Mid-wife crisis

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Cecile de Scally is the first midwife to be licensed to practice in Dubai Healthcare City.

Cecile de Scally is the first midwife to be licensed to practice in Dubai Healthcare City. She tells Medical Times how Dubai's antenatal provision is still in its infancy and why maternity and paternity leave legislation has a lot of growing up to do.

How is antenatal care structured in Dubai?

It is by an obstetrician in a hospital or associated with a hospital and it is a hospitalised birth. A woman who falls pregnant goes to an obstetrician and is followed by an obstetrician through her pregnancy and depending where she gives birth is either assisted by that obstetrician or by a midwife - it depends on the different hospitals.

Midwives in Dubai only really play a role in the hospital helping the doctors. There is also no real scope in Dubai for any type of home birth - even things like water births are not widely available.

Then why did you set up on your own? What role can you play?

I set up on my own because there is so much scope for a midwife in Dubai to provide better care for mothers. For the first time now Dubai Healthcare City (DHCC) has licensed me as a midwife and there is apparently a second midwife to be licensed as well.

We need to test the waters with the scope of our practice. From what I understand, I would be able to do antenatal care here, however, as there is no hospital yet at DHCC it turns out I cannot deliver a child here yet.

What are the current gaps in care for new mothers?

When I speak to clients they are not educated about what they could have. They come to me with no knowledge of what I do. They've been told to go to antenatal classes by their doctor and they are not really aware of what a midwife really is.

Sometimes they will ask if I will go to the hospital with them in the ‘doula' type of role, which is really a support role. I have gone in with several mothers as a birthing partner.

I also support the husband - because the guys get really neglected. Even if they have been to antenatal classes they don't really feel that confident and if the hospital says they are going to do a caesarean then they're not sure how to cope with it.

Why do you think patients are so willing to accept medical intervention?

Women sometimes think that labour is very short - they forget that the pregnancy is nine months and at the end the baby has to be born slowly. It has to take time for these changes to occur. A lot of women are under the impression that if they have been under labour for four or five hours then they should already have had their baby.

They need to be reassured that it is okay to have four or five hours of labour at home and then go to the hospital where they might have another eight or nine hours to go. It makes them a lot more confident.

What sort of patients do you normally see?

I see mostly expat mothers. I don't tend to see a lot of Arabic mothers because they have family support. They have the traditional birth attendants that work with their families and those birth attendants are very active in supporting the woman through her birth.

They essentially are the same as a doula in Dubai or in the western world. They are supported well and encouraged that this is a normal occurrence, whereas with the expat community the mothers have no support. They are on their own, they have not had good support, they are frightened and they have misconceptions that haven't been answered.

Al Wasl hospital's neonatal intensive care unit (NICU) recently had to be closed for a period to deal with a nosocomial infection - what impact did that have?

None of my particular clients had the need for a NICU unit at the time so I think we were very fortunate. I am very sure that Al Wasl closing down had a huge impact on the need in Dubai. Even with Al Wasl open there are not enough NICU beds.

The private hospitals do not have them because of the expense of the discipline - so they rely on places like Al Wasl and Dubai hospital. When you are in a private hospital you have to pay for it out of your own pocket. Some insurance companies pay, some don't.

Surely NICU units could potentially be a big earner for private hospitals?

They would be able to do it, but who would be able to afford it? If you are pregnant, a lot of the insurance companies won't even touch you because they know the potential payout for NICU is huge. In the US, people would pay the extra amount for the cover.

I think they need to move towards offering this to parents. It is a money thing as well - if they pay the premium and don't use it then there is no expense for the insurer, just profit. The premium would be very high but if you can offer a policy that would cover parents for all eventualities then I think a lot of parents would say yes.

How serious a problem is postnatal depression in Dubai?

Postnatal depression is a big issue here. Back at home people would have a lot of family support. Here you've got a husband that has to return to work quite quickly, you have a mother that might visit for a couple of weeks so you might be covered for the first six weeks but after that you are on your own.

We are going to have a postnatal depression support group running from here and it is going to be run by a mother who herself went through postnatal depression to the point where she had actual physical illness symptoms.

What provision is there for maternity and paternity leave?

Most fathers go back to work here after one or two days. If they can, they can take their annual leave. Maternity leave is 45 days - paternity leave depends on the company. Most fathers go back to work here after one or two days.

Dubai has a very long way to go - there is no real activity that I know of to move forward to increase maternity leave, establish paternity leave or provide adequately for breastfeeding mothers in the workplace.

Could the private sector be doing more? What about a community nursing service?

I started a community nurse service at the American Hospital in 2004. It certainly didn't develop into the programme that I wanted it to and it needed to be more aggressive - we needed more people doing it.

They've currently gone onto one home visit for each patient, although I don't know how that is going. I get requests every day to go to people's homes and because I can't have a Department of Health licence, I can't go.

I would have to collaborate with a practice outside of DHCC. They licence doctors for the Department of Health and Medical Services, but they don't licence nurses.

What do you tell parents when they call?

Currently I am just saying no - but if it is urgent then I go and don't charge the patient. The legalities of charging makes it a formal service so I just don't charge, which is obviously not great from a business point of view.

But if someone with a premature baby calls and is worried then what can I do? Tell her to find someone else?

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