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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

New challenges for animal science discussed

2006-04-04

Some of the guests attending the congress were from the left Dr Heinz Meissner (honorary president of the South African Society for Animal Science (SASAS) and senior manager at the Animal Production Institute of the Agricultural Research Council), Mr Paul Bevan (President of SASAS) and Prof Magda Fourie (Vice-Rector: Academic Planning at the UFS).
Photo: Lacea Loader

New challenges for animal science discussed

The South African Society for Animal Science (SASAS) is presenting its 41st Congress at the University of the Free State’s (UFS) Main Campus in Bloemfontein.

The congress started yesterday and will run until Thursday 6 April 2006. The theme is New challenges for the animal science industries.

It is one of the largest congresses in the 45 years since SASAS was founded in 1961. Among the delegates 12 African countries are represented, with the biggest delegation from Kenya. Delegates are also from the United States of America, Iran, Turkey, Germany, the Netherlands and Portugal and African countries like Zimbabwe, Mozambique and Botswana.

“Many of our members play an important role in the training of animal scientists at universities. The congress is specifically industry orientated so that scientists can interact with farmers through the respective producer organisations,” said Prof HO de Waal, Chairperson of the organising committee and lecturer at the UFS Department of Animal, Wildlife and Grassland Sciences.

According to Dr Heinz Meissner, honorary president of SASAS and a senior manager at the Animal Production Institute of the Agricultural Research Council, the National Livestock Strategy (NLS) Plan clarifies the role and responsibility of the livestock sector.

“Through this strategy we need to focus on enhancing equitable access and participation in livestock agriculture, improve global competitiveness and profitability of the livestock sector and ensure that the ventures implemented do not over utilise our resources,” said Dr Meissner.

In her welcoming address, Prof Magda Fourie, Vice-Rector: Academic Planning at the UFS highlighted the related challenges that the UFS will be focusing on specifically over the next five years. “We have identified five strategic clusters that represent broad areas of excellence in research and post-graduate education. Two of these are food production, quality and safety for Africa and sustainable development,” she said.

“The food safety and security cluster will focus on the production of food in all its varieties within the African context, encompassing the entire value chain – from production to consumption and nutrition related issues. This would include a strong emphasis on sustainable production systems,” she said.

According to Prof Fourie the rural development cluster will engage in questions around the role of higher education in sustainable development. “One of the focus areas in this strategic cluster pertains to sustainable livelihoods. It refers to a way of approaching development that incorporates all aspects of human livelihoods and means by which people obtain them,” she said.

Prof Fourie said that the challenges we are facing such as food production can only be effectively addressed through collaborative efforts. “That is why it is important that collaboration takes place between different scientific disciplines, researchers, institutions and countries who are confronted with similar difficulties,” she said.

According to Prof de Waal the congress will give key role players a unique opportunity to present a profile of what they perceive an animal scientist should be and state their specific requirement regarding the animal sciences and its applications.

“In this way we can determine what the industry’s needs are and we can re-align our curriculum to suit these needs,” said Prof de Waal.

During the next two days, various areas of interest will be discussed. This includes ruminant and monogastric nutrition, animal physiology, beef, dairy, sheep and ostrich breeding and sustainable farming covering the range from commercial to the small-scale farming level.

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

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