Latest News Archive

Please select Category, Year, and then Month to display items

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

Association of Former SRC Presidents – first of its kind

2013-08-19

Some of the former SRC presidents who attended the inaugural dinner were, from the left: Roelf Meyer, Bloemfontein Campus 1970; Dr More Chakane, Qwaqwa Campus 1990; vice-chairperson of the AFSP; Dr Anchen Laubscher, first woman president of the Bloemfontein Campus 2003; and Prof Voet du Plessis, Bloemfontein Campus 1967/8.
Photo: Stephen Collett
19 August 2013

The University of the Free State (UFS) made history this weekend with the establishment of its Association of Former SRC Presidents (AFSP) – the first association of its kind after the merging and incorporation of public institutions in 2003–2004.

Twenty-two former SRC presidents attended the inaugural dinner to launch the association on Women's Day, Friday 9 August 2013, and recognised especially the attendance of all four female presidents that previously chaired the SRC. Other guests included former rectors and chairpersons of the UFS Council, as well as chairpersons of the Alumni.

The attending presidents served during the period 1967–2012, either at the former University of the Orange Free State (UOFS), the Qwaqwa Campus of the former University of the North, South Campus of the former Vista University and the University of the Free State.

“Your very personal narratives as former student leaders during the troubled past of our history in South Africa matter most as you design the questions for and purpose of an authentic conversation with student leaders today – this will set your association apart from others," said Rudi Buys, Dean of Student Affairs.

Former SRC president of 1975/6 and now founding member and chairperson of the association, Dr Michiel Strauss, said that this is the opportunity for former student leaders to give back to the younger generation.

“It is true that many middle-aged white South Africans have a deep sense of debt and obligation towards the youth of our country. We owe them an apology for the discrepancies of the past. This apology should be more than just words. Deeds of reconciliation and restitution must be seen.

“As for myself; I was president of the SRC of the then UOFS in the same period in which the biggest part of the youth of South Africa suffered so much in their struggle for freedom in our country.

“In my personal capacity, as well as in my official capacity as SRC president, I did nothing to try and understand and/or co-operate in the struggle of my peers. This fact haunts me until this day.

“The question then for people like me and so many others, is: Where do I invest my time and energy and passion for this country? Where will my contribution make a real difference? There is no better answer to this burning question than to invest in the human resources in our beloved South Africa, and more focused – to invest in the young people.

“There is something meaningful and beautiful happening at the UFS and it is now a leader in academic standards, reconciliation, leadership formation and nation building. I can think of no better place to make my small contribution,” Dr Strauss said.

“As former student leaders, we have a sense of purpose to contribute to the university and there is no better time to start than now. It is my privilege to be part of this great initiative and I look forward to what will be achieved,” said Dr More Chakane, deputy chairperson of AFSP and former SRC president of the Uniqwa Campus of the University of the North in 1990 (now the Qwaqwa Campus of the UFS).

Roelf Meyer, known for the prominent role he played in the negotiations to end apartheid in South Africa and chairperson of the Civil Society Initiative (CSI) of South Africa, said his time as a leader at the university has given him the opportunity to apply and use his skills and experience and share it with the new leaders of the institution. "The UFS is highly regarded because of the exceptional standards and excellence portrayed by its senior leadership. Where I can make a difference, I'll do it with pleasure and pride," he said. Meyer served as SRC president in 1970.

The association met on Saturday 10 August 2013 to adopt its interim constitution and consider operational matters, while also reaching agreement on its core functions in support of its purpose to transfer change leadership skills to incumbent student leaders and mediate meaningful contributions of Alumni to the growth of the university.

“We greatly value the declared intention of AFSP to work with the university to design meaningful and sustainable mentorship programmes to support and guide student leaders on campus, and have pledged our support in this regard,” said Buys.

Back

Economic and Management Sciences

Education

Health Sciences

The Humanities

Law

Natural and Agricultural Sciences

Theology and Religion

Open Distance Learning

Business School

We use cookies to make interactions with our websites and services easy and meaningful. To better understand how they are used, read more about the UFS cookie policy. By continuing to use this site you are giving us your consent to do this.

Accept