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Birth in Iran

I have returned from Iran and can now post several articles and some photos about my experiences in Iran. This is the first report.

Today was the first day of the workshop I am facilitating in Iran. They (the Ministry of Health, the UN Population Fund and the Hospital that is hosting the event have gone to endless trouble to make everything as comfortable as possible and they are being wonderful hosts – I am embarrassed by all the attention I am receiving.

The group is made up of some policy makers from the Department of Health (who are midwives and doctors), Midwifery educators from a number of Universities (many of whom are also practising midwives), some Obstetricians (who only stayed for a few hours), some students and other key midwives. They have been forthcoming and interested, asking many questions!

After the formal opening speeches, we got down to work. First I asked the group to tell me about birth in Iran. After some consultation with colleagues in small groups, they described the typical care pattern for pregnant women, noting that there are variations between city and rural areas. It seems that pregnant women have the following routine:

If a caesarean birth is indicated (and this happens up to 75% of the time in some hospitals) it will be done under general anaesthetic – epidurals are not routinely offered for surgical births. Few forceps or vacuums are offered, and caesarean is the preferred method used whenever there is a problem in labour.

Doctors perform almost all of the births in both the public and private system, with the midwives acting as assistants. Midwives usually care for 5 woman at a time during labour.

There is no organised system for prenatal education for women at all – whatever they learn will be picked up during the 5 minute midwifery consultations during pregnancy.

This is a brief outline of what I learned today. It is not a pretty picture but is typical of birth in developing countries. It seems they have learned their birth management techniques from the Americans 40 years ago and haven’t shifted since – there is a long way to go.

We touched on evidence based care, informed consent, defensive practice and litigation today and will explore these in depth later on. I spent most of my day fielding basic questions that reflected almost total disbelief that birth could happen in any other way. Certainly some in the group have experience of physiological births, some because they were practising many years ago, before birth had become so centralised in large hospitals. The midwifery educators have knowledge of the evidence but are struggling to convey it to their students who are unlikely to see any of it in practise. I was told at one point that much midwifery education is based on medical texts not midwifery tests, with Williams Obstetrics being the basic text for both midwives and doctors.

It is hard to know where to start with all this. We’ve done the pelvis exercise an explored how they can use the pelvis to resolve difficulties during birth. There is a perception that I am going to teach them “the method” for training women and this is going to be hard to debunk, given that they are used to telling women what to do and expecting them to conform. All I can do is show them another way and leave them with evidence and ideas. Perhaps on the next visit (yes, they are already talking about that!) we can go further, but my first task will be to try and shift some attitudes towards birth and get them thinking.

Posted by andrea at April 16, 2006 06:25 PM