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

UFS committed to transformation

2005-02-23

UFS committed to transformation

The management of the University of the Free State (UFS) takes note that plans are being made to stage a student protest at the UFS main campus on Monday 28 February 2005 .

This is in line with a concerted national campaign to highlight the issue of transformation at higher education institutions.

At this stage the UFS management has not received any application from student formations to stage such a protest at the main campus in Bloemfontein .

The UFS upholds the right of all staff and students to hold legal, non-violent protests and in this spirit encourages the student formations to apply for permission to hold their protest. However, the UFS management has been - and always will be willing to discuss the important issue of transformation of the UFS with staff unions and student formations.

Again the UFS management appeals to student formations to make use of this open door policy and not to adopt a confrontational position. In fact the management and the Senate of the UFS have come out in support of a new phase of transformation at the UFS.

In his speech at the official opening of the UFS earlier this month (on 4 February 2005 ), the Rector and Vice-Chancellor, Prof Frederick Fourie, announced that a comprehensive transformation plan for would be drafted for the UFS.

This Transformation Plan would address issues such as:

a new institutional culture for the UFS
the need for representivity in the staffing of the UFS
ensuring relevance of curricula for the South African and African context
enhancing excellence in the overall academic life of the UFS
ensuring greater interaction among black and white students and staff
addressing outstanding issues in the incorporation of the Qwaqwa and Vista campuses, among others

Concerning some of the issues that are being put forward to motivate for a protest march, the UFS would like to highlight the following facts:

The situation at the Qwaqwa campus

It is not true that the UFS has decided to close down the Qwaqwa campus. This is a complete falsehood. The campus was incorporated into the UFS in January 2003 and since then every effort is being made to ensure the viability of the Qwaqwa campus.
In fact the UFS has just upgraded residences at the Qwaqwa campus – to the tune of R6,8-million.
In addition, another R1,4-million has been set aside for the upgrading of other facilities on the Qwaqwa campus.
More staff has been appointed and the library is acquiring more books etc.
The management of the UFS wants to assure staff at the Qwaqwa campus once again that there has been no decision to close the campus.
We realise that the incorporation of the campus into the UFS has given rise to certain fears and concerns, but these are being addressed, including the question of reporting lines of staff and the further delegation of powers to the head of the Qwaqwa campus, Prof Peter Mbati.

The situation at the Vista campus

A number of processes are currently under way to address outstanding issues following the formal incorporation of the Vista campus into the UFS in January 2004.
This includes the integration of former Vista staff into the UFS as well as the alignment of the conditions of service of the former Vista staff with the UFS conditions of service.
Indeed, over the last few weeks, a climate of trust has been developing and a number of meetings have taken place in contrast to the situation that obtained at the end of 2004.
Just last week, the Rector reassured the Vista Task Team representing the former Vista staff that these staff members are indeed part of the UFS staff complement.
When the Vista campus was incorporated into the UFS, it was agreed that no new first years would be registered there, so as to avoid duplication with the main campus which is only a few kilometers away.
Instead, those students who were registered as Vista students at the time of incorporation (January 2004) would be allowed to complete their studies.
In terms of this agreement another process of consultation with key stakeholders on and off campus would be initiated to determine how the physical facilities of Vista could be used to contribute to educational and skills provision in the region and the province.
This process is still in its early stages and no final decision has been made regarding the long term strategic reconfiguration of the Vista campus.
In any case, as stated by the Rector, former Vista staff do not have to fear about their work security as this is not dependent on the future use of Vista campus – the two issues are not related.

Financial aid for students at the Qwaqwa campus

Concerning financial aid to students at Qwaqwa, the UFS has to date (that is up to 22 February 2005 ) made available R25 000 each to 705 students.
That amounts to R17,6 million.

Financial aid for students at the Vista campus

Concerning financial aid to students at Vista , the UFS has to date (that is up to 22 February 2005 ) made available R14 500 each to 104 students.
That amounts to R1,5 million.

Registration

The registration processes at both these campuses are not yet completed. So final figures are not yet available.
What we can say so far, is that 1339 students have registered at the Qwaqwa campus and that more are expected to register. At Vista , 545 students have registered so far, and more are expected to do so.
In an effort to assist students during the registration process, management has put in place a structure which is called the Monitoring Committee.
This Monitoring Committee provides counseling on courses of study but also sorts out problems relating to academic fees, etc.
This is how the UFS management in a concrete way gives expression to its commitment to broadening access for academically deserving students.

Alleged racism

There have recently been unsubstantiated allegations of racism leveled at the UFS.
We would like to state unequivocally, that the UFS does not and will not tolerate racism in any way.
There are policies and procedures in place to deal with such allegations and those who feel aggrieved should bring this to the attention of the Director of Diversity, Mr Billyboy Ramahlele.
The UFS also has sensitisation programmes for staff and students to assist in bringing about a truly non-racial, non-sexist, inclusive, multicultural and multilingual campus.

Conclusion

The UFS management remains committed to the further transformation of the institution so that it can play its role in supporting the goal of a non-racial, democratic South Africa united in its diversity.
We are committed to the successful incorporation of the Vista and Qwaqwa campuses and to the speedy resolution of all outstanding issues facing staff and students on these campuses.
We appeal once again to staff and students on these campuses, who are indeed members of the broader UFS community, to play a constructive role in the debate about the strategic direction of the UFS and all its campuses.

Issued by: Mr Anton Fisher

Director: Strategic Communication

Cell: 072-207-8334

Tel: 051-401-2749

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