Midwives’ competence and challenges in managing urgent childbirth during escalation and closure conditions in the West Bank-Palestine: A qualitative study

PROBLEM: The political instability in the West Bank, stemming from Israeli occupation characterized by violence, and movement restrictions, simultaneously hinders access to maternal and childbirth services. BACKGROUND: Midwives are the first respondent during humanitarian crises, wars, and acute situations, delivering vital care and support to mothers and newborns. OBJECTIVE: To explore the competencies and challenges faced by Palestinian midwives in delivering childbirth services to women with limited access to hospitals, particularly during violence and closure in the West Bank. METHODS: A qualitative study was conducted through in-depth, face-to-face interviews with a purposive sample of 20 Palestinian midwives from the West Bank, utilizing an interview guide. Thematic analysis was employed to identify key themes and sub themes. RESULTS: This study reveals two key themes: the competence of midwives and the challenges they face in providing childbirth services amid closures and violence in the West Bank. Midwives are driven to deliver lifesaving care to women who have limited access to hospitals, including assisting with births. However, they encounter several obstacles, such as intrapersonal factors, political and safety concerns, issues related to competency and available resources, geographic and infrastructure limitations, social pressures, psychological barriers, and policies within the healthcare system. CONCLUSION: Empowering midwives is vital to ensuring that women have safe childbirth services in areas with limited access to hospitals. Empowerment can be achieved by strengthening their skills, providing legal protections, and ensuring access to medical instruments. Furthermore, midwives should be provided with support and guidance to enhance their mental and emotional well-being.