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

New student leaders for UFS

2013-08-29

Rudi Buys, Dean of Student Affairs (centre), with newly elected president of the Bloemfontein Campus SRC, Phiwe Mathe (left) and Matlogelwa Moema, president of the Qwaqwa Campus SRC.
Photo: Sonia Small
29 August 2013

Photo Gallery
2013/14 Student Representative Councils: YouTube video

Phiwe Mathe and Matlogelwa Moema, both third year students, have been elected as presidents of the 2013/14 Student Representative Councils (SRC) of the University of the Free State’s Bloemfontein and Qwaqwa Campuses respectively. They now also serve as the presidency of the Central SRC and will take up their seats as voting members of the UFS council in September 2013. Thirty-eight candidates contested the 19 elective seats of the campus SRCs, for which 83 nominations were received.

Rudi Buys, Dean of Student Affairs, announced the completion of the elections at the two campuses as successful.Buys deemed the elections highly significant, considering it is the third year of peaceful elections since students adopted changes in student governance in 2011. These changes included, among others, the introduction of independent candidacy for elective portfolios and organisational candidacy in SRC sub-councils that hold ex-officio seats on the campus SRC. Changes also included the establishment of student representative seats in faculty forums and the adoption of reviewed SRC constitutions, Buys said.

The SRC elections at the Qwaqwa Campus were completed on 23 August 2013, while the elections at the Bloemfontein Campus took place on 26 and 27 August 2013. Elections at the Qwaqwa Campus showed a voter turnout of 44% and at the Bloemfontein Campus a turnout of 31.5%, which is among the highest in the country.

Both campuses reached the required quorums and the campus elections bodies, the IEA (Bloemfontein Campus) and IEC (Qwaqwa Campus), declared the elections free and fair and announced the results as a true reflection of the will of the student bodies at the campuses.

This year also saw the piloting of a central SRC elections oversight committee (CEC) to strengthen independent oversight of all elections. The CEC monitors the elections as free, fair and democratic and consists of senior academics and former student leaders of the Student Elders Council. Prof Loot Pretorius, inaugural chair of the CEC, announced the CECs confirmation of the SRC elections across campuses as free, fair and democratic.

Celebrations marked a mass meeting on the Bloemfontein Campus where the new student leaders were announced on Thursday 29 August 2013. There were cheers and singing as Quintin Koetaan, Head of the Bloemfontein IEA, on behalf of the two elections bodies, read the names of the newly-elected student leaders of both campuses. Delivering his victory speech, Phiwe thanked competitors for running a good debate, saying it was not about characters or personalities, but rather the ideas that would best serve a Kovsie. “Students will remain central and the ‘R’ is back in SRC,” he told the resounding crowd. Matlogelwa reiterated this message and said, "the SRC is for students and will serve all students equally."

Following on the heels of the SRC elections, voting for residence committees will take place next week with 618 candidates contesting 231 available positions. The elections of association executive committees will also take place in September.

The new SRC members of the Bloemfontein Campus are:

President: Phiwe Mathe
Vice-President: Tshepo Moloi
Secretary: Masiteng Paul Matlanyane
Treasurer: Willem du Plooy
Arts andCulture:Hlonipa Matshamba
Accessibility and Student Support:Anastasia Sehlabo
First Generation Students: Nthabiseng Malete
Legal and Constitutional Affairs: Mosa Leteane
Media, Marketing and Liaison: Callie Hendricks
Sport: Laurika Hugo
Student Development and Environmental Affairs: Bataung Qhotsokoane
Transformation: Christopher Rawson
Assosiations Council and Ex officio:Ntakuseni Razwiedani
Academics Affairs Council and Ex officio: TBC
Residence Council and Ex officio: Andricia Hinckermann
Commuter Council and Ex officio:Clarise Haasbroek
Postgraduate Council and Ex officio: Oluwatoba Fadeyi
International Council and Ex officio: Brian Hlongwane
Student Media Council and Ex officio: Keabetswe Magano
RAG Fundraising Council and Ex officio: Jaco Faul
Rag Service Council and Ex officio: Suzanne Maree

The new SRC members of the Qwaqwa Campu are:

President: MP Moema
Deputy-President: NT Mndebele
Secretary General: JC Mosiea
Treasurer General: NT Zuma
Politics and Transformation: IT Dube
Media and Publicity: ZF Madlala
Student Development and Environmental Affairs:SS Mtetwa
Off-Campus Students: TSJ Sithole
Arts and Culture: S Mabele
Academic Affairs: NE Litabo
Sport Affairs: TSG Mohlakoana
Religious Affairs:TW Mofokeng
Residence and Catering Affairs: A Ndabankulu
RAG Community Service and Dialogue: S Yende

Issued by: Lacea Loader
Director: Strategic Communication

Telephone: +27(0)51 401 2584
Cellphone: +27 (0) 83 645 2454
E-mail: loaderl@ufs.ac.za

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