Midwifery in the UAE - The reality...
Being a midwife in Dubai sounds great right, far from the trenches of the NHS, poolside on your day off, tax free salary and a solid tan (even for a ginger like me).
But the realities of midwifery here are very different to ‘the dream’ the hospital recruiters sell you. For me, the practice here makes the NHS look shiny and desirable again. I found the biggest challenges of working in the NHS were the understaffing, the under funding and the over subscription of services. But is was also structured, patient centred and supportive. I worked with truly awesome people. And it was a multi disciplinary team, everyone valued everyone else's opinion regardless of job title.
I honestly didn’t know what I was going to lose when I came here. I took for granted the glory of a national health service that does not turn people away if their insurance coverage isn’t right. Or that no matter what hospital you walk in to, up and down the country your care is the same, the approaches are based on the best evidence and as midwives we have the safety net of blanket policies and guidelines.
I jumped on a plane, 3511 (ish) miles later I landed in a healthcare system that is bias towards people who earn more money. A land where patients are not the centre of care, money is. And where doctors can basically practice however the hell they want. Evidence be damned. Oh and midwives have zero autonomy. Some of the practice I have witnessed here over the last 4 years has been absolutely insane. And to question it can often result in you suddenly finding yourself unemployed. As I so abruptly found out a couple of years back.
Before I go any further in to my rant I should say that there are many incredible Doctors, Midwives and birth workers here in the UAE. I have have had the pleasure of working with some skilled and compassionate people, and I still am fortunate enough to do so. I will always recommend those amazing professionals to women who ask, as this is what we need to be candid about who can provide honest, compassionate and high quality care. I have learned so much from practicing here and working in a different culture has allowed me to grow as a professional in ways I did not see coming. I came from a high risk unit that had 20 rooms to a 4 bed unit. I learned to reconnect with low risk births again. I also have the greatest friends as a result of being colleagues. That is something
One of the problems with healthcare here is that are no national guidelines for maternity care. Clinical skills and decisions don’t even need to be evidence based because if a doctor says it then it must be right…..I have seen downright unsafe practice, witnessed obstetric violence and perhaps most frustratingly an absolute loss of consent and patient centred decision making. As a disclaimer I do want to add in here that this is a generalisation and in no way applicable to every doctor or midwife out there.
Since we have no autonomy here, we are really restricted as midwives. It is really difficult to bite your tongue when you know (from years of education and experience) that something that is happening is not in the best interest of a woman. But a lot of the time that is what we have to do. We have to bite our tongues and try and do good by stealth. Doing good by stealth is literally the main role for most midwives and nurses here. I find myself trying to provide education and perspective to women and their partners in labour. Which is not the most ideal time. Sending women links on their mobile to evidence or research regarding their care whilst they are in labour.
Because our time as midwives is not billable and nor are we allowed to be professionals in our own right then we do not get to interact with women throughout their pregnancy. We mainly see them when they rock up to labour ward. This means that the only information some women get is from their obgyn, the internet, or some random hospital antenatal classes. At least in the NHS we practiced independently, in our own sphere of practice, as experts in normal pregnancy and birth.
One thing you should also remember when you see instagram accounts full of pool days and beach vibes is that our working week is significantly longer than the UK. 48 hours is a standard working week. So when you actually break down the salary in to an hourly rate, we don’t actually make that much more here. Not really. And 48 hours a week is A LOT. Your free time is basically spent trying to rest and recover before you are hit with more shifts. Part of the reason I decided to step back and find part time work was that I was just tired. And miserable. I began to realise that my work life balance didn’t exist.
I know that I haven’t painted this role in the greatest light. But it is the reality. And things never change if we sugarcoat reality. When we pretend things are fine we are basically ignoring the cracks in the foundations of something that was never right from the start. There are great things about being a midwife here. I for one, find that my role has never been more needed. By that I mean generally, as a midwife who is trained to have women at the centre of care. The absolute lack of pre and postnatal care here is insane. The difference you can make here as a midwife is unbelievable, not by doing anything clinical, but just by being there. Listening. Building a rapport with women and just supporting them. I do more good work without even laying my hands on someone. And that in itself is completely worth everything I just mentioned.
It is also really easy to forget that Dubai is still a young country, despite the fancy aesthetics, it is still in its infancy. And the same is applied to the healthcare system. We need a change. A shift in perspective, ethics and choice. And it is coming. But it is not without its problems and hurdles. What we need here is more midwives who can petition for that change. To advocate, to do good where we can but perhaps most importantly to educate the masses, to tell them that this is not how maternity care should be. And maybe then, when women demand better then we will finally see the change that we need, the change that will serve them better.