Midwives who are properly trained and acknowledged for their skill and experience save lives and hugely contribute to maternal health in South Africa.
However, there is a dire need for professional midwives and competent educators. Dr Elgonda Bekker of 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’s a practical, transformative thesis to improve the education of SA midwives.
Sadly, she died just months after she had received her degree. Now her colleagues at the UFS School of Nursing continue to build on her foundations.
Too much too soon, too little too late
The World Health Organisation (WHO) states 10-15% of births may need intervention through caesarean section. A recent analysis, however, found 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 [World Health Organization] target, the private sector rate is not justifiable,” Bekker wrote. The case fatality rate for mothers who died after a c-section had been performed showed an increase – an indication 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 SA, both manifest because of the disparity between private and public health care.
Bekker’s research showed the high c-section rate in the private sector is a classic example of over-medicalisation of obstetric care, whereas the public health-care system follows a midwifery-led model of care. “Midwives are a vital solution to correct this disparity,” she wrote. “Competent midwives, educated to standards, can prevent [such] interventions . . .”
Midwifery is a disempowered profession
Winnie Moroa Motlolometsi, a midwifery educator, explained that professional nurses in SA 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.
So it’s difficult to calculate the number of practising midwives. Furthermore, the conflation of nursing and midwifery requires training as a generalist practitioner.
Depending on the training institution, professional nurses may or may not comply with the International Confederation of Midwives’ Global Standards for education and regulation of the midwifery profession.
So, wrote Bekker, midwifery is a disempowered profession, because the global guiding documents are neither considered by the regulatory authority nor the national health department. There is a triple gap for competencies, coverage and access:. insufficient numbers of competent midwives;. midwives who can cover maternal health services; and. midwives who render services that address the needs of women.
While midwifery educators are qualified, they’re not necessarily clinical specialists, jeopardising the quality of maternal health care.
Dr Deidre van Jaarsveldt of the UFS School of Nursing says Bekker’s study frames midwifery as a disempowered, woman-led profession, caring for women challenged by an unequal society. In practice, it’s difficult to distinguish midwives from general nurses.
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