Latest News Archive

Please select Category, Year, and then Month to display items

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

Mushrooms, from gourmet food for humans to fodder for animals

2016-12-19

From the UFS Department of Microbial Biochemical and
Food Biotechnology are, from left: Prof Bennie Viljoen,
researcher, MSc student Christie van der Berg,
and PhD student Christopher Rothman
Photo: Anja Aucamp

Mushrooms have so many medicinal applications that humans have a substance in hand to promote long healthy lives. And it is not only humans who benefit from these macrofungi growing mostly in dark spaces.

“The substrate applied for growing the mushrooms can be used as animal fodder. Keeping all the medicinal values intact, these are transferred to feed goats as a supplement to their daily diet,” said Prof Bennie Viljoen, researcher in the Department of Microbial, Biochemical and Food Biotechnology at the UFS.

Curiosity and a humble start
“The entire mushroom project started two years ago as a sideline of curiosity to grow edible gourmet mushrooms for my own consumption. I was also intrigued by a friend who ate these mushrooms in their dried form to support his immune system, claiming he never gets sick. The sideline quickly changed when we discovered the interesting world of mushrooms and postgraduate students became involved.

“Since these humble beginnings we have rapidly expanded with the financial help of the Technology Transfer Office to a small enterprise with zero waste,” said Prof Viljoen. The research group also has many collaborators in the industry with full support from a nutraceutical company, an animal feed company and a mushroom growers’ association.

Prof Viljoen and his team’s mushroom research has various aspects.

Growing the tastiest edible mushrooms possible
“We are growing gourmet mushrooms on agricultural waste under controlled environmental conditions to achieve the tastiest edible mushrooms possible. This group of mushrooms is comprised of the King, Pink, Golden, Grey, Blue and Brown Oysters. Other than the research results we have obtained, this part is mainly governed by the postgraduate students running it as a business with the intention to share in the profit from excess mushrooms because they lack research bursaries. The mushrooms are sold to restaurants and food markets at weekends,” said Prof Viljoen.

Photo: Anja Aucamp

Natural alternative for the treatment of various ailments
“The second entity of research encompasses the growth and application of medicinal mushrooms. Throughout history, mushrooms have been used as a natural alternative for the treatment of various ailments. Nowadays, macrofungi are known to be a source of bioactive compounds of medicinal value. These include prevention or alleviation of heart disease, inhibition of platelet aggregation, reduction of blood glucose levels, reduction of blood cholesterol and the prevention or alleviation of infections caused by bacterial, viral, fungal and parasitic pathogens. All of these properties can be enjoyed by capsulation of liquid concentrates or dried powdered mushrooms, as we recently confirmed by trial efforts which are defined as mushroom nutriceuticals,” he said.

Their research focuses on six different medicinal genera, each with specific medicinal attributes:
1.   Maitake: the most dominant property exhibited by this specific mushroom is the reduction of blood pressure as well as cholesterol. Other medicinal properties include anticancer, antidiabetic and immunomodulating while it may also improve the health of HIV patients.
2.   The Turkey Tail mushroom is known for its activity against various tumours and viruses as well as its antioxidant properties.
3.   Shiitake mushrooms have antioxidant properties and are capable of lowering blood serum cholesterol (BSC). The mushroom produces a water-soluble polysaccharide, lentinan, considered to be responsible for anticancer, antimicrobial and antitumour properties.
4.   The Grey Oyster mushroom has medicinal properties such as anticholesterol, antidiabetic, antimicrobial, antioxidant, antitumour and immunomodulatory properties.
5.   Recently there has been an increased interest in the Lion’s Mane mushroom which contains nerve growth factors (NGF) and may be applied as a possible treatment of Alzheimer’s disease as this compound seems to have the ability to re-grow and rebuild myelin by stimulating neurons.
6.   Reishi mushrooms are considered to be the mushrooms with the most medicinal properties due to their enhancing health effects such as treatment of cancer, as well as increasing longevity, resistance and recovery from diseases.

Description: Mushroom research photo 3 Tags: Mushroom research photo 3

Valuable entity for the agricultural sector
Another research focus is the bio-mushroom application phenome, to break down trees growing as encroaching plants. This research is potentially very valuable for the agricultural sector in the areas where Acacia is an encroaching problem. With this process, waste products are upgraded to a usable state. “It is therefore, possible to convert woody biomass with a low digestibility and limited availability of nutrients into high-quality animal fodder. By carefully selecting the right combination of fungus species to ferment agro-wastes, a whole host of advantages could become inherently part of the substrate. Mushrooms could become a biotechnological tool used to ‘inject’ the substrate that will be fed to animals with nutrition and/or medicine as the need and situation dictates,” said Prof Viljoen.

Back

Economic and Management Sciences

Education

Health Sciences

The Humanities

Law

Natural and Agricultural Sciences

Theology and Religion

Open Distance Learning

Business School

We use cookies to make interactions with our websites and services easy and meaningful. To better understand how they are used, read more about the UFS cookie policy. By continuing to use this site you are giving us your consent to do this.

Accept