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War zone midwives deliver

With hospitals seen as costly and unsafe, many Iraqis turn to qabilas like Samira Majeed, who's unlicensed but indefatigable.

January 15, 2007|Molly Hennessy-Fiske | Times Staff Writer

Baghdad — THE woman was nine months pregnant and in shock: She had just watched her father and uncle die at a bomber's hands. The baby was coming, but her family was afraid to take her to a hospital, where they might be kidnapped or killed by roving militias.

And so, like many Iraqis these days, they turned to an unlicensed midwife.

The baby girl was born in Samira Majeed's makeshift delivery room, a chilly, windowless apartment foyer with a sheet of battered linoleum spread across the floor like a rug. Although the infant appeared healthy, she didn't cry -- a sign of trouble, Majeed told the family.

Majeed checked the baby's mouth. Sure enough, she wasn't breathing. So the midwife started to shake her, gently at first, then harder.

Desperate, Majeed resorted to a lifesaving technique she learned from her mother, a midwife herself.

"I breathed in her mouth to give her life," Majeed said, and then she pricked the newborn's ear to revive her.

Within moments, the baby began to cry. She would live.

As gunmen increasingly target hospitals and clinics in Iraq's deepening civil war, expectant mothers rely on the country's 2,000 midwives, or qabilas, and 3,000 lower-skilled rural "birth attendants" -- all of whom the state no longer licenses or trains, in an effort to steer women to government clinics.

Last week, a Sunni Arab woman took her 2-month-old baby to a doctor to get a birth certificate. They were kidnapped and killed.

Majeed, who says she has delivered more than 300 babies in the last decade, was once licensed and even made house calls. But she has stopped leaving her Karada neighborhood, afraid to trust families or the streets, where militias set up checkpoints.

A Sunni Arab, she treats patients of all sects.

Women come knocking at her small door, nearly hidden below a concrete staircase in her run-down apartment building. She greets them, a short woman with a round face and wide eyes, wearing velour sweatpants and colored scarves.

Majeed leads patients into her delivery room, where the family sink and freezer sit beside a cabinet that holds painkillers, syringes, antiseptic, a stethoscope and other medical supplies.

IF the electricity isn't out, as it is a few times a day, Majeed's patients can gaze around the delivery room at her good-luck charms: a gold plaque printed with a verse from the Koran about God's life-sustaining power; a picture of the Shiite Muslim child martyr Abdullah. In the far corner, in the shadows, hangs a black-and-white photograph of a baby with a caption in English: "To be or not to be."

More babies are dying in Iraq today than when U.S. forces arrived in March 2003, and medical experts say poor health policy is as much to blame as the civil war.

Iraq's Health Ministry stopped licensing midwives and training birth assistants in 2003, even though they deliver half the country's babies, up from one-quarter in 2000, according to figures from the ministry and the United Nations Development Program. Studies by the UNDP indicate that better training for midwives could save the lives of Iraqi mothers and babies.

Iraqi health officials said they would rather see women go to the country's 1,848 government-run clinics.

"We stopped training and issuing licenses because our ultimate objective is to encourage mothers to seek professional help from our health centers in order to decrease any complications that may arise and act upon them in a thorough manner," said Dr. Ahlam Kadhem, the ministry's chief of maternal and child health.

But Kadhem acknowledges that the clinics' reach is limited, in part because of the increasing violence. The facilities serve only 30% of residents in 15 of the country's 18 provinces. The three provinces in the Kurdish north have their own, autonomous clinics.

U.S. troops and charities have helped build hospitals, but security concerns drive away staff and patients and have prevented the construction of 120 new clinics, Kadhem said.

Costs are also a concern.

Zainab Nima, 40, is nine months pregnant with her fourth child. The tall Shiite woman, whose head scarf frames large brown eyes, intends to give birth at home in the southern city of Kifil. She scoffs at hospitals, calling them "one-star hotels."

"Doctors are now just like tradesmen, uncaring about the pains and the needs of the patients," she said. "Many families are unable to afford the costs."

Aliaa Khamil, 33, of the nearby city of Hillah is seven months pregnant with her first child and also plans to deliver at home, although she's heard the government warnings that she should go to a hospital.

DURING a recent visit to a clinic, she said she was worried she would be mistreated at the local hospital, which is short on supplies. She has already forgone ultrasounds and supplements her doctor recommended because they cost about $18, too expensive for the homemaker and her husband, a teacher who earns $110 a month.

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