Tuesday, October 9, 2012

Maternity Care in Kuwait: Where's My Fairy Godmother?


I’m walking out of the doctors office at New Mowasat, and there are a string of lyrics running through my head: “Where have all the [midwives] gone, and where are all the [docs]? Where’s the street smart Hercules to fight the rising odds? Isn’t there a white knight upon a fiery steed? Late at night I toss and turn, and I dream of what I need. Ahhh, Ahhhh…I need a hero, I’m holding out for a hero till the end of the night!” Where's my fairy godmother, my midwife to save the day? I’m 24 weeks pregnant with my 5th baby, and I still haven’t found an enlightened care provider in Kuwait.

To explain my exasperation, let me break it down. Research on maternity care practices have shown that:

  1. Healthy, normal pregnant mothers do just as well or better under the care of a midwife (Hatem 2009)
  2. Routine use of interventions have been shown to lead to more complications, like infections, unnecessary interventions, and cesareans, and do not always improve outcomes. These routine interventions can include:
  3. Mothers and babies both have better outcomes and shorter labors when they have continuous support from someone they know (a sister, mother, doula, husband) and (Hodnett 2011)
  4. Routine separation of mother and baby and the routine feeding of infant formula to babies in nurseries interfere with mother baby bonding and successful breastfeeding. (Moore 2012)

Kuwait maternity hospitals only offer prenatal care from obstetricians -although some hospitals use nurse-midwifes on the labor and delivery floor- much like a labor and delivery nurse. Midwifery as an autonomous care provider is not recognized in Kuwait. Kuwait government maternity hospitals isolate mothers from their loved ones when they check into the hospital- no one is allowed to accompany them for the rest of their labor and birth, and they labor in group maternity wards separated by curtains. At least private hospitals allow mothers to labor in private rooms with the support of their loved ones with them.  Both government and private hospitals routinely use interventions to actively manage their laboring mothers, and both routinely separate mothers and babies after birth and offer formula. In this respect, government hospitals might be more progressive than private hospitals, encouraging babies to stay with their mothers more often and working to eliminate the routine use of infant formula- thanks to the MOH Breastfeeding Promotion Committee. I applaud the luxurious rooms and service at the private hospitals, but they would do well to remember that they are hospitals and not hotels, and their first priority should be to provide evidence-based medical care, not luxury packages.

So, my question to the Ministry of Health is, what are current maternity care policies in Kuwait based on, because it’s not based on medical evidence.

I’ve had one hospital birth, one birth-center birth (in a birthing tub) and two home births (with midwifes and the use of a birthing tub). There’s a reason I haven’t gone back to the hospital to give birth: research has indicated what practices are best for mothers and babies, yet many hospitals still seem to base their protocols and regulations on fear of litigation and patient management rather than medical evidence. I want to birth someplace where I feel safe. For me that is at home with a trained midwife. So how can I birth the way I want while living in Kuwait? Sigh…I’m still holding out for a hero…anyone seen my fairy godmother?

15 comments:

  1. I applauded your truth felt cries here, and hear the sensible voice coming through! Kuwait is way behind and that is a FACT! I would however, be interested to hear which Doctor you saw at Mowasat and whether you would recommend them? I'm desperate for a good obstetrician now i'm pregnant. Any advice would be greatly accepted.
    Thanks :)

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