In a quality-of-care assessment of mothers and newborn babies in maternity units in the Gaza Strip, occupied Palestinian territory (oPt), WHO oPt identified poor management of normal childbirth, early discharge, and lack of privacy for women as challenges for the delivery of care to pregnant women. The Palestinian Ministry of Health agreed that these challenges could be addressed by the introduction of a midwifery-led model of care. The aim of this study was to solicit the views of staff and women who had been through childbirth with respect to the introduction of the midwifery-led model of care.
Methods
Six focus groups were organised and each group consisted of eight to 12 health professionals (midwives, nurses, or doctors). Selection criteria for the health professionals were experience in midwifery-led model of care and working in a maternity unit of one of the main hospitals in the Gaza Strip. Two focus groups had midwives, two had male and female obstetricians, one had nurse managers, and one had primary health-care midwives and doctors. Three other focus groups were formed with women who had given birth at any time in their lives. Thematic analysis was used to identify themes and subthemes to form the basis for the analysis, and NVivo (version 8) was used to code and emerge themes and subthemes. The Ministry of Health provided the approval to do the study. All participants provided verbal informed consent.
Findings
Midwives stated that they lacked training in evidence-based practice. The consensus opinion of the doctors was that normal childbirth is the responsibility of midwives, and they mentioned that the midwives needed training. Managers stated that midwives with a postgraduate education could cope with the increased responsibility, but new graduates needed additional training. Professionals working in primary health care recommended better documentation in the mother—child handbook. Most women said that they preferred women to care for them during childbirth; however, they could not differentiate between midwives and female doctors, and claimed they were not kept well informed about progress and did not have sufficient support during childbirth.
Interpretation
Before the midwifery-led model of maternity care can be introduced in the Gaza Strip, midwives need to be given additional training so that they can focus on their core responsibility. The health-care system will assist midwives to respond to these challenges to improve the continuity of care.
