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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

Parking at UFS for visitors

2007-11-10

UFS creates more parking for visitors

In its effort to make it easier for visitors to park on the Main Campus of the University of the Free State (UFS) in Bloemfontein, two paid parking areas will be put into operation as from Monday, 5 November 2007.

These parking areas are part of a comprehensive new parking strategy of the UFS, which is being implemented since September 2007. As part of the strategy, areas of the central campus have been reserved for staff and visitors and hundreds of new parking areas were developed for students at the entrance in Wynand Mouton Avenue (at the Faculty of Health Sciences) and the entrance in DF Malherbe Avenue (at the Agriculture Building).

“The paid parking areas for visitors, which are as close as possible to the busy and largely closed-off central campus, were created as an additional service to visitors,” said Ms Edma Pelzer, Director of Physical Resources at the UFS.

According to Ms Pelzer, persons who attend meetings, seminars or short courses, visiting colleagues, consultants, service providers, family of students and staff members, clients, etc. can make use of this parking.

“We have found that it is often difficult for visitors to obtain parking in or close to the central campus. Now they will have a choice to either park in the visitors parking areas at a minimal fee or to park in any of the open unreserved parking areas on campus,” said Ms Pelzer.

The areas, which will be closed off behind booms on weekdays from 06:00 until 18:00, are situated to the eastern side of the “Red Square”, east of the CR Swart and Idalia Loots Buildings and west of Campus Avenue North between the Psychology and the Flippie Groenewoud Buildings.

Media Release
Issued by: Lacea Loader
Assistant Director: Media Liaison
Tel: 051 401 2584
Cell: 083 645 2454
E-mail: loaderl.stg@ufs.ac.za
2 November 2007

Parking for visitors: Important notice:

As from Monday 5 November 2007 two paid parking areas on the UFS Campus will be put into operation. The areas will be closed off behind booms on weekdays from 06:00 until 18:00. These will be manned and R3 per hour will be charged.

The following areas are involved:

P3: The area to the east of the “Red Square”, east of the CR Swart and Idalia Loots Buildings.
P6: The area to the east of Campus Avenue North between the Psychology and Flippie Groenewoud Buildings.

The friendly co-operation of users of motor vehicles on campus is requested to allow this implementation to proceed as smoothly as possible.

Parking for visitors: More information

The strategy to create paid parking areas for visitors

The decision to reserve areas in the central campus areas for the convenience of visitors was taken as part of the comprehensive new parking strategy of the UFS approved by the Executive Management in May 2007 and which is being implemented since September.

All visitors need not park in these areas. Visitors may park for free on any open (unreserved) parking bay on campus. These paid parking areas for visitors, as close as possible to the busy and largely closed-off central campus, have been created as an additional service to visitors.

The strategy to close off parts of the central campus for staff members and visitors was implemented after sufficient alternative parking areas had been developed for students.

What is meant by the term “visitors”?

It includes all persons who are not students of staff members of the UFS and who visit the campus for one reason or another. Persons who attend meetings, seminars or short courses, visiting colleagues, consultants, service providers, family of students and staff members, et cetera are included.

As at present, it will, of course, be possible to make special arrangements with Protection Services to make it possible for VIP visitors to park as near as possible to their destinations.

No student or staff member will be actively prevented from parking in the area. They will, however, be discouraged by the fact that R3 per hour will be charged without exception.

The visitors’ parking area and access to it

P3: The area to the east of the “Red Square”, east of the CR Swart and Idalia Loots Buildings. The area is within easy walking distance for visitors to, among others, the following buildings: George du Toit Administration Building, Theology Building, Idalia Loots Building, CR Swart Building, Johannes Brill Building, Van der Merwe Scholz Hall.

The area is conveniently accessible from the following entrances: Nelson Mandela Drive, Groenewoud Street and Wynand Mouton Drive.
P6: The area to the west of Campus Avenue North, between the Psychology and Flippie Groenewoud Buildings. The area is within easy walking distance for visitors to all the academic buildings in the central campus, such as the Chemistry Building, Stef Coetzee Building, the Geography Building, et cetera and located directly opposite the general information point on the Thakaneng Bridge.

The area is conveniently accessible from the following entrances: Fürstenburg Road and DF Malherbe Avenue (at the Agriculture Building).

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