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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

UFS Centenary 2004 / 2005 October (centenary) fest Activities

2004-10-08

Friday, 08 October 2004
17:00 – 24:00
Callie Human Centre, UFS
Macufe Rock Concert
With: Rooibaardt, Karen Zoid, The Narrow, F****polisiekar, Stuurbaard Bakkebaard (from the Netherlands), DJ Bob, Ready D, Neva Me.
Cost : R50-00
Bookings : Pacofs (051-447 7772)

Sunday, 10 October 2004
16:00 – 18:00
Callie Human Centre, UFS
Macufe Three Tenors Concert
With: Phillip Kotze, Chris Coetzer and Du Preez Stolz, as well as Angela Kerrison. Free State Symphony Orchestra conducted by Chris Dowdeswell.
Cost :R60-00 (adults), R40-00 (children, scholars, students and pensioners)
Bookings : Pacofs (051-447 7772)

Tuesday, 12 October 2004
11:00 – 15:00
Centenary Complex, UFS
Inauguration of Centenary Complex
Open day with a variety of musical recitals in different rooms
Cost : Free
Enquiries : Elize Rall (051-401 3382)

15:00 – 17:00
Parking area next to the Centenary Complex, UFS
Kovsie Mosaic Day
Collage of the Century, Dance to the beat, Cultural Cartoon,
Who’s line is it anyway?
Cost : Free
Enquiries : Louis Botha (051-401 2819) or
AC Geldenhuys (084 585 3338)

Wednesday, 13 October 2004
19:00
Centenary Complex, UFS
Première of documentary film : The Life and Legacy of King Moshoeshoe
Note : By invitation only
Enquiries : Elize Rall (051-401 3382)

Thursday, 14 October 2004
18:45 – 21:00
Red Square (in front of Main Building), UFS
Centenary Honorary Doctorate Degree Graduation Ceremony
Conferred on: Me. Antjie Krog, Prof. Jakes Gerwel, Mr. Karel Schoeman, Dr. Frederick van Zyl Slabbert, Prof. Saleem Badat, Dr. Khotso Mokhele, Prof. Robert Bringle, Prof. Leo Quayle, Prof. Jack de Wet, Prof. Kerneels Nel (posthumously), Prof. Boelie Wessels and Prof. Jaap Steyn .
Cost : Free. Please RSVP if you would like to attend.
Enquiries : Elize Rall (051-401 3382)

Friday, 15 October 2004
18:30
Centenary Complex, UFS
Alumni Dinner and Centenary Award Ceremony
Approximately 140 centenary medals will be awarded in acknowledgement of exceptional contributions to the development of the University. The award ceremony is followed by the Alumni dinner in the Callie Human Centre.
Cost : R100-00/person
Enquiries : Elize Rall (051-401 3382)

15:00 (to 12:00, Saturday, 16 October 2004),
UFS campus
Reunion : Momentum Adventure and Expedition Association
Including : Setting up of the Kovsie Momentum base camp, champagne breakfast and abseiling.
Cost : R50-00/person for breakfast
Enquiries : Gerrit van der Merwe (072 4317 153) or
Niel Fraser (082 772 5642)
Website : www.uovs.ac.za/associations/momentum_hrcc.

19:00 (to 11:00 Sunday, 17 October 2004)
Reunion : Cantare Revue Group
Including : Formal dinner, budget show, bring and braai, church service.
Cost : R100-00/person for the dinner
Enquiries : Louis Botha (051-401 2819)

19:00 (to 24:00 Saturday, 16 October 2004
Reunion : House NJ van der Merwe
Including : Senior Student’s Association and concerts
Cost : R5-00/person
Enquiries : Tutu Ntlathi (051-401 4122 / 072 865 2227)

Saturday, 16 October 2004
09:00 – 10:00
Committee Room 120, Faculty of Theology
Founding of Theology Alumni Association
Enquiries: Henna Nel (051-401 2669)

10:00 – 12:00
Parking area, CR Swart Building, UFS
Alumni Campus Tour
Including : Visits to the new physical developments on campus
Cost : Free
Enquiries : Jeanette Jansen (051-401 3594)

10:00 – 12:00
Sonnedou gazellie (next to NJ van der Merwe Residence), UFS
Reunion : Ladies’ Tea
Visit our new gazellie and find out what Sonnedou is up to these days.
Cost : R25-00/person
Enquiries : Anne-Marie Delport (072 109 0507)

12:00 – 16:00
JBM Hertzog Residence (garden in front of Senior Student’s Association), UFS
Reunion : Braai
Cost : Approximately R20-00/person
Enquiries : Hattingh Bornman (084 240 5226)

12:00 Vergeet-my-nie Residence, UFS
Reunion : Braai
Bring and braai. We supply the facilities. Bring old photographs and stories. Enjoy Aunt Juls’ last visit.
Cost : Free
Enquiries : Mari Jordaan (051-444 2832/072 392 4444)

12:00 HF Verwoerd Residence Senior Student’s Association, UFS
Reunion : Spit roast
Cost : R60-00/person
Enquiries : Jan-Chris Landman (051-401 3613 / 082 664 6062)

18:30 Floreat Hall, Bloemfontein Civic Centre (Braam Fisher Building)
Irawa 60 Reunion
For all former editors, former and current main editorial staff and coworkers
Cost : R100-00/person
Enquiries : Sanri van Wyk (072 333 1011)
Elzette Boucher (072 180 6265)

19:00 – 24:00 Red Square (in front of Main Building), UFS
Informal Alumni Reunion
Spit roast and stories in a marquee
Cost : R60-00/person
Enquiries : Elize Rall (051-401 3382)

Sunday, 17 October 2004
10:00 – 11:00
Kovsie Church
Church Service

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