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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

Moshoeshoe Memorial Lecture to focus on Leadership challenges

2006-03-27

Lecture to focus on Leadership challenges

n Thursday 25 May 2006 – Africa Day – the University of the Free State (UFS) will host the inaugural King Moshoeshoe Memorial Lecture in honour of this great African leader and nation-builder.

Prof Njabulo Ndebele, internationally renowned writer and academic, and Vice-Chancellor of the University of Cape Town (UCT), will deliver the inaugural lecture at the Main Campus in Bloemfontein on the topic: Reflections on the Leadership Challenges in South Africa.

“I see the lecture as part of a larger debate on leadership models, particularly the concept of African leadership, as well as the ongoing discourse about nation-building and reconciliation,” says Prof Frederick Fourie, Rector and Vice-Chancellor of the UFS.

According to Prof Fourie, the Moshoeshoe project was launched at the UFS in 2004 to coincide with South Africa’s first decade of democracy and was part of the University’s centenary celebrations, having been founded in 1904.

“Through this project the UFS seeks to honour a great African leader and demonstrate our commitment to transformation so as to create a truly inclusive and non-racial university,” said Prof Fourie.

“As the founder of the Basotho nation, King Moshoeshoe is widely credited for his exceptional style of leadership, displaying the characteristics of diplomacy, reconciliation and peaceful co-existence in his efforts to unite diverse groups into one nation,” said Prof Fourie.

As part of its ongoing Moshoeshoe project, the UFS commissioned a television documentary programme on the life and legacy of King Moshoeshoe. This was completed in 2004 and broadcast on SABC 2 later that year.

For further information, Me Tumi Tabane can be contacted at (051) 401-2828 or tabaneme.stg@mail.uovs.ac.za.

Abridged curriculum vitae of Njabulo S Ndebele

Professor Njabulo S Ndebele is currently Vice-Chancellor and Principal of UCT.

Njabulo Ndebele began his term of office at UCT in July 2000, following tenure as a scholar in residence at the Ford Foundation’s headquarters in New York. He joined the Foundation in September 1998, immediately after a five-year term of office as Vice-Chancellor and Principal of the University of the North in Sovenga, at the then Northern Province. Previously he served as Vice-Rector of the University of the Western Cape. Earlier positions include Chair of the Department of African Literature at the University of the Witwatersrand; and Pro-Vice-Chancellor, Dean, and Head of the English Department at the National University of Lesotho.

An established author, Njabulo Ndebele recently published a novel The Cry of Winnie Mandela to critical acclaim. An earlier publication Fools and Other Stories won the Noma Award, Africa’s highest literary award for the best book published in Africa in 1984. His highly influential essays on South African literature and culture were published in a collection Rediscovery of the Ordinary.

Njabulo Ndebele served as President of the Congress of South African Writers for many years. As a public figure he is known for his incisive insights in commentaries on a range of public issues in South Africa. He holds honorary doctorates from Universities in the Netherlands, Japan, South Africa and the United States of America. He is also a Fellow of UCT.

Njabulo Ndebele is also a key figure in South African higher education. He has served as Chair of the South African Universities Vice-Chancellor’s Association from 2002-2005, and served on the Executive Board of the Association of African Universities since 2001. He has done public service in South Africa in the areas of broadcasting policy, school curriculum in history, and more recently as chair of a government commission on the development and use of African languages as media of instruction in South African higher education. He recently became President of the Association of the AAU and Chair of the Southern African Regional Universities Association (SARUA).

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

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