A doctor speaks to female patients in a Kirkuk hospital. (photo: دورة صحية لنساء كركوك )
After Kirkuk woman, Rua Abdullah, gave birth to her first son in a state hospital, she swore she would never repeat the experience.
“The doctors treat the patients badly and they make giving birth tougher than it is already,” Abdullah explains. “After dealing with all kinds of humiliation and insults I finally heard the cries of my son. I praised God because I was still alive. But then I swore never to go back to that hospital.”
And in fact, Abdullah, who is 27, gave birth to her next child – a daughter – in the home of one of the area’s midwives.
Stories like Abdullah’s are becoming more common here. Expectant mothers have lost confidence in government hospitals because of poor services and treatments and they prefer to use the services of private midwives. Sometimes, women will even pay to bring their midwives to hospital with them; this usually costs around US$80.
There’s a lack of awareness about what can go wrong at a midwife's, the doctor says.
“The number of women who prefer to give with the help of a midwife is increasing in Kirkuk,” Hassan Sabar, a doctor and spokesperson for the health department in Kirkuk, confirmed to NIQASH. “This is especially true in the villages and districts, compared to the city centre.”
Both educated and uneducated women are turning to midwives, who also have the legal power to give out birth certificates in Iraq. This is even though many of the women living in city centres are well aware of the potential dangers when they give birth in somebody’s home. For example, if the baby or mother need medical intervention, they would then have to be transferred to a hospital.
Noor Mohammed, 35, is trained as a lawyer and has three children. None of them were born in the local hospitals because, Mohammed says, she doesn’t trust the local hospitals and she had heard many bad things about the way patients are treated there from friends and relatives.
Instead Mohammed’s mother and sisters prepared a room in her own home, complete with sterile equipment. “The midwife then came to my house and I gave birth to my children there,” Mohammed explains. “It was a very good feeling to do this at home.”
Her first child was actually born at the midwife’s house. She says the midwife she uses is very experienced and Mohammed trusts her implicitly. “At her house, the room was clean and all the tools she might need were there,” Mohammed says, “including – most importantly – a machine used to revive a baby’s heart if it stopped beating and another one to remove fluid from a baby’s lungs.”
Visiting one of the area’s most experienced midwives, Baxan Ahmad Mohammed, and one finds a similar variety of specialized equipment. It is more like a birthing centre than a bedroom, with a sterilizer, surgical equipment, a special bed as well as a variety of medicines and other machines for resuscitation and monitoring.
The Kirkuk maternity hospital.
Of course, the standards among midwives here differ, Ahmad Mohammed told NIQASH. She herself has been a nurse since 1988, at the state hospital, and in 1993 she began practicing as a midwife after getting certified by the authorities. In Kirkuk, she is nicknamed “grandmother” because of her role but not all midwives are like her.
“Some have a lot of experience and have also taken courses in medicine to educate themselves further,” she says. “But others lack the required experience. Some of these are responsible for women’s deaths.”
Ahmad Mohammed then tells a horror story about a mother who came to her in her ninth month and asked to be given medication to bring on contractions: She wanted to give birth before a certain date.
Ahmad Mohammed refused. “I only give that injection in rare cases, when the patient needs it and her health allows it,” she says.
The woman left but she obviously managed to find somebody who would give her the injection. Later in the evening, Ahmad Mohammed was working at the local hospital where she is also a nurse, when the woman was brought in, bleeding heavily. “The staff couldn’t do anything to save her and she passed away,” Ahmad Mohammed notes.
It is not always legal for expectant mothers to seek out the help of a midwife. The Iraqi Ministry of Health’s guidelines say that the first and fifth child should be delivered in hospital and that any females with a medical history that includes issues like diabetes, obesity or heart problems, or who have previously had caesareans, should also be having their babies in a hospital.
If a woman like this goes to a midwife, the midwife apparently bears the legal consequences if something goes wrong.
Sabar of the health department says midwives operating in Kirkuk are tested annually and are required to undergo further training. “If a midwife violates these conditions, they may be prevented from doing further business,” Sabar says.
Shalah Abdul-Rahman, a Kirkuk obstetrician, says she understands why locals are choosing midwives over hospitals. For one thing, there are not enough beds for patients, she notes. “There are not enough staff either and often spaces are small and crowded,” she continues. “So women don’t like to come here because there are too many people and the staff are always too busy.”
However, Abdul-Rahman adds, a lot of locals don’t seem to be fully aware of the dangers of going to a midwife for birthing rather than to a hospital. “There’s a lack of awareness about what can go wrong,” she says.