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The Politics of Contemporary Maternity and Childbirth: Lines of Conflict among Palestinian Healthcare Professionals
This paper analyzes interviews with Palestinian healthcare providers of multiple generations in July 2016 and June 2017: three ob-gyns (2 men), seven women nurse-midwives, and two traditional women midwives who worked with public and private medical institutions in historic Palestine, often across institutions. I follow three lines of tension among the nurse-midwives, between some of them and traditional midwives, and in relation to physicians and medical institutions in contexts that have over time medicalized (and masculinized) maternal and childbirth healthcare to the point where “most women do not feel safe delivering without the hospital complex behind them.” The first relates to the autonomous status of midwifery, which through the mid-1960s dominated Palestinian life. Both autonomy and preponderance have largely disappeared as a result of medico-legal and policy changes led by physicians, especially ob-gyns. Nurse-midwives explained that “obstetrics makes you a rich man.” But they were divided on whether they should have more independence from physicians, with some fighting for it, including the ability to suture torn vaginal tissue after birth. One called the Ministry of Health under the Palestinian Authority a “Ministry of Physicians” that set the rules in their favor on basis that “physicians know everything.” Others lacked confidence in that level of authority or feared a newly dominant litigious sensibility among Palestinians that if something were to go wrong meant they had to carry the consequences. The second line of inquiry relates to the medicalization of pregnancy and childbirth care in comparison to the approaches of traditional midwives. Here older nurse-midwives were more likely to integrate the holistic methods of traditional midwives, and like traditional midwives, carried an enormous amount of knowledge about women’s bodies gained through experience, examination and touch interventions for infertility, miscarriage, abortion, pregnancy, and childbirth. These practitioners were more likely to value autonomous midwives as “keepers of the secrets of wombs and paternity,” in a relationship of shared power with birthing women. An additional line of difference emerged from four providers who were highly cognizant of the psychic and sexual dimensions of pregnancy and childbirth, including the ways in which lack of sexual and bodily knowledge among young women, fear, and sexual trauma can shape pregnancy and childbirth but are excluded from allopathic medical training and institutional practices, which are oriented toward the normative family, delimited international health metrics of “development” for maternity and infancy, and legal constraints.
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