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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

Council votes on appointment of senior staff

2004-11-18

The Council of the University of the Free State (UFS) today voted on the filling of three senior vacancies, including one post at Dean level and two at the level of Vice-Dean.

The Council voted as follows:


Dr Natie Luyt will be offered the post of Dean: Student Affairs	Prof Engela Pretorius will be offered the post of Vice-Dean: Faculty of Humanities	Dr Choice Makhetha will be offered the post of Vice-Dean: Student Affairs

“There are special challenges for the UFS in the short and medium term regarding transformation of our residences, and a certain combination of management qualities and skills is desirable. As a result of the diversity of the UFS’s student community it is therefore important to us to follow a team approach to deal with the challenges. With the combination of Drs Luyt and Makhetha, I believe we will be able to manage student affairs effectively and skillfully,” says Prof Frederick Fourie, Rector and Vice-Chancellor of the UFS.

“It is wonderful that we are able to celebrate the outcome of this process that has brought forward such excellent candidates who reflect our country’s diversity. It shows that we can achieve the goals of quality and diversity at the same time,” says Prof Fourie.

Prof Pretorius obtained all her qualifications (BA, BA (Hons) (cum laude), MA (cum laude) and D Phil) from the UFS, except for the Certificate in Gender Policy Management (cum laude) which she obtained in 2000 from WITS. She joined the Department of Sociology at UFS in 1980 and has headed the Department since 2001. She acted as Vice-Dean: Faculty of Humanities since July 2004. She has some thirty publications to her credit, published both nationally and internationally and has delivered 20 national and international papers. She is a member of the South African Sociological Association and is a member of the Council of the association and of the Editorial Board of Society in Transition, the society’s journal. She is also a member of the South African Academy for Science and Art and the Federation of African Women Educationalists in South Africa (FAWESA). Project involvement includes the Australian Women’s Executive Development Programme and the project Executive Development of Senior Women in South African Higher Education Institutions. She is also an NRF panelist.

Dr Luyt obtained his qualifications (BA, BA (Hons) (cum laude), MA (cum laude) and D Phil) at the UFS and started his career at the same institution in 1980 as lecturer in Political Science. He was promoted to senior lecturer in 1983 and appointed as Director: Student Affairs in 1997. He has been acting as Dean: Student Affairs since 2003. Dr Luyt completed several work-related training courses, among others a course in ethnic and multiculturality at the Swiss Institute for Federalism and a course in conflict management at the South Tyrolean Economic and Social Institute.

Dr Makheta also obtained all her qualifications (BA, BA (Hons), MA in Political Science and Ph D in Political Science) at the UFS and started working as a student assistant in Political Science at the same institution in 1999. She was promoted to junior assistant in 2000, coordinator and facilitator of Political Science in 2001, assistant/acting Director: Student Affairs in 2001 and acting Director: Student Affairs in 2003. Dr Makhetha is currently a Senior Political Analyst at the Department of Foreign Affairs.

The UFS Council also approved the promotion of nine professors to the rank of senior professor. They are Proff Louise Cilliers (Department English and Classical Languages), Dap Louw (Department of Psychology), Philip Nel (Department Afro-Asiatic Studies, Sign Language and Language Practice), Dirk van den Berg (Department of History of Art and Visual Culture Studies) Dingie van Rensburg (Director: Centre for Health Systems Research and Develoment), Andries Raath (Department of Constitutional Law and Philosophy of Law), James du Preez (Department of Microbial, Biochemical and Food Biotechnology), Johan Grobbelaar (Department of Plant Sciences) and Louis Scott (Department of Plant Sciences).

This is the first group ever of senior professors at the UFS. The post level was created to provide better career and earnings opportunities for high quality academics and to increase the attractiveness of an academic career to young people.

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

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