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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 announces the closure of Reitz Residence and the establishment of an institute for diversity

2008-05-27

Statement by Prof. Teuns Verschoor, Acting Rector of the UFS

The Executive Management of the University of the Free State (UFS) today announced a unanimous decision to close the Reitz Residence, effective at the end of the current university semester, and establish an institute for diversity on the same premises.

Four students from the Reitz Residence were responsible for making the now infamous Reitz video, depicting four female colleagues from the University and a worker of Prestige Cleaning Services who were lured into participating in a mock initiation ceremony during which they were humiliated and demeaned.

University management repeated its strong condemnation of the video, made in apparent protest against the University’s integration policy implemented at 21 residences accommodating some 3 400 students on the Main Campus in Bloemfontein.

The Reitz video reopened racial wounds, and is deeply regretted. It was an isolated manifestation of resistance to the impact of ongoing transformation initiatives at the University. The video and other acts of public violence and vandalism on the campus have undermined the efforts of the University to foster diversity in student and staff life and create an inclusive institutional culture on the campus.

The actions of a relatively small group of students also inflicted severe damage on the University’s reputation and standing in the local and international academic community. The UFS management had therefore decided that closure of the Reitz Residence was an unavoidable strategic imperative and an important gesture of reconciliation towards all South Africans who had been offended.

The University has apologised unreservedly for the video. Two of the students who were still residents in Reitz were barred from the campus and subsequently terminated their studies at the UFS, while the other two students had already completed their studies last year.

In an endeavour to make restitution and to offer a lasting contribution to transformation, both at the UFS and in the country as a whole, the UFS has committed itself to establishing an institute for diversity on the premises of the former Reitz Residence.

Reitz will therefore be closed as a residence from 20 June 2008. The UFS has appointed a fully representative special committee to assist current Reitz residents in finding alternative accommodation.

The Institute for Diversity is envisaged as a centre of academic excellence for studying transformation and diversity in society – a living laboratory for combating discrimination and enabling and enhancing reconciliation in societies grappling with the issues of racism, sexism and xenophobia.

The declaration of Higher Education South Africa (HESA) published on 28 March 2008 highlighted that racism, intolerance and discrimination are societal phenomena present on many campuses. However, these issues are not restricted to institutions of higher learning, and are symptomatic of a broader social malaise.

In responding to the challenge faced by the University regarding its own transformation issues, as well as those faced by the country, the UFS will study the anti-transformational impulses on the campus as a microcosm of much broader socio-political challenges. The University will transform itself over time into a beacon of hope, combating racism and other forms of discrimination in South Africa and elsewhere in the world.

The Institute for Diversity will add impetus to the University’s existing transformation programme. Six strategic clusters, including a transformation cluster, were created in 2007 as part of the University’s long-term strategic planning.

The University has already provided seed capital of R1 million to design and establish the Institute. Planning will take place during 2008/09, with the Institute being formally opened in the 2010 academic year. An international fund-raising drive to raise an initial target of R50 million will be launched shortly.

Note to editors: The Reitz video was apparently made late last year, but only entered the public domain on 26 February 2008.

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
27 May 2008

UFS e phatlalatsa ho kwalwa ha hostele ya Reitz le ho thehwa ha Institute for Diversity

Phatlalatso ka Prof. Teuns Verschoor, Morektoro ya tshwereng mokobobo wa UFS

Kajeno bolaodi ba Yunivesithi ya Freistata (UFS) bo phatlaladitse qeto e ananetsweng ke bohle ya ho kwalwa ha hostele ya Reitz mafelong a sehla sena sa pele sa dithuto (semester), le ho thehwa ha Institute for Diversity meahong eo ya Reitz.

Baithuti ba bane ba hostele ya Reitz ba ile ba eba le seabo kgatisong ya video e mpe moo basebetsi ba bane ba bomme ba yunivesithi le mosebetsi wa khamphane ya Prestige Cleaning Services ba ileng ba hohelwa ho ba le seabo mme ba tlontlollwa le ho nyenyefatswa hampe.

Bolaodi ba yunivesithi bo boetse ba nyatsa ka mantswe a bohale video eo e ileng ya hatiswa ka maikemisetso a ho ipelaetsa kgahlanong le leano la diphethoho dihosteleng tse 21 tsa yunivesithi Bloemfontein tseo e leng bodulo ho bathuti ba ka bang 3400.

Morektoro ya tshwereng mokobobo wa UFS, Prof. Teuns Verschoor, o boletse hore video eo ya Reitz e boetse e butse maqeba a semorabe mme e seollwa ka matla. O re e ne e le ketsahalo e ikgethileng ya boipelaetso kgahlanong le diteko tse tswelang pele tsa ho tlisa diphethoho yunivesithing. O re video eo le diketsahalo tse ding tsa merusu le tshenyo ya thepa khamphaseng di setisitse diteko tsa yunivesithi tsa ho tlisa poelano hara baithuti le basebetsi, le ho theha moetlo o akaretsang ka hare ho yunivesithi.

O tswetse pele ka hore diketso tseo tsa sehlotshwana sa baithuti di boetse tsa senya yunivesithi serithi le lebitso mona hae le dinaheng tse ding. Kahoo bolaodi ba UFS bo nkile qeto yah ore ho kwalwa ha hostele ya Reitz ke ntho o kekeng ya qojwa mme e boetse ke mohato wa bohlokwa wa poelano ho ma-Afrika Borwa ohle a anngweng ke taba ena.

Yunivesithi e kopile tshwarelo mabapi le video ena. Ba babedi ba baithuti ba amehang kgatisong ya video eo, ba neng ba ntse ba dula hosteleng ya Reitz, ba ile ba thibelwa ho kena khamphaseng mme yaba ba tlohela dithuto tsa bona, ha ba bang ba babedi bona ba ne ba se ba phethetse dithuto tsa bona selemong se fetileng.

Prof. Verschoor o boletse hore ho leka ho kgutlisetsa maemo setlwaeding le ho tshehetsa leano la diphethoho UFS le naheng ka bophara, UFS e ikanne ho theha Institute for Diversity hona meahong eo ya Reitz.

Kahoo hostele ya Reitz e tla kwalwa ho tloha ka la 20 Phupjane 2008. UFS e thontse komiti e ikgethang e akaretsang bohle ho thusa baithuti ba dulang hosteleng ena hajwale ho fumana bodulo bo bong.

Institute for Diversity e tla ba setsha se kgabane sa dithuto tsa diphethoho le poelano setjhabeng – setsha se tla lwantshana le kgethollo mme se kgothalletse le ho matlafatsa poelano hara batho ba tobaneng le mathata a kgethollo ya mmala, ya bong le lehloyo la melata.

Tokomane ya Higher Education South Africa (HESA) e phatlaladitsweng ka la 28 Hlakubele 2008, e pepesa dintlha tse amanang le kgethollo ya mmala, tlhokeho ya mamellano le kgethollo ka kakaretso e le dintho tse teng dikhamphaseng tse ngata. Dintlha tsena ha di teng feela ditsheng tsa thuto e phahameng, empa le setjhabeng ka kakaretso.

Prof. Vershoor o boletse hore UFS e tla lekola dikgato tse kgahlanong le diphethoho ka hare ho khamphase jwaloka karolo ya diphepetso tse nammeng hara setjhaba ka kakaretso. O re yunivesithi e tla fetoha ha nako e ntse e tsamaya ho ba mohlala o motle wa tshepo, twantsho ya kgethollo ya mmala le mekgwa e meng ya kgethollo Afrika Borwa le lefatsheng ka bophara.

Institute for Diversity e tla thusa ho matlafatsa lenaneo la jwale la diphethoho la yunivesithi. Ho thehilwe di Strategic Clusters tse tsheletseng selemong se fetileng, tse kenyeletsang Transformation Cluster, jwaloka karolo ya merero ya UFS.

Yunivesithi e se e nyehelane ka tjhelete e kana ka diranta tse milione ho rala le ho theha institute ena. Ho rerwa ha yona ho tla etswa ka 2008/09, mme institute ena e tla bulwa semmuso selemong sa dithuto sa 2010. Haufinyana ho tla thakgolwa letsholo la matjhaba la ho bokeletsa tjhelete e kana ka diranta tse dimilione tse mashome a mahlano.

Tlhokomediso ho bahlophisi ba ditaba: Video ya Reitza e hatisitswe selemong se fetileng mme ya hlahella pepeneng ka la 26 Hlakola 2008.

Phatlalatso ya boraditaba
E entswe ke: Lacea Loader
Motlatsa molaodi: Dikgokahano
Tel: 051 401 2584
Cell: 083 645 2454
E-mail: loaderl.stg@ufs.ac.za
27 Motsheanong 2008

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