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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

New South African literature festival offers something for everyone

2016-03-23

The University of the Free State (UFS) in partnership with the Vrystaat Arts Festival is proud to present the first literature festival in central South Africa from 11-16 July in Bloemfontein. Afrikaans books and writers will feature prominently, in addition to other indigenous languages such as Sotho and Zulu. Several authors will be celebrating literature in English.

Vice-Chancellor and Rector of the University of the Free State Professor Jonathan Jansen says: ‘The aim of the festival, part of the bigger Vrystaat Arts Festival, is to strengthen a culture of reading, not just in the Free State but nationally. The festival will market books as well as embrace new developments in the field of writing. I am incredibly excited about this inaugural event, which the university will support in the long-term.’

The theme of this year’s literature festival is ‘Our Africa’ and promises to provide all booklovers and readers tantalizing food for thought. Some of the authors attending the festival include, amongst others, the Hertzog-prize winner Adam Small, celebrating his 80th birthday as well as the release of his latest drama. Another legendary writer, dramaturge and actor, John Kani, will be speaking at the festival about his most recent theatre productions. The ever popular Marita van der Vyver will be visiting the festival from France, and the highly acclaimed writer Zakes Mda, will be flying in from the United States to deliver the inaugural Sol Plaatje Lecture. Mda, also a visual artist, will have some of his works on display.

Other international guests include Chika Unigwe, originally from Nigeria, who rose to fame in Belgium, and was described by South African writer Zukiswa Wanner as one of the five most renowned writers from Africa. Also attending will be Iranian writer Kader Abdolah, whose novels have been translated into more than 21 languages. Abdolah, a political refugee who escaped from Iran to the Netherlands in the 1980s, went on to establish himself as one of the most prominent Dutch novelists. Wilfried N’Sondé, originally from the Congo, who now lives in France, will also be a festival guest.

Theo Kemp, Coordinator of the Literature Festival says: ‘It is critical for us that robust debates on current affairs takes place as part of the festival. Festival participants will be able to engage with a range of authors on topical and sometimes sensitive issues. We welcome this debate – it is rare to have a platform where we can argue passionately yet respectfully about the future of our country in an international context.’

Critical topics covered include themes such as the state of Africa’s economies (with analyst and writer Victor Kgomoeswana); the relevance of the Anglo-Boer War in contemporary society (with Albert Blake and Johan Kruger); philosopher Achille Mbembe talking with Kevin Bloom and Richard Poplak about the changing face of Africa; and the political analysts Susan Booysen and John Matisonn examining the South African landscape in a post-municipal election environment.

Theuns Eloff, previous Rector of the University of Potchefstroom, whose new book What now, South Africa is launched this year, will partake in discussions around current affairs. So to Melanie Verwoerd and Sonwabiso Ngcowa aim to explore the phenomenon of the so-called ‘born frees’ in their book 21 at 21: The Coming of Age of A Nation.

Climate change and its impact on the Free State’s environment is another critical topic covered by Bob and Mary Schole with their book launch of Climate Change: Briefings from Southern Africa.

Festival goers can also look forward to a poetry café, where music and poetry will be mixed; informal visits with writers around food and story telling; as well as word and music productions where popular travel writers such as Johan Bakkes, Dana Snyman, Erns Grundling and Pienkes du Plessis will be present.

Writers will also be involved in a range of panel discussions – including on the ethics of writing biographies (Lindie Koorts and Mark Gevisser); alternative narratives of South Africa in the eighties (Ivan Vladislavic and Johann Roussouw); and discussions with writers such as Hans du Plessis, Bernard Odendaal, Hanlie Retief, Rudie van Rensburg and Irma Joubert.

Workshops will also feature in the programme with writers such as Francois Smith and Henning Pieterse, associated with the Department of Afrikaans and Dutch at the UFS, offering short courses on creative writing; while Johann Roussouw from the Department of Philosophy at the UFS will present a series of talks on the books of Karel Schoeman.

The final festival programme will be launched on 28 April 2016.

The Vrystaat Literature Festival was initiated by the University of the Free State in partnership with the Vrystaat Arts Festival. Project sponsors include Media24, ATKV, Vlaamse Letterenfonds, Institut Francais, Nederlandse Letterfonds, Van Rensburg Pataloe and the Flemish Embassy.

For further enquiries contact:
Theo Kemp
theo.kemp@volksblad.com
+27(0)83 462 9613
www.vrystaatartsfestival.co.za

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