'Shedding light' on the challenges faced by Palestinian maternal health-care providers.

OBJECTIVE: to explore the challenges and barriers faced by Palestinian maternal health-care providers (HCPs) to the provision of quality maternal health-care services through a case study of a Palestinian public referral hospital in the Occupied Palestinian Territory. DESIGN AND METHOD: descriptive qualitative study. The data are from a broader study, conducted in 2005 at the same hospital as part of a baseline assessment of maternal health services. PARTICIPANTS: 31 maternal HCPs; nine midwives and 14 nurses and eight doctors. FINDINGS: the quality of care provided for women and infants at this Palestinian public hospital is substandard. The maternal HCPs work within a difficult and resource-constrained environment. ISSUES INCLUDE: high workload, poor compensation, humiliation in the workplace, suboptimal supervision and the absence of professional support and guidance. Midwives are perceived to be at the bottom of the health professional hierarchy. CONCLUSIONS: there is a need for managers and policy makers to enable maternal HCPs to provide better quality care for women and infants during childbirth, through facilitating the roles of midwives and nurses and creating a more positive and resourceful environment. IMPLICATIONS FOR PRACTICE: Palestinian midwives need to increase their knowledge and use evidence-based practices during childbirth. They need to unite and create their own circle of professional support in the form of a Palestinian midwifery professional body.

Maternal and child health in the occupied Palestinian territory.

The Countdown to 2015 intervention coverage indicators in the occupied Palestinian territory are similar to those of other Arab countries, although there are gaps in continuity and quality of services across the continuum of the perinatal period. Since the mid 1990s, however, access to maternity facilities has become increasingly unpredictable. Mortality rates for infants (age

Evoking the guardian angel: childbirth care in a Palestinian hospital.

The purpose of this study was to assess the quality of maternity care in a large, public, Palestinian referral hospital, as a first step in developing interventions to improve safety and quality of maternity care. Provider interviews, observation and interviews with women were used to understand the barriers to improved care and prepare providers to be receptive to change. Some of the inappropriate practices identified were forbidding female labour companions, routine use of oxytocin to accelerate labour, restriction of mobility during labour and frequent vaginal examinations. Magnesium sulfate was not used for pre-eclampsia or eclampsia, and post-partum haemorrhage was a frequent occurrence. Severe understaffing of midwives, insufficient supervision and lack of skills led to inadequate care. Use of evidence-based practices which promote normal labour is critical in settings where resources are scarce and women have large families. The report of this assessment and dissemination meetings with providers, hospital managers, policymakers and donors were a reality check for all involved, and an intervention plan to improve quality of care was approved. In spite of the ongoing climate of crisis and whatever else may be going on, women continue to give birth and to want kindness and good care for themselves and their newborns. This is perhaps where the opportunity for change should begin.