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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

UFS takes lead in improving quality of training in economics in schools

2006-06-20

The fourth international workshop for trainers in the National Council on Economic Education’s (NCEE) outreach programme for Africa, Latin America, Asia and the Middle East will be presented in Bloemfontein from 18-24 June 2006.

“Because of the rapid success we achieved in the Free State with similar workshops in Economics education that were presented by the NCEE the past year, we have now invited representatives from education departments and universities of five other provinces to attend the international workshop for trainers,” said Prof Klopper Oosthuizen, lecturer at the University of the Free State’s (UFS) Department of Agricultural Economics and initiator of the cooperative agreement with the NCEE.

The UFS and the Free State Department of Education are the NCEE’s first partners in Africa who received this training. “The attendance of the five provinces and universities is the first step in the extension of the programme to the rest of the country,” said Prof Oosthuizen.

The NCEE is based in the United States of America (USA) and the workshop forms part of the council’s effort to improve the quality of the training of Economics teachers and lecturers across the world.

“South Africa is urgently in need of efforts to improve the integration of black people into the market economy. An understanding of how markets work is one of the pillars of democracy. Equipping young people with economic understanding and skills will help empower them for responsible roles as individuals and citizens,” said Prof Oosthuizen.

According to Prof Oosthuizen representatives from the education departments of the Northern Cape, Western Cape, Eastern Cape, KwaZulu-Natal and North West will also be attending the international workshop for trainers. Representatives from the Universities of Rhodes, of KwaZulu-Natal, North West and the Durban University of Technology as well as the Cape Peninsula University of Technology will also attend the workshop.

During this workshop teachers and lecturers in Economics will receive certificates.

Various subjects will be covered during the workshop such as world trade patterns, cost and benefits of free trade, exchange rates and international finance. The training will be done by representatives from the NCEE by using methods such as direct instruction and role play.

The NCEE is also in the process of training teachers and learning facilitators in the Free State in an effort to improve the quality of Economics classes in secondary schools.

“A group of 84 teachers and learning facilitators were trained in December 2005, 50 were trained in January 2006 and the last group of 40 will be trained at the UFS Main Campus in Bloemfontein from 26 June - 1 July 2006,” said Prof Oosthuizen.

During this seminar the teachers will be trained in issues such as broad social goals in an economy, economic decision making, government’s role in a market economy and fiscal policy. The training will also be done by representatives from the NCEE.

The NCEE has been working together with international partners since 1992 to strengthen their Economics teaching systems. They have already succeeded in increasing literacy in Economics at schools in the USA and more than 20 East Block countries. More than 1,5 million learners in the East Block countries have already been served by this initiative. Since 2004 the NCEE’s focus has moved away from the East Block countries to Africa, Asia, Latin America and the Middle East.

“Our future plans include strengthening the growing partnership between the UFS, the Free State Department of Education and the NCEE. We also want to establish a council and centres for economic education which will serve as an umbrella for our joint efforts,” said Prof Oosthuizen.

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

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