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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

Shortage of quantity surveyors discussed at UFS

2006-03-24

During the recent visit of the Association of South African Quantity Surveyors (ASAQS) to the University of the Free State (UFS) were from the left Mr Egon Wortmann (Director: ASAQS), Prof Basie Verster (representative of the Free State on the ASAQS and head of the Department of Quantity Surveying and Construction Management at the UFS), Mr Greyling Venter (Chairperson: Free State branch of the ASAQS), Prof DG Brümmer(Vice-President: ASAQS) and Mr Patrick Waterson (President: ASAQS).
Photo supplied

Shortage of quantity surveyors discussed at UFS

“The South African building industry is experiencing an unprecedented high level of economic growth and prosperity. This is causing a definite shortage of registered quantity surveyors,” said Mr Egon Wortmann, Director of the Association of South African Quantity Surveyors(ASAQS) during the association’s recent visit to the Department of Quantity Surveying and Construction Management at the University of the Free State (UFS).

“This shortage is especially noticeable in local and national governments where unqualified and inexperienced staff, consultants and/or facilitators are now appointed,” said Mr Wortmann.

In doing so, the authorities that have adopted this approach are according to Mr Wortmann actually acting illegally and are not in compliance with the legal and statutory requirements of South Africa. “These unprofessional practices are unproductive, it leads to frustration and is strongly condemned by the ASAQS,” he said.

“The service delivery of these unqualified and unregistered service providers is often sub standard and does not comply to the legal requirements of the profession. It may also result in the tarnishing of the image and high professional standards set by the quantity surveying profession,” said Mr Wortmann.

“Universities offering programmes in quantity-surveying and construction management are also negatively affected by the high levels of activity in the building environment. Suitable lecturing staff are leaving the academic institutions as they are attracted to better opportunities being offered in the building industry. The ability of the tertiary institutions to attract young academics, to train them and to keep them in the longer term, is therefore almost impossible”, said Prof Basie Verster, head of the Department of Quantity Surveying and Construction Management at the UFS and representative of the Free State on the ASAQS.

According to Prof Verster the UFS supplies more than its quota of qualified quantity surveyors to the South African building industry. “Although more than 460 students are registered in construction related programmes at the UFS, we are as the ASAQS’s concerned about the shortage of students that can enter the construction industry. In our case, we are experiencing a shortage in black female students,” he said.

“Of the 460 postgraduate students, 38% are black of which 20% are female students. Graduates do also not necessarily stay in the country. As the UFS’s programmes are accredited overseas, a lot of our students leave the country for working opportunities elsewhere,” said Prof Verster.

Mr Patrick Waterson, President of the ASAQS, appealed to quantity surveyors to, when they are approached, consider academic careers or to make themselves available to lecture on a part time basis. “I also appeal to quantity-surveying practices, construction companies and developers to consider taking part in training activities,” he said.

The ASAQS has over the years developed a proud tradition within the quantity-surveying profession. Consequently membership of this organisation is a sought after goal for many members within the building environment. International agreements with various countries are also in place whereby it is mutually agreed that local as well as overseas qualifications are mutually acceptable on a reciprocal basis.

A more recent addition to the list of agreements is the reciprocity agreement entered into with the Royal Institution of Chartered Surveyors which makes it possible for South African based quantity surveyors to practice in over 120 countries worldwide.

Media release
Issued by: Lacea Loader
Media Representative
Tel: (051) 401-2584
Cell: 083 645 2454
E-mail: loaderl.stg@mail.uovs.ac.za
23 March 2006

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