I am a direct entry midwife, qualified for three years after 20 years as a birth partner for whomever wanted my company during birth. I have a dream to live and work in India with village women. To finance the fulfillment of this dream I am working as a midwife in Riyadh Armed Forces Hospital, Riyadh, Saudi Arabia. I have completed four months of a one-year contract. The salary is tax-free, lots of overtime is available and we are provided with accommodation including electricity, gas, etc. The sun shines every day and it is very dry and bearable.
Midwifery here is out of the Dark Ages, however, mainly because of hospital policies. It is policy to continuously monitor everyone in labor even if they come in fully dilated and pushing. Almost everyone has artificial rupture of membranes, fetal scalp electrode, IV fluids and everyone has to lie on a bed. Vaginal examinations are done for everyone even if they come in with a stubbed toe or broken fingernail! Active pushing is the order of the day. Physiological third stage--what's that? As for alternative positions, if you are lucky you might get away with catching a baby with mum in the left lateral position but such things are frowned upon.
All women with breech presentations must have epidurals, and here they are of the old variety which turn women into beached whales--when they work! All breeches are delivered in the lithotomy position; forget the hands off approach. Breeches are dragged and cork screwed out. I honestly don't know how some of them survive.
It must be said that some interventions are necessary. There are many complicated cases here. Cardiac problems are seen almost every other day. It's not uncommon for women with transplanted organs or on renal dialysis to be pregnant. Congenital abnormalities are frequent, as consanguinous marriage is common. At least 1 in 3 babies has meconium stained liquor. Many women are dehydrated or ketotic when they come in and need IV fluids. They won't eat or drink because they don't want to get fat or their husband might find another wife. Or they have abandoned their traditional healthy way of eating and have become huge, courtesy of McDonald's, KFC and Coca-Cola, rendering them prone to gestational and true diabetes.
What keeps me here besides financial gain to fulfill my dream? The Arabic women, who are adorable. They have an absolutely wicked sense of humor. Even though my Arabic is very limited and they speak no English, I have such fun with them (and I hope they do with me). They are very gentle women; so sweet and grateful for any kindness shown to them. Unfortunately some of the midwives and support staff have been here a very long time and are very much in the 70s mood of "just do as you are told." They can be very rough. Consequently many women are very afraid when they come into hospital. I don't hold out much hope for changing things on a grand scale but if I can make a difference for individual women I am privileged to care for during labor and birth, I am willing to persevere, and I'm slowly developing a repertoire of tricks to help women avoid unnecessary interventions.
There is so much more to say about midwifery in Saudi Arabia. If anybody would like to discuss it more or offer me inspiration, I'd love to hear from you. Email me at rama1105@hotmail.com.
Yours in the service of women,
Rama--your sister in the desert!
Reprinted from Midwifery Today E-News (Vol 1 Issue 34, Aug 20, 1999)
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