A Midwife's Tale

Proposed nursing bill would make Mandate-era Midwives Ordinance obsolete.

A humorous etymology of the word "obstetrics" has it that the word comes from "obstacle" - the nickname given by midwives to the doctor supposed to be helping them, who in fact often causes the birth to be delayed. Even if the word has a different origin, midwives have been standing by the crib of the newborn ever since the days of Moses. According to another legend, the name of the Biblical midwife Shifra originates in her practice of helping the newborn baby begin breathing with the help of a tiny tube (shfoferet in Hebrew ). Because midwives are medical workers, they require a professional license. In Europe, evidence of midwife licensing has been found since as early as the fifteenth century.

According to archived documents, in the 1920s, five kinds of midwifes were available in Palestine: a daya - an independent traditional midwife who learned the secrets of the trade while apprenticing with a traditional midwife; an Arabic midwife who took a six-month course in a government institute; a Jewish midwife, sometimes a member of the pre-Zionist Jewish community (the Yishuv ), who studied for one year in one of the European schools for midwives and received a certificate; a female "feldsher" (health care professional ), who usually came from Eastern Europe; and a nurse-midwife qualified according to the American model, adopted at Hadassah Hospital.

maternity ward - 26092011

The British Mandate set down the rights and obligations of midwives in the Midwives Ordinance, enacted in Palestine in 1929. The legislation focused mostly on improving the level of health services provided to the local residents and on establishing British rule in this field, rather than on ensuring the legal status of midwives. The main issue that worried the British was infant mortality, which was relatively high in Palestine, especially among the Muslim population.

This situation required standardization through legislation, which provided midwives with protection against professional trespassing. The ordinance required midwives to report births, thereby giving the legislature control over information regarding births and incidences of newborn deaths. The British sought to prevent dayas from attending births, since they considered these midwives unprofessional. They therefore defined two kinds of registered midwives: "licensed" midwives, who had studied in an institution recognized by the ministry of health for at least six months; and "registered midwives" - women who worked as midwives without certification (dayas ).

The British did not intend to directly distinguish between the Jewish community and the Arab one, but the legislation implicitly indicated the gap in status between the two groups. The "licensed" midwives (mostly Jewish women ) were allowed to practice their profession throughout the country, while "registered" midwives (mostly Arab women ) could only work in specific regions, according to market demand.

The British did however encourage women who had not received professional training as nurses (mostly Arab women ) to study for a short period and receive the license. In other words, the distinction between midwives who were also nurses and midwives who had only studied midwifery was not clear-cut. In this way, the legislature rejected the American model of a nurse-midwife and emphasized the common ground between Jewish and Arab midwives. The process set in motion by the legislation brought about a significant reduction in infant mortality in Palestine, though the gap between the Jewish and Muslim populations in this respect remained intact.

Midwives have not necessarily had much to gain from the changes made in the law recently. According to the 1929 ordinance, a midwife is someone "prepared to examine, set a diagnosis, prescribe medicines, heal or care for the mother." These are five typical medical procedures that certified midwives are allowed to perform. By contrast, the current version of the Midwives Ordinance allows midwives "to tend to her (the mother only ) or to assist in the birth." In other words, the role of the midwife has been contracted - from a healer, similar to a doctor, to an assistant, similar to a nurse.

Since 1929 the ordinance has only been changed five times. Today midwives work in hospitals, but the authorization they had to perform extraordinary procedures has in the meantime been granted to nurses as well. Nurses and midwives are now in the same "basket" and the national Head Nurse has been put in charge of the registry in which a "midwife section" is also included. According to a nursing bill proposed in 2008 and still under discussion, a midwife will be recognized as having nursing expertise. If the bill is accepted, the Midwives Ordinance will be revoked.

Dr. Katvan is a professor at the Academic Center of Law and Business in Ramat Gan. Dr. Bartal is a professor at the Hadassah - Hebrew University School of Nursing in Jerusalem.