About Us

SARCM

The South African Registry of Community Midwives is an organisation that has been set up by a group of passionate and dedicated midwives, birth workers and parents who believe that everyone should have access to well trained, well supported out-of-hospital community reproductive care and out-of-hospital birthing options. We believe that out-of-hospital birth, community-centred care, and education should once again be normalised for low-risk parents and babies.

Studies repeatedly show that countries with tiered level care and integrated community midwifery practices have the best neonatal and maternal outcomes, conversely, systems with centralised or privatised obstetric care show the worse outcomes. We understand the difficult position the public healthcare system is in, that they must serve a high volume of patients with minimal resources and stretched staff. We understand that the nurses and healthcare professionals, overall, want what’s best for their constituents. But unfortunately, this is not enough, and the high burden on the system leaves many neglected, abused, and/or unseen entirely

SARCM aims to train community-based midwives with extensive clinical skills, outside of the current model of hospital training, to increase access to highly skilled reproductive healthcare, screening, and support at a grassroots level. With this we hope to alleviate some of the burdens on our national healthcare systems, allowing them to do what they do best; care for those who truly need medical intervention and support. 

It is also true that in this time of increasing global health worries, such as the current covid pandemic, it is illogical and unfair that low-risk families, carrying low-risk pregnancies should be subjected to the stress of overburdened hospital care in a place where risk of infection is so much higher. In addition to the increased risk of contracting covid, people giving birth in hospitals nowadays are largely having to face this important rite of passage without their partners, birth companion, or support of any kind. 

In order to make out-of-hospital care and birth as safe as possible there needs to be specifically tailored comprehensive training for reproductive care providers who wish to practice in out-of-hospital settings, as this model of care is fundamentally different from that followed in a hospital environment, but still with an emphasis on a solid foundation of clinical skills. SARCM aims to create a seamless integration of specialised community-based midwives into the current healthcare system. 

SARCM is developing a direct-entry, advanced diploma training platform with international standards for midwifery that will provide an alternative route to midwifery certification in South Africa. 

We acknowledge the rich history of traditional midwifery and birth practices in South Africa that stretches across the varied cultures and traditions of this nation. These midwives and birth attendants are still working, still supporting their communities, still closing the gaps of healthcare in places that are either not reached by the current healthcare system, or that have refused engagement with the healthcare system for various reasons, including mistrust, spiritual beliefs, cultural traditions, personal choice and freedom, etc. 

We recognise that current obstetric practices are inherently colonial concepts, created in the vacuum left when traditional birthing practices were dismantled and abolished by settler colonialists. It is in the light of this as well as the multiple cases of obstetric violence that are coming forward, that SARCM recognises the importance of comprehensively and compassionately trained community midwives and birth practitioners at an advanced level. SARCM is developing a platform for continuing professional development in out-of-hospital midwifery with recognition of prior experience. 

We’ve come together to form this organisation with the goals of standardising basic and advanced education in community midwifery in order to grant ourselves a seat at the table of legislation in this country. The International Confederation of Midwives has defined a midwife as someone who has completed training and is recognised by the country in which they practice. This excludes any midwife who has not trained through the practice lens of The South African Nursing Council. And, according to South African legislation, in the Nursing Act, none can call themselves a midwife unless they are registered with The South African Nursing Council. This leaves a category of highly trained foreign midwives unable to register with SANC and unable to practice as midwives. This is a massive disservice to our communities and the capabilities of midwives trained outside the SANC model. 

In relation to the Sustainable Development Goals (SDG), countries have united behind the new target to accelerate the decline of maternal mortality by 2030, and we believe that increasing access to community-based midwives can help achieve this. SDG 3 includes an ambitious target: “reducing the global MMR to less than 70 per 100 000 births, with no country having a maternal mortality rate of more than twice the global average”.  

SARCM follows and promotes The Midwives’ Model of Care

The Midwifery Model of Care is a philosophy of care that is based on the fact that pregnancy and birth are normal life processes. The Midwifery Model of Care includes monitoring the physical, psychological and social well-being of the mother throughout the childbearing cycle; providing the parent with individualised education, counselling and prenatal care, continuous hands-on assistance during labour and delivery, and postpartum support; minimising technological interventions and identifying and referring clients who fall outside their scope of practice.

The Objectives of SARCM

  1. To promote excellence in Community (out-of-hospital) Midwifery practice.
  2. To endorse The Midwives’ Model of Care as the gold standard for childbirth and reproductive health.
  3. To establish and maintain an up-to-date qualification and training standard of the Registered Community Midwife in line with international standards and evidence-based best practice.
  4. To offer a Registered Community Midwifery training route and qualifying exam to SARCM students that is recognised by The South African Qualifications Authority (SAQA) and the Department of Health.
  5. To maintain a registry of Registered Community Midwives as set forth by SARCM’s framework for qualification and training.
  6. To promote and offer continuous professional development (CPD) through continuing education of midwives and birth workers so that all people and babies will have access to practitioners who can provide excellent prenatal care, safe and empowering births and comprehensive postpartum care in an out-of-hospital setting.
  7. To position Registered Community Midwives as acknowledged authorities, working to improve perinatal health in collaboration with other healthcare professionals.
  8. To build an identity as a cohesive organisation representing the profession of Registered Community Midwifery, as well as the tradition of community midwifery at regional, national and international levels.
  9. To collect and disseminate high-quality research about Community Midwifery led care.
  10. To engage midwives in dialogue and to encourage solidarity in the profession across South Africa.
  11. To recognise experience and diversity among midwives and to foster inclusive community building by extending training, recognition and autonomy to midwives outside of the current SANC nursing system. This includes, but is not necessarily limited to, Traditional Birth Attendants, foreign-trained midwives, direct-entry midwives, SANC trained nurse-midwives and Registered Community midwives.
  12.  To sponsor continuing education opportunities for midwives.
  13. To increase access to Registered Community Midwives in all settings.
  14. To lobby for the rights of independent birth workers and to work to change laws that infringe on the practicing rights of Registered Community Midwives.
  15. To promote dignity and Informed Choice for all pregnant and birthing people.
  16. To affirm the rights of parents to give birth where and with whom they choose.

 

SARCM intends to engage with key role players in the South African maternal healthcare sector in order to further its objectives, as well as creating public awareness around informed choice for expectant parents through media and education campaigns.

[1] “Midwife-Led Care Delivers Positive Pregnancy and Birth Outcomes.” World Health Organization, World Health Organization, 29 Aug. 2013, www.who.int/workforcealliance/media/news/2013/midwifecochrane/en/.

[2] Johanson, Richard, et al. “Has the Medicalisation of Childbirth Gone Too Far?” BMJ (Clinical Research Ed.), BMJ, 13 Apr. 2002, www.ncbi.nlm.nih.gov/pmc/articles/PMC1122835/.

[3] Honikman, Simone, et al. “Abuse in South African Maternity Settings Is a Disgrace: Potential Solutions to the Problem.” SAMJ: South African Medical Journal, South African Medical Association, www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742015000300023.

[4] Midwives, International Confederation of. “ICM Definitions.” ICM, www.internationalmidwives.org/our-work/policy-and-practice/icm-definitions.html.

[5] “The Midwives Model of Care.” Midwives Alliance of North America, 24 Sept. 2020, mana.org/about-midwives/midwifery-model.