Do we Need More Midwives in South Africa?

Posted by on Apr 19, 2015 in Writings

Do we Need More Midwives in South Africa?

Apparently, if you call up the South African Nursing Council (SANC) (under which all registered South African midwives must fall) then you will be told that there is a long list of registered midwives in South Africa – their database seems to reflect an adequate amount of trained and registered midwives.

Midwives are known to improve the outcomes of births and yet here in South Africa, our maternal mortality rates do not reflect this. Since the Millenium Development Goals were set in 1990, with decreasing maternal mortality by 75% by 2015 being one of the goals, South Africa’s maternal mortality have risen.

If you scratch below the surface, you will discover that South African midwifery training at present requires four years of nursing which includes only six months of midwifery. There is an option to study Advanced Midwifery at university level after qualifying as a midwife and some midwives may choose to go this route. What essentially happens, is that many nurses are trained who can call themselves midwives, are registered and listed as midwives, and can work as midwives but who may not choose to work as midwives, or who feel no particular compassion for the pregnant and labouring women they serve, or may not have a passion or drive for midwifery. And even if they do feel passionate about midwifery, they often feel inadequately equipped to work in the settings they are placed in after qualifying.

This post by a newly qualified midwife sums up for me so much of what many midwives in South Africa feel.

This post by a newly qualified midwife sums up for me so much of what many midwives in South Africa feel.

Some Facebook support groups have sprung up for midwives in South Africa and they have grown as a place for midwives to voice their fears and concerns, as well as a place for them to share stories and information.When I see that midwives are too afraid to work in the labour ward – I feel that our midwifery education system has failed them.

Jason Marcus and Jenna Morgan, both midwifery educators in South Africa, refer to the current South African midwifery training as ‘the fruit salad’ and both feel strongly that South Africa needs to look at the needs of our pregnant population and meet those needs through our midwifery training. At present, both feel that those needs are not being properly looked at and, therefore, are not being met.

When I hear stories of abuse in South African maternity wards, from mothers, medical students, midwives, doulas and through the media (and I have witnessed it on numerous occasions), then I know that something vital is missing. That we are failing pregnant and labouring women.

Last year, I sat with a support group of mothers from SWEAT (Sex Workers Education and Advocacy Taskforce) and discovered that out of about ten of the mothers present, four had chosen to give birth at home unassisted, some because of precipitous labour, but primarily because it felt easier and safer to give birth alone than to be mistreated and shunned. And when they called me a couple of weeks later to let me know that a first time single mother, who lived under a bridge and survived as a sex worker, had died whilst trying to birth on her own under that bridge, I knew our maternity system had failed her.

When I drive past Red Hill informal settlement and I give lifts to the women who are hitch-hiking to have their antenatal check-ups, or to take their sick babies to the clinic and I hear the stories of how many women avoid those antenatal checks, or don’t even book at the hospital, and try to arrive at the hospital as late as possible, or not at all, because it is too far, or too tedious or because of how they are treated, then I know our maternity system is failing these women.

So what is the answer?

More midwives?

Or maybe the question should not be,

Do we need more midwives in South Africa?

But rather:

How do we adequately equip the midwives serving South African women?  

How do we ensure that the needs of pregnant and labouring South African women are met?

And how do we bring back the trust that women have lost in a system which has so desperately failed them?