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20 December 2021 | Story Elsabé Brits
Dr Elgonda Bekker
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

It’s Rag Time!
2014-01-14

 

Zakes Bantwini, Mango Groove and Robbie Wessels 
Photos: Supplied

Kovsie Rag Community Service will start 2014 off with the well-known Rag festivities, with enthusiastic students already starting with float building in January. The theme for Rag CS 2014 is ‘Movies.’

As from 20 January, a cheerful atmosphere will be present at the Kovsie Rag farm, with senior and junior students working hard, while social cohesion is developing between them. Great entertainment will be part of these festivities, with the likes of DJ Euphonik and Adam performing on 31 January.
In the midst of all these activities, the annual ‘Chicken Run’ evening collections will take place on 21, 23 and 28 January, as well as the Ritsim sales in Bloemfontein and surrounding areas on 24-25 January.

The hard work will reach its peak with the judging of the floats on the morning of 1 February, after which the floats will depart at 09:00 for the first procession of the day. This route will end at Twin City Mall at 11:00, where 10 000 meals will be distributed to communities in Heidedal and Mangaung. Learners from Heidedal schools will entertain the public with their talents.

Our very popular family festival will already start at 16:00 with the opening of the gates at Chevrolet Park Cricket Stadium. Young and old will be entertained by well-known and vibrant artists, such as Robbie Wessels, Mango Groove, Zakes Bantwini, as well as a spectacular firework show. Come early to ensure a great spot on the grass.

The float winners will be announced at 17:00, whereafter the main procession of the day will depart from the Tempe robot in Nelson Mandela Drive at 18:00. The public can look forward to this ever popular procession through the streets of Bloemfontein, with decorated floats and students cradling collection tins proceeding to Chevrolet Park. The 2012/2013 UFS Rag queen, Mr Rag and their retinue will greet the public from the main float. Finalists for the 2013/2014 UFS Rag queen and Mr Rag titles, as well as drum majorettes, will also accompany the procession.

Do not miss out on this wonderful family festival – come early, bring your family and picnic blanket/chairs to ensure a great spot on the grass – a variety of refreshments will be on sale.

Tickets available from Computicket and entrance gates.

Tickets: R60 per person
R30 per child under 12

We would also like to make use of this opportunity to remind you of our vibrant 2013/2014 UFS Rag coronation ball, where the UFS Rag queen and Mr Rag CS for 2014 will be crowned on 14 February 2014 in the Callie Human Centre, UFS Campus.

Limited tickets will be available at R500 per couple and can be bought from the Rag Community Service office from 5 February 2014.

Enquiries:

Karen Scheepers +27(0)51 401 2423 ( ScheepersK@ufs.ac.za )
Esmé Wessels +27(0)51 401 3769 ( Wesselse@ufs.ac.za )

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