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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

Twee broers lewer intreerede

2004-06-10

‘n Unieke geleentheid sal homself môre, 9 Junie 2004, voordoen wanneer twee broers - proff Francois en Janse Tolmie - tydens dieselfde geleentheid hul intreeredes aan die Universiteit van die Vrystaat (UV) sal lewer.

Prof Francois Tolmie is verbonde aan die UV se Departement Nuwe Testament en die onderwerp van sy lesing is Die impak van die metodologie op die verstaan van die Nuwe Testament. Prof Janse Tolmie, sy jonger broer, is verbonde aan die UV se Departement Rekenaarwetenskap en Informatika en die onderwerp van sy lesing is Die rol van inligtingstegnologie in kennisbestuur.

Hoewel die studievelde vér verwyderd staan, klop die twee broers se missies wat betref die terugploeg van die verworwe vakkennis ten bate van die gemeenskap. Prof Francois Tolmie is nóú betrokke by dowes en Prof Janse Tolmie tap weer kunsmatige intelligensie ten bate van die mediese wetenskap en geestesgesondheid.

Prof Francois Tolmie verwerf die grade BA, BA Honneurs (Grieks), MA (Grieks), B Th en M Th almal cum laude aan die UV. In 1992 verwerf hy 'n D Th (Nuwe Testament) en in 2004 'n Ph D (Grieks) aan dieselfde universiteit. Na sy militêre diens as kapelaan in Walvisbaai aanvaar hy 'n beroep na die NG-gemeente Walvisbaai. Hy begin sy akademiese loopbaan op 1 April 1990 as senior lektor in die Departement Nuwe Testament en word in 1999 tot medeprofessor en in 2003 tot professor bevorder.

Sy navorsingspesialiteit is die Johannesevangelie en die Brief aan die Galasiërs. Hy is tesourier van die Nuwe Testamentiese Werksgemeenskap van Suid-Afrika, lid van die Society of Biblical Literature en die Studiorum Novi Testamenti Societas, redakteur van Acta Theologica en assistent-redakteur van Neotestamentica. Hy het reeds 34 artikels in geakkrediteerde tydskrifte gepubliseer, asook drie populêr-wetenskaplike boeke en talle bydraes in populêr-wetenskaplike boeke. Hy het twee akademiese boeke in die buiteland gepubliseer - onderskeidelik in Nederland en in die VSA. Later vanjaar verskyn 'n derde akademiese boek in Duitsland. Hy is ook een van die vertalers van die Afrikaanse Bybel vir Dowes.

Prof Janse Tolmie verwerf die grade B Sc, B Sc (Hons) en M Sc (Cum Laude) in Rekenaarwetenskap aan die UV.

Hy is vanaf 1989 betrokke by die UV en was ook ’n dosent aan die Militêre Akademie in Saldanhabaai in 1990/91 en het klas gegee by DePaul Universiteit in Chicago in 2002.

In 1992 is hy vir ses maande gesekondeer na ’n patologiese firma, Van Drimmelen en Vennote, in Johannesburg vir die ontwikkeling van kennisgebaseerde sagteware. Met hierdie projek word hy een van slegs ’n handjievol navorsers in die wêreld wat daarin kon slaag om ’n mediese kundigheidstelsel te ontwikkel wat werklik gebruik word.

Hy verwerf sy Ph D in 1994 en in 1994/95 doen hy navorsing aan die Besigheidskool van Carleton Universiteit in Ottawa, Kanada. Hy word in 1997 bevorder tot mede-professor en in 2003 tot volprofessor. Vanaf 2003 tree hy op as departementele voorsitter van die UV se Departement Rekenaarwetenskap en Informatika.

Hy het meer as 30 publikasies al die lig laat sien, insluitend verskeie internasionale kongresbydraes en artikels in geakkrediteerde joernale. Hy was ook vir 2 siklusse geëvalueer by die NRF. Sy portfolio sluit in die ontwikkeling van sagteware of prototipes vir groot maatskappye soos Van Drimmelen en Vennote en Bayer Diagnostics (VSA). Sy privaatbesigheid fokus op die ontwikkeling van nismarksagteware vir tersiêre instellings. Die sagteware word tans gebruik deur afdelings aan verskeie universiteite in Suid-Afrika.

Die geleentheid vind om 19:00 in die CR Swart-ouditorium op die kampus plaas.

MEDIAVERKLARING

Uitgereik deur: Lacea Loader
Mediaverteenwoordiger
Tel: (051) 401-2584
Sel: 083 645 2454
E-pos: loaderl.stg@mail.uovs.ac.za

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