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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

State of our campuses: Impact of non-completion of the 2016 academic year on UFS students

2016-10-08

Dear Parents/Guardians and Students,

Impact of non-completion of the 2016 academic year

The University of the Free State (UFS) reiterates its support and commitment to the cause of free higher education. We have stated our position in all the available spaces. We want to work with UFS students to put pressure on the government to commit itself to accept the many suggestions put forward to make free education possible within a negotiated timeframe.

We are also seriously committed to our responsibility of providing education to all students enrolled at the university. We are doing our outmost to ensure that we can resume academic activities next week.

Description: " Academic non-completion 2016 Tags: " Academic non-completion 2016

We want to bring to your attention what will happen to individual students if the UFS cannot resume classes fully on Monday 10 October 2016.

Currently we have extended the academic year by one week. Some faculties are working on Saturdays and Sundays, starting earlier and finishing later to complete the material that needs to be taught and the practical work that students need to do to be able to write exams.

In the three biggest faculties at the university: Education, the Humanities, and Natural Sciences, this is what will happen:

Education will fail to graduate 1 193 students
Humanities will fail to graduate 1 125 students
Natural and Agricultural Sciences will fail to graduate 1 390 students

In the professional faculties: Economic and Management Sciences, Health Sciences, and Law, this will happen:

Economic and Management Sciences will fail to graduate 997 students
Health Sciences will fail to graduate 633 students
Law will fail to graduate 619 students

In total, approximately 6 000 students will not receive complete transcripts of their degrees and the certificates for their qualifications.

The university currently has 3 238 students on NSFAS bursaries. None of these students will be able to apply for bursaries for the lost year. They will be regarded as having failed or not completed their courses. They will not only miss this year, but the opportunity of studying in the future.

These students come from families to which their success in higher education was supposed to mean a change in the future of the entire family. Some parents/guardians hold more than one job to be able to pay tuition fees.

In not allowing the year to continue and students to finish, we are throwing away the efforts that entire families of poor people have made for four or five years to put their children through university. The promise of free education for future generations means nothing to these families who are poor in the present.

In terms of the academic calendar, it is a false argument to say that universities will be able to enrol first-years, because what 2016 students will miss, is the second semester.

We do not have the capacity to teach double the number of students in the second semester. This also misses the point that those students who were completing modules in order to graduate, will waste an entire year (assuming they have funding) to complete their degrees. This argument does not see the knock-on effect that students, not promoting in modules from first to second and second to third year, etc., will have. Finally, this also misses the point of what will happen to students who have to repeat first-semester modules.

In terms of academic staff, students are discounting the willingness of academic staff to teach double or to have the academic year extended by approximately six weeks between teaching and examinations. The same can be said for all the administrative and support staff required for running the university.

In our case, all the students in the University Preparation Programme (UPP) on the South Campus in Bloemfontein will be stuck without being able to move into mainstream modules, preventing a new intake of UPP students for 2017. These are the poorest and most disadvantaged students at the UFS.

It is absolutely necessary to find a means of protest and political action that will not jeopardise the future of current students and the country’s desperate need for critical skills. The interdict against violent protest secured by the UFS is still in force. The police will intervene if the interdict is not respected and the UFS will have no control over police actions.

We trust that parents/guardians and students understand the implications of the situation.

Kind regards,

Prof Nicky Morgan
Acting Rector
University of the Free State

Released by:
Lacea Loader (Director: Communication and Brand Management)
Telephone: +27 51 401 2584 | +27 83 645 2454
Email: news@ufs.ac.za | loaderl@ufs.ac.za
Fax: +27 51 444 6393

State of our campuses #11: Academic activities on UFS campuses continue

State of our campuses #10: Impact of non-completion of the 2016 academic year on UFS students

State of our campuses #9: Academic programme on all UFS campuses to resume on Monday 10 October 2016

State of our campuses #8: UFS extends vacation as from 28 September until 7 October 2016, 28 September 2016

State of our campuses #7: All three UFS campuses will be closed today, 27 September 2016.

State of our campuses #6: All UFS campuses reopen on Tuesday 27 September 2016

State of our campuses #5: UFS campuses to remain closed on Monday 26 September 2016

State of our campuses #4: Decisions about the UFS academic calendar

State of our campuses #3: UFS campuses closed until Friday 23 September 2016

State of our campuses #2: UFS Bloemfontein and South Campuses closed on Tuesday 20 September 2016 (19 September 2016)

State of our campuses #1: Academic activities suspended on UFS Bloemfontein Campus (19 September 2016)

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