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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

Emma Sadleir talks about social media etiquette
2016-05-18

Description: Emma Sadlier Tags: Emma Sadlier

Emma Sadleir
Photo: Supplied

“We have all become celebrities, we have become social figures because of our power to publish information. We have all become brands, and we need to protect our brand. Digital content is sometimes dangerous content,” said Sadleir.

On 11 May 2016, the University of the Free State, in collaboration with the Postgraduate School, hosted, Emma Sadleir, a leading social media expert, in the Equitas Auditorium on the Bloemfontein Campus. She is an admitted advocate, specialising in social media law.  Dr Henriette van den Berg, Director of the Postgraduate School, described Sadleir’s presentation as a privilege for all the staff and students who attended.

Sadleir said that there are two important rules that staff and students of an institution should try to follow. The first is not to bring the name of the institution into disrepute; and the second is not to breach the goodwill of the institution or, in other words, not to bite the hand that feeds you.

“The common law, even if there is no policy, is that anything that brings the company into disrepute can lead to disciplinary consequences up to termination,” said Sadleir.

Sadleir focused on hate speech and free speech, stating that free speech is a right that is entrenched in the constitution, but, like every other right, it has limitations. She mentioned Penny Sparrow, Matt Theunissen, Velaphi Khumalo, and Judge Mabel Jansen, all of whom have been lambasted by the public over their racist posts on social media. Sadleir stressed that, even on social media, content has to be within the confines of the law, and people must remember our rights are not absolute. We have a lot of freedoms, but no one cannot disseminate hate speech.

“Would you publish whatever you thinking on a billboard, close to a busy highway with your name, picture and employers details or the institution you studying at? If you have no grounds to justify the comment, do not post it,” warned Sadlier.  

According to the South African Bill of Rights, everyone has the right to privacy, but an expectation of privacy has to be enforced. She said people over-document their lives on social media, decreasing your right to privacy drastically. “It is like CCTV footage of your life. It is simple, the more you take care of your privacy, the more you have,” said Sadleir.

Sadleir said it was important for Facebook users to have privacy settings where they can review posts where they are tagged. According to Sadleir, managing your reputation is not only limited to what you post about yourself but also managing what others post about you.

She cited a 2013 case in the Pretoria High Court in which a new wife wrote a scandalous Facebook post about her husband’s ex-wife, tagging the husband in the post. The courts found both the new wife and the husband guilty of defamation.

“If you have been tagged in something but have not been online and seen the content, you are then an innocent disseminator. The moment you are aware of the post you are liable for the content,” said Sadleir.

“It takes 20 years to build a reputation and five minutes to ruin it. If you think about that, you'll do things differently,” Sadleir said, concluding her presentation with the quotation from Warren Buffet.

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