Birth & Midwifery in Saudi Arabia
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Aisha Alhajjar is an American midwife (BSM and CPM) married to a Saudi. She began assessing and stimulating the birth culture in Saudi Arabia since her arrival in the country in 2010. She has created an Islamic childbirth education and doula program, AMANI Birth, and has trained numerous childbirth teachers and doulas with materials available in English and Arabic (as well as Indonesian and German) who work in the local communities.
The current midwifery model in Saudi Arabia is more of a hospital obstetric nursing role than it is midwifery; however, she has organized conferences and rallied leaders and champions of autonomous midwifery practice and is a founding board member of the newly formed Saudi Midwifery Group (SMG). SMG is working with the Ministry of Health, which has recently created a Midwifery Task Force (MTF) with recognition that Saudi Arabia would be best served by a midwifery-led birthing culture with need to cultivate 10,000+ midwives over the next five to ten years. With this in mind, teams are in place to develop a national bachelor of science in midwifery (BSM) program using International Confederation of Midwives’ (ICM) standards. There is a lot of work to be done for midwifery and birthing in Saudi Arabia and we are pleased at the visionary steps and support being shown today in concordance with Saudi Arabia’s recent announcement of the Saudi Vision 2030.
What is the biggest challenge facing normal birth in your country and what is being done to address it?
At current, Saudi Arabia has a highly medicalized, obstetric model of maternity care that mirrors the United States. Unfortunately, intervention rates are unacceptably high and a completely normal physiologic birth a rarity. Autonomous midwifery practice is non-existent and homebirth is illegal.
Fortunately there is a lot of visionary work taking place in Saudi Arabia right now. This is a huge leap from the status of birth and midwifery today.
Although there are still many hurdles, change is on the horizon. AMANI Birth has introduced childbirth education and public awareness about normal physiologic birth and a woman’s right to make her own decisions is slowly rising. The foundation of the Saudi Midwifery Group and the Midwifery Task Force within the Ministry of Health are huge steps recognizing the need for quality midwifery education, autonomous midwifery practice, and collaboration of care with peer professionals, such as nurses and doctors.
The Saudi Midwifery Group was given a voice to speak at the 25th Anniversary Celebration of the Saudi Society of Obstetrics and Gynecology (SSOG) conference in March 2016 and they celebrated the International Day of the Midwife on May 5, 2016 with a mini midwifery conference.
Below are some paraphrased excerpts from interviews with the leaders at the SSOG conference in March, 2016:
Professor Hassan Abduljabbar, President of (SSOG)
The Saudi Society of Obstetrics and Gynecology recognizes that many things need to be done for midwifery in Saudi Arabia. Unfortunately, midwives in Saudi Arabia are not recognized as a body outside of nurses, yet they are not a group of doctors either.
We need them to be an autonomous profession, like in most of Europe, like in England where midwives lead all the obstetric services. In the West they have this natural childbirth, whether at home or in the hospital, where actually the doctor has minimal to do with delivery unless there is a medical indication.
For Saudi Arabia we have a vision that midwifery will go back to what it used to be, a respected profession, because we know that doctors intervene and make things more complicated because they want to finish very quickly; whereas the midwife is there all the time and is patient to wait. We want to go back to the normal way with the midwife as the normal provider of care; so the SSOG decided to support the founding of the Saudi Midwifery Group.
We will support midwifery to go higher and convince the medical professionals and the Ministry of Health and Saudi Commission for Health Specialties. There are so many doctors interested to support the midwifery model and we know that in a completely normal delivery doctors should not interfere and we can trust midwives to call us if a complication arises, which is really good about midwives, they know when to call even better than a junior doctor.
We are pleased with the enthusiasm of the members of the Saudi Midwifery Group and we’ve seen how much they have accomplished in this short time. In short, I believe that we should go back to midwifery and we should allow midwives to handle normal deliveries.
Dr. Faisal Kashgari, Segretary General of (SSOG)
It is an honor for the Saudi Society of Obstetrics and Gynecology to have a midwifery group under our umbrella and we know they will one day have their own society. We know this is the beginning and our society is giving the midwives our support so they can stand on their own in a few years’ time.
I think that midwifery is the future. I fondly remember, as an OB student, “Mama Dawn,” the South African midwife who took me under her wing on my first day as a resident. I was struggling in the labor room and she took me and said, “Come sit. I will explain everything.” She told me, “In three month’s time I’m sure that you will be excellent.” She taught me everything and I cannot ever forget her and that’s why I respect midwifery so much.
I am very happy with the excellent presentations by the Saudi Midwifery Group at the SSOG conference. Even our organizing committee didn’t think there would be so much attendance for this session and people came and even had good discussions.
I think the Midwifery Group is very active and has accomplished a lot since the first meeting in August, 2015. We know this is a big challenge; we want to change the whole culture, not only from the doctors’ side, but even the general public. It will take time and in the first three years we have to build everything as we are putting all the pillars to renew midwifery in our culture.
I mean if you go back 50–60 years, everything was done by midwives. Only in the last 50 years has birth become the business of the obstetrician and we want to change it back again. It’s a behavioral change for our culture and I think it will take 3–5 years. The first three years we have to put all the pillars and make our team and our plan and invest in people and in the next coming few years work hard on public awareness so when we really launch everything the public is ready to accept it. I think we need a lot of campaigns and we need to manage the ways to reach the public.
In the meantime we really need to invest in the manpower and create a bachelor degree for midwifery. Our first and biggest challenge right now is the Saudi Council to recognize and register the specialty of midwifery. I think we will get that as we now have the Vice Chair of the Saudi Midwifery Group a seat on the scientific committee of the Saudi Council.
But what I really see is that we have to change the perceptions of the public and the nurses, and the doctors in general about what an important service midwifery is. In fact, my wife and I personally used a midwife when we had our baby in Germany and it was an excellent experience for us, even though we are both obstetricians ourselves. It was a really different experience than what we know of birth as obstetricians. It was different and she was different than an obstetrician, she was holding her hand and doing midwife stuff, and it was really different and nice. We saw with our own eyes how midwives decrease the pain naturally, which decreases morbidity.
My own experience is one reason I really want to support midwifery in Saudi Arabia. Midwifery should be an autonomous profession that would collaborate with, and refer to, OBs but they should not be under OBs and this is the vision and task for the Saudi Midwifery Group. For now the group is under us, but this is just a first step and from the beginning we envision the future where midwifery will stand on its own.
Dr. Roa Altaweli, Vice Chair of SMG and first Saudi PhD in Midwifery
I was surprised at the huge number of attendees at the midwifery section of the SSOG conference. And I felt very happy with the attention they gave to midwifery. I feel that midwifery is very supported by the obstetricians with the realization that we have a lot of challenges to face ahead.
We have to overcome the perception of midwifery in the community, amongst other doctors, the current view of what midwifery is—and the people working in that model now, and nurses who think that midwifery is only a subspecialty of nursing. We have a vision to improve and develop the autonomous midwifery profession in Saudi Arabia and we recognize that we will face resistance to the existence of midwifery as its own profession.
But I do feel good about it as we have moved a good distance just in the last year, from founding the Saudi Midwifery Group, establishing our website, registering members and supporters, and beginning the development of direct-entry midwifery education.
This is all really huge and I know that a lot of midwives have felt isolated for so long and many who have studied midwifery in the past have turned to nursing or other professions because they felt midwifery was not respected or supported here. With the founding of the SMG midwives are connecting, sharing our vision for the future, and feeling proud to be a midwife in Saudi Arabia.
I personally am involved in so many exciting initiatives with the Ministry of Health for midwifery and of course the Vice Chair of the Saudi Midwifery Group, whose first goal is to establish the midwifery profession, led by midwives.
Right now it’s so important for birthing women to learn that they have options in childbirth and they shouldn’t just accept the routine obstetric practices. Women have to learn to stand up for themselves and make informed decisions. When we have a midwifery model of care women will find they have more options and it is more natural with less interventions and midwives offer information and support women to make informed decisions about their care.
Midwives really support women during childbirth rather than just using routine interventions to get the process over with. Midwifery is women centered care rather than professional centered care and I’m really happy to be a part of this vision and am looking forward to the future where we have more midwives in Saudi Arabia and the community benefits from the development of midwifery-led care.
Professor Lesley Page, International Advisory Board Member for SMG and Royal College of Midwives (RCM) President
I was pleased to be invited to speak for the Saudi Midwifery Group at the Saudi Society conference about the evidence and safety of midwifery practice. We know that midwifery saves mothers’ and babies’ lives with a better quality of safe care. I believe that every woman should be cared for by a midwife.
I can see that Saudi Arabia has a great opportunity and is taking steps forward to develop direct-entry midwifery education and autonomous midwifery practice. They know they need to increase midwifery in the country and allow midwives to practice autonomously within a system of care that collaborates with their nursing and medical colleagues.
I was pleased that after the four presentations about midwifery at the obstetric conference there was quite lively discussion and it seems the leaders are ready to support this movement and they know what midwifery is and recognize that at one time there had been midwifery practice in this country and it needs to be reinstated in Saudi Arabia.
I think some of the biggest challenges they will face in developing midwifery in Saudi Arabia will be creating the appropriate curriculum with a place to experience midwifery clinical practice to learn midwifery skills, along with the sheer number of midwives that have to be educated (estimated 10,000 at a minimum). I think, given the efforts that are underway, that within five years Saudi Arabia will see significant differences and understanding of what midwifery is.
I believe that within ten years there will be a significant, transformative change for all women in Saudi Arabia. There’s no doubt this will improve outcomes in this country, as the evidence shows that when you introduce educated midwives who are integrated into a complete system of care you get lower morbidity and mortality rates and better birth experiences and stronger family integrity.
I would like to wish Saudi Arabia good luck and I think it is a leader in this region and many people will be watching and following what’s happening. I sense that the members of the SSOG and SMG are people who are motivated and will move initiatives forward very quickly.
Midwifery is budding in Saudi Arabia and it’s a promising time to be a midwife here. The support that is being shown by the Saudi Society of Obstetrics and Gynecology and the Ministry of Health are encouraging hope for a midwifery-led birthing culture in the near future.
Aisha Al Hajjar
BSM, CPM, LM, AMANI