South African sign languages with each other. The book will be about the deaf telling us about themselves and how they live. It will also focus on the use of story telling techniques and the grammar used by deaf people. We want to see if the hand forms and the grammatical markers and other linguistic features that deaf people from these two countries use are the same or not,” said Mr Philemon Akach, lecturer at the UFS Sign Language Division and coordinator of the research.

According to Mr Akach, the sign language community in South Africa, with about 600 000 deaf people who use South African Sign Language (SASL) as first language, is quite big. “Over and above the deaf people in South Africa, there are also the non-deaf who use SASL, like the children of deaf parents etc. This book can therefore be used to teach people about the deaf culture,” he added.

Another of Mr Akach’s achievements is his election as Vice-President of the newly established World Association of Sign Language Interpreters (WASLI). The association was established earlier this month during a conference in Worcester.

Mr Akach has been actively involved with sign language interpretation since 1986 and has been interpreting at the World Congress of the World Federation of the Deaf (WFD) since 1987. “My appointment as Vice-President of the WASLI is an emotional one. I have been involved with deaf people for so long and have been trying to create awareness and obtain recognition for sign language, especially in Africa,” said Mr Akach. WASLI is affiliated to the WFD.

According to Mr Akach there was no formal structure in the world to support sign language and sign language interpreters. “Now we have the backup of WASLI and we can convince governments in other African countries and across the world to support deaf people by supporting WASLI and therefore narrow the communication gap between the deaf and the hearing. My main aim as Vice-President is to endeavour for the recognition of sign language and spoken language interpreters as a profession by governments,” he said.

According to Mr Akach the formal training of interpreters is of vital importance. “Anybody who has a deaf person in his/her family and can communicate in sign language can claim that they are an interpreter. This is not true. It is tantamount to think that all mother tongue or first language speakers are interpreters. Likewise students who learn sign language up to whatever level and are fluent in signing, should still join an interpreter’s programme,” he said.

“Sign language interpreting is a profession and should be presented as an academic course alongside other spoken languages. The UFS has been taking the lead with sign language and spoken language interpretation and was the first university on the African continent to introduce sign language as an academic course,” he said.

“Although sign language has always been an unknown language to young people it has become quite popular in recent years. This year we had a total of 160 students at the Sign Language Section of the UFS and the numbers seem to increase steadily every year,” he said.

Mr Akach’s assistant, Ms Emily Matabane, is deaf and they communicate in sign language. Ms Matabane also handles the tutorials with students to give them hands-on experience on how to use sign language.

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

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