Roa Altaweli In the 1960s and 1970s, childbirth in Saudi Arabia was a social event rather than a medical one and most women gave birth at home, attended by other women or traditional midwives (Dayas or Qabelah) and accompanied by close family and friends. There has been a great shift worldwide and in Saudi Arabia from home births to hospital births. In 2009, most childbirths in Saudi Arabia occured in hospitals, 91 percent of women delivered in health facilities and 98 percent were attended by skilled healthcare personal. General maternal health in Saudi Arabia is good and most of women who live in the Kingdom, receive antenatal, prenatal and postnatal care. In 2009, maternal mortality ratio (MMR) was estimated at 24 per 100,000 live births. In recent times, labor and birth are no longer treated as a natural process without a requirement for interventions in most cases; despite the fact that childbirth outcomes are better when labor and birth are supported without the routine use of medical interventions. In the modern world today, it is very common to see women who are admitted to the labor room confined to bed, monitored continuously for no reason except that it is hospital policy and subject to decisions about their care made for them by healthcare professionals. It is essential that women's desires and needs are respected and that they should be in a position to make informed decisions about their care. With the advancement of technology and the number of hospitals increasing every year, more women give birth within a labor ward setting and in the presence or under the observation of doctors. Births that are supervised by obstetric doctors are often medicalized and women in labor are treated as having a medical condition; this is seen in the increased use of interventions in low risk pregnancies. Interventions during childbirth such as continuous electronic foetal monitoring (EFM), lithotomy positioning, episiotomy, forceps and vacuum deliveries or artificial rupture of the membrane to speed up labour have been on the rise in Saudi Arabia, as in many other countries. Such medical interventions have become routine during normal childbirth in maternity wards worldwide, even in women with straightforward pregnancies. All these interventions take place in the absence of a firm body of evidence to support their efficacy. Studies have also shown that one unnecessary intervention in the physiological process of childbirth often leads to a cascade of interventions that may finally necessitate a Caesarean section. For example, continuous EFM during labour in low-risk women is associated with an increase in emergency Caesarean section with no long-term health benefits to either mother or child. In line with the worldwide rise in the Caesarean section rate, Caesarean delivery is one of the most commonly performed surgical procedures in Saudi Arabia. There is a significant increase of more than 80 percent in the Caesarean section rate within government hospitals in the Kingdom from 1997 to 2006, possibly due the increased rate of unnecessary medical intervention during normal childbirth and medicalization of childbirth. In 2011, normal births constituted around 73 percent of total childbirths in government hospitals. Caesarean sections constituted around 23 percent of total births. However, these childbirth statistics only represent data from government hospitals because data from private hospitals is not available. This raises the question of whether private hospitals have a higher or lower Caesarean section rate than government hospitals. A plan of action is needed to encourage normal childbirth and to eliminate practices that are unnecessary and likely to be uncomfortable for women. PhD. student in Midwifery City University London
