Hospital Policies and Practices Concerning Normal Childbirth in Jordan

Abstract

In Europe and North America, movements have long been established to make childbirth safer for the mother and the newborn and more responsive to the needs of individual women. In particular, women's groups have resisted the medicalization of childbirth and have argued that childbirth is a normal and important event in women's lives, and that women should make birthrelated decisions in partnership with health-care providers. Therefore, professional expectations and regulatory mechanisms to conform to the standards of up-to-date evidence-based medicine, together with consumer pressures to respond to the preferences of pregnant women, have contributed to repeated revisions of policies and practices concerning childbirth (Khayat and Campbell 2000).Internationally, recommendations for reducing maternal mortality, now one of the Millennium Development Goals, have called for prompt and high-quality services for women who experience potentially fatal complications. Because maternal deaths are largely avoidable and are strongly associated with the absence of good medical care before, during, or after delivery, emphasis is placed on providing prompt emergency obstetric care for the minority of women facing potentially fatal complications (Maine 1999). Less attention is paid to whether evidence-based practices are followed for all deliveries, including normal, uncomplicated deliveries, which constitute the majority of the cases on maternity wards. Yet even apparently uncomplicated deliveries are not risk free for either the mother or the newborn, and good practices can prevent problems or identify them early, whereas poor or unnecessary practices can cause harm (WHO 1998;Campbell et al. 2005).Although the majority of women in much of the Arab Middle East now deliver in hospitals (see Table 1

Childbirth care practices in public sector facilities in Jeddah, Saudi Arabia: A descriptive study

“…These findings support an earlier study carried out in Jordan in which the majority of hospitals reported having written policies regarding childbirth, breastfeeding and the care of mothers (Sweidan et al, 2008). In contrast, the majority of Syrian and Lebanese hospitals studied did not have written childbirth policies (Khayat and Campbell, 2000;Abdulsalam et al 2004).…”

“…Enemas were found to be given routinely in around 45% of the hospitals. A similarly high rate (67%) was found in Jordanian hospitals (Sweidan et al, 2008). Enemas cause discomfort and embarrassment for women during labour.…”

“…This rate is comparable to the national population-based rate of 21% in 2008 (MOH, 2008) whereas the WHO recommends a maximum rate for Caesarean section of not more than 15% of all pregnancies (Sweidan, 2008). However, Waldenstrom (2007) argues that the appropriate Caesarean section rate is widely debated and she questions the evidence on which the WHO recommendation is based.…”

“…During childbirth both professional and social supports are essential (Sweidan et al, 2008). In a comprehensive review of continuous social support for women during childbirth Hodnett et al (2007) found that women who had continuous support during labour were likely to have a slightly shorter labour, were more likely to have vaginal birth spontaneously, be more satisfied with the childbirth experience, and were less likely to have pain medication.…”

“…Some studies found had examined the routine policies and practices of normal birth worldwide (Maimbolwa et al, 1997;Festin et al, 2003;Turan et al, 2006;Harris et al, 2007;Danichevski et al, 2008;The SEA-ORCHID study group, 2008;Chalmers et al, 2009). In the Arab world, studies of hospital policies and practices for normal childbirth have begun to assess whether they are within EBP (Khayat and Campbell, 2000;Abdulsalam et al, 2004;Khalil et al, 2005;Wick et al, 2005;Hassan-Bitar and Wick, 2007;Sweidan et al, 2008;Khresheh et al, 2009). All have shown deviation from EBP for normal childbirth.…”