Background: Good maternal care, by modern standards, includes choice. Changing Childbirth, the case was made “The way a woman gives birth can affect the whole of the rest of her life- how can that not matter- unless the woman herself doesn’t matter.”
Perspectives:
This dialogue was conducted between Palestinian midwives and nurses that operate in the West Bank, Jerusalem, and Israel. A key issue for choice in childbirth in the Israel/Palestine region are the vast differences between giving birth in Israel and giving birth in Palestine. When the dialogue facilitator asked the first question about choice in childbirth, midwives practicing under the Palestinian system responded “what choice?”
Palestinian midwives in Israel noted that choice in childbirth was built into the hospital’s birth model. They noted that mothers were aware that they had options, were encouraged to choose whether or not to have birth plans, visit the hospital before giving birth, attend pre-natal classes, and her doctor. These choices are up to pregnant women regardless of their ethnic, national, or religious affiliation.
Palestinian midwives operating under the Palestinian system noted that in their institutions, pregnant women are not consulted as to their preferences, and choices are made by clinicians and the material situation. In particular, they note that there is no facilitation through the birth process, which is complicated by a large volume of young mothers, patriarchal culture, lack of knowledge that there are different ways to give birth, and poverty. For caregivers, midwives are disempowered by the material situation of their institutions that facilitating choice becomes a low-priority. Midwives name the quick overturn of patients in the maternity ward (sometimes mothers after birth only stay a couple hours under supervision before discharge); the lack of materials, including hot water, gloves, and sheets, as their primary concerns in insuring a safer birth; and the politics of the health system and hospital, including relationships with doctors.
Recommendations:
We, nurses and midwives in Israel and Palestine, call for institutional and policy interventions in order to improve Palestinian women’s ability to choose how they want to give birth.
· Communication between midwife and patient regarding existing options for birth. This communication must coincide with trust-building between midwife and patient.
· Education for the public, including pre-natal classes through clinics and hospitals, education in schools, and public media campaigns about options women have in childbirth.
· Government investment in birth services and general hospital and clinical services, including paying the salaries of medical staff.
In our context, it is important to recognize the underlying causes of a weak health system in the Palestinian Authority, including the lack of political will to improve health services. As nurses and midwives, we recognize that many factors are beyond our control. Through the listed interventions, we hope to start a bigger dialogue about how to protect women’s human rights in birth in Palestine.