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Why midwifery should be in the hands of trained midwives

20 December 2021 | Story Elsabé Brits

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

Full week of graduation ceremonies at UFS in April

2015-04-10

Autumn always sees the UFS’s first graduation ceremony of the year on the Bloemfontein Campus.

From 14 – 17 April 2015, graduates will once again be rewarded for their hard work while top speakers will address them in the Callie Human Centre. There will be a ceremony at 09:00 and at 14:30 each day on all four days of the graduation.

The programme for the 2015 April Graduation is as follows:

Tuesday 14 April 2015:

Professor Himla Soodyall will be the speaker at both ceremonies on this day. Prof Soodyall is a Medical Scientist for the South African Institute for Medical Research. She is also a Principal Medical Scientist for the National Health Laboratory Service, and a Director for the Human Genome Diversity and Disease Research Unit at the University of Witwatersrand.

During the first ceremony of the day at 09:00, all diplomas/certificates and B degrees in the Faculty of Natural and Agricultural Sciences will be awarded. Only Honours degrees in the Faculty of Natural and Agricultural Sciences will be awarded at the 14:30 ceremony.

Wednesday 15 April 2015:

Wednesday will see Ndumiso Hadebe take the stage to address graduates at both ceremonies.

At the age of 23, Hadebe is the Founder and Managing Director of Master Frontiers Consulting, a firm that capacitates leaders and managers to achieve business goals through their people. He worked previously as a Researcher at Shanduka Black Umbrellas, a flagship enterprise and supplier development programme of the Shanduka Foundation.

He has been received numerous awards for excellence in leadership, such as the Sedibeng District Municipal Mayor’s Award for Service and Leadership. He is a Brand South Africa Ambassador and Read Educational Trust Ambassador.

All diplomas/certificates, B and Honours degrees in the Faculty of Economic and Management Sciences, except B Com degrees, will be awarded during the morning ceremony at 09:00. Later, at the 14:30 ceremony, only B Com degrees in the Faculty of Economic and Management Sciences will be awarded.

Thursday 16 April 2015:

Multiple award winning South African TV presenter, Leanne Manas, will be the speaker at both Thursday ceremonies.

Manas has graced our screens for over a decade. Not many broadcasters can boast having had live TV experience, 5 days a week for 12 years. She is currently the anchor of SABC 2’s flagship breakfast programme, Morning Live. Leanne is a qualified Speech and Drama teacher. having studied at London Trinity College. She also has an Honours degree in English.
Diplomas/certificates up to and including Honours degrees in the Faculty of the Humanities, Social Sciences, and Communication Sciences will be awarded during the ceremony at 09:00. The 14:30 ceremony will have diplomas/certificates up to and including Honours degrees in the Faculty of the Humanities’ other qualifications except for Social Sciences and Communication Sciences.

Friday 17 April 2015:

Dr Maria Phalime will be the speaker at both ceremonies on Friday.

Phalime is a medical doctor and award-winning author. She practiced for a brief period as a general practitioner in South Africa and the United Kingdom, before leaving medical practice to pursue non-clinical interests. She has worked in trade and investment promotion, and has undertaken research and consulting in the areas of economic development and business facilitation.

Diplomas/certificates up to and including Honours degrees in the Faculty of Education (CE, NPDE and ACE excluded) will be awarded during the ceremony at 09:00. Diplomas/certificates up to and including Honours degrees in the Faculties of Health Sciences, Law, and Theology will be awarded at the 14:30 ceremony.

Click here for the simple layout of the 2015 April Graduation programme:
http://www.ufs.ac.za/adhoc-pages/2014-graduation-ceremony/graduation-ceremony

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