Pregnancy and childbirth in Palestinian communities under military occupation: midwife Mary McNabb presents her impressions from a visit to Palestinian communities in East Jerusalem, Ramallah Bethlehem and Hebron, June 15-July 6, 2002.

• Auteur: McNabb, Mary

"The Palestinian territories today are witnessing the onset of mass famine" (Said, 2003)

As a result of the occupation of the West Bank by the Israeli Defence Force (IDF), material and social deprivations and the risk of physical injury or death are matters of everyday reality for Palestinian mothers and their families (Hippias Education Collective, 2003). During pregnancy, women live in fear of a variety of threats to themselves and their unborn children: exposure to gunfire; effects of poisonous gases used by security forces; going into labour during prolonged curfews; and getting trapped in a car or ambulance at IDF checkpoints, on the way to hospital. In the last two years, at least six women have given birth while waiting at Israeli checkpoints and 46 pregnant women have died along with their unborn children because of the prolonged delays (Wick, 2002). Military control of everyday life imposes restriction on all Palestinians' movements, including emergency obstetric and neonatal transport services. As a result, the incidence of life-threatening situations around childbirth is increasing (Wick, 2002; Al Wakeel, 2002). Women are being forced to give birth at home without professional assistance, during IDF closures. Apart from direct exposure to the dangers, news of shootings and sudden curfews are creating high levels of anxiety, with concomitant increases in spontaneous abortions, pre-term labour and reduced fetal growth (Jabr, 2002; Reinhart, 2002; Starhawk, 2002).

In response to the present crisis, more women seem to be using contraception because of the climate of fear created by the occupation (Najjab-Khategb, 2002). At the same time, pregnant women are turning to traditional skills to deal with the lack of reliable access to healthcare, to provide for their own safety during labour and birth.

`Old people, especially women, are more popular again. They have so much to contribute now. Under curfew and closures, with no access to hospitals, delivery of new babies is being done at home, without doctors. The skills of old women are needed again as midwives.' (Ghassan, 2003).

Evidence obtained during my visits to Hebron, Tarqoumia and Ramallah suggests that 30-60% of women now make arrangements to give birth at home, in a safe house, local midwifery birthing centre or clinic. Community midwives are responding to the growing need for home-based care, including the skilled management of complicated cases. In addition, hospital-based midwives, nurses and obstetricians are voluntarily responding to desperate calls for help. These professionals often work on their own to assist women during labour and to deal with emergencies, guided by telephone advice from experienced obstetricians. Under these extreme conditions, most babies are born in good health, and some complicated births have good outcomes, even without skilled birth attendants. However, some babies do die, either before or after birth. These tragedies are partly due to the absence of generally agreed protocols for safe practice in community settings and the denial of adequate emergency obstetric-neonatal services with access to hospital care. According to the data from the Palestinian National Authority Ministry of Health (PNAMOH) there has been a 56% increase in stillbirths since 2000 (PCB, 2001).

Effects of the military occupation on place of birth

Since it was established in 1994, the PNAMOH has promoted a maternity care policy of encouraging hospital births for all women. Numbers of hospital births steadily increased and by 1999 only 10% of births were taking place at home (Wick, 2002). However...