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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

Dr Francois Deacon appears in international film, Last of the Longnecks, due to research on giraffes

2017-04-04

Dr Francois Deacon was invited by the producer of Last
of the Longnecks to be part of a panel handling a question-
and-answer-session about the film.
Photo: Supplied

A great honour was bestowed on a researcher at the University of the Free State (UFS) when he was invited to the preview of the documentary film, Last of the Longnecks. Dr Francois Deacon, lecturer and researcher in the Department of Animal, Wildlife and Grassland Sciences at the UFS, who also has a role in the film, attended the preview at the Carnegie Institution for Science’s Smithsonian National Museum in Washington DC, in the US, in March this year. The preview formed part of the DC Environmental Film Festival.

The Environmental Film Festival in the US capital is the world’s leading showcase of films with an environmental theme and which aims to improve the public’s understanding of the environment through the power of film. During the festival, the largest such festival in the US, more than 150 films were shown to an audience of 30 000 plus.

Dr Deacon was invited by the producer of Last of the Longnecks to be part of a panel handling a question-and-answer-session about the film directly after the show. He described it as the greatest moment of his life.

Role in the film Last of the Longnecks

“My role in the film was as the researcher studying giraffes in their natural habitat in order to understand them better, so that we may better protect them, and be able to provide better education on the problem in Africa,” says Dr Deacon.

“Together with Prof Nico Smit, also from the UFS Department of Animal, Wildlife and Grassland Sciences, Hennie Butler from the Department of Zoology, and Martin Haupt from Africa Wildlife Tracking, we were the first researchers in the world to equip giraffes with GPS collars and to conduct research on this initiative,” he says. This ground-breaking research has attracted international media attention to Dr Deacon and Prof Smit.

“Satellite tracking is proving to be extremely valuable in the wildlife environment. The unit is based on a mobile global two-way communication platform, utilising two-way data satellite communication, complete with GPS systems.

“It allows us to track animals day and night, while we monitor their movements remotely from a computer over a period of a few years. These systems make the efficient control and monitoring of wildlife in all weather conditions and in near-to-real time possible. We can even communicate with the animals, calling up their positions or changing the tracking schedules,” says Dr Deacon.

The collars, which have been designed to follow giraffes, enable researchers to obtain and apply highly accurate data in order to conduct research. Data can be analysed to determine territory, distribution or habitat preference for any particular species.

Over a period of three years (2014-2016), the Last of the Longnecks team from Iniosante LLC captured on film how Dr Deacon and his team used the GPS collars in Africa to collect data and conduct research on the animals.

“With our research, which aims to understand why giraffes are becoming extinct in Africa, we are looking at the animal in its habitat but not only the animal on its own. If the habitat of these animals is lost, they will be lost as well. Therefore, our focus is on conservation and better understanding the habitat. The giraffe is only a tool to better understand the habitat problem,” says Dr Deacon.

Since the beginning of his research Dr Deacon and his team have had six new collar designs, with animals in four different reserves being equipped with the collars. The collars use the best technology available in the world and make it possible to determine how giraffes communicate over long distances, and how their sleep patterns function. Physiological and biological focus is placed on the giraffe’s stress levels, natural hormone cycles, and milk quality in cows.

Photo: Supplied

Experience at the film festival

“Absolutely amazing. Totally beyond our frame of reference as South Africans.” This is how Dr Deacon describes his experience of the three days in Washington DC during the film festival.

“It was an absolute honour to be part of the global preview of the film and to be able to work with Ashley Davison, the director of the film, and his team. I am just a rural farm boy who dreams big, and now this dream is known worldwide!” he says.

The film, which will be launched in April, will be screened in South Africa on the National Geographic channel in May 2017. Meanwhile, the film will also be shown at eight other film festivals in the US.

Work will start on a follow-up documentary in October and Dr Deacon is excited about the prospect. A mobile X-ray machine will be available from October. Internal sonars could also be performed on each of the animals. Researchers from around the world will form part of the team which will be led and co-ordinated by Dr Deacon and his co-workers at the UFS.

Former articles:

18 Nov 2016: http://www.ufs.ac.za/templates/news-archive-item?news=7964
23 August 2016: http://www.ufs.ac.za/templates/news-archive-item?news=7856
9 March 2016:Giraffe research broadcast on National Geographic channel
18 Sept 2015 Researchers reach out across continents in giraffe research
29 May 2015: Researchers international leaders in satellite tracking in the wildlife environment

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