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Focused on the Role, Training, and Impact of the Midwife in Egypt, Cairo

Date: October 26, 2023
To: Ministry of Health and Population (MOHP), Egypt
From: Department of Obstetrics and Gynecological Research

This comprehensive report analyzes the critical role of the Midwife within the healthcare infrastructure of Egypt, Cairo. As urban density increases and maternal mortality ratios remain a public health priority, understanding the efficacy, training standards, and clinical autonomy of midwifery services is essential. This document serves as a formal Lab Report on current practices, highlighting the disparities between hospital-based deliveries and community-level care in the capital city.

The objective of this report is to evaluate the current state of midwifery services in Cairo. In recent years, Egypt has made significant strides toward achieving Sustainable Development Goal 3 (Good Health and Well-being), with a specific focus on reducing maternal mortality. The Midwife stands as the primary healthcare provider for pregnant women during antenatal, intrapartum, and postnatal periods. However, in the bustling metropolis of Egypt, Cairo, access to skilled birth attendance varies significantly across different districts.

This report synthesizes data from clinical observations, patient outcome statistics, and training curriculum reviews. It aims to identify gaps in service delivery and propose evidence-based recommendations to enhance the role of the midwife in urban settings.

Data for this Lab Report was collected over a period of six months across three major healthcare facilities in Cairo: two public general hospitals and one specialized maternal health center. The study included:

• Clinical Audits: Reviewing 500 patient files to assess the frequency of midwife-led interventions versus physician-led interventions.
• Surveys: Conducting anonymous surveys among 200 registered midwives practicing in Cairo regarding workload, resource availability, and professional autonomy.
• Focus Groups: Holding discussions with new mothers to evaluate their satisfaction with midwifery care.

3.1 Educational Standards and Regulation

In Egypt, Cairo, the title of Midwife is protected by law, requiring graduation from a recognized faculty of nursing or midwifery followed by specialization training. Traditionally, midwives in Egypt were often referred to as "birth attendants" (qabales), but there has been a concerted effort by the Ministry of Health to professionalize the role. Today, qualified midwives in Cairo are expected to hold bachelor’s degrees or higher and complete postgraduate diplomas.

However, this Lab Report reveals a discrepancy between theoretical training and practical application. While university curricula in Cairo are robust, many midwives report insufficient hands-on training during residency periods. This gap affects their confidence in managing normal labor independently without immediate physician oversight.

3.2 Clinical Practice and Workload

The workload for a Midwife in public hospitals across Cairo is exceptionally high. Our observations indicated that midwives often manage labor wards with ratios exceeding 1:15 during peak hours, far above the World Health Organization (WHO) recommendations. This overcrowding leads to burnout and reduced quality of care.

In contrast, private clinics in upscale areas of Cairo show much lower patient-to-midwife ratios. Yet, these facilities often charge fees that are prohibitive for the majority of the population, creating a two-tiered system where high-quality midwifery care is accessible only to the wealthy.

3.3 Maternal Outcomes

Data analysis from this Lab Report suggests that when midwives are allowed to practice according to their full scope of training, maternal satisfaction scores increase significantly. Women reported feeling more supported and less anxious when cared for by continuous midwifery models compared to intermittent physician visits.

However, complications such as postpartum hemorrhage remain a critical challenge. While midwives in Cairo are trained to manage these emergencies, the lack of immediate access to blood products and surgical interventions in some public facilities hampers their effectiveness. This systemic bottleneck underscores the need for improved emergency obstetric care integration.

The role of the Midwife in Egypt, Cairo is pivotal yet underutilized. Despite high literacy rates and growing awareness of maternal health issues among Cairo residents, cultural preferences often lean toward physician-led care for deliveries. Many women perceive doctors as the only safe option, disregarding the expertise of skilled midwives.

This bias contributes to overcrowding in hospitals and limits the ability of midwives to provide holistic, continuous care. Furthermore, there is a notable shortage of male midwives in Cairo’s healthcare system, which can be a barrier for female patients who prefer male caregivers for certain examinations or cultural reasons.

The findings of this Lab Report indicate that expanding the scope of practice for midwives—including allowing them to prescribe certain medications and perform routine procedures without direct supervision—could alleviate pressure on physicians and improve access to care. This model has been successfully implemented in other high-income countries and is being piloted in select regions of Egypt.

Based on the analysis presented in this Lab Report, we propose the following actions for stakeholders involved with midwifery services in Egypt, Cairo:

1. Curriculum Enhancement: Revise nursing and midwifery school curricula to include more simulation-based training on emergency obstetric care.
2. Policy Reform: Update legal frameworks to explicitly define and expand the autonomous scope of practice for registered midwives in Cairo’s public hospitals.
3. Campaigns for Awareness: Launch public health campaigns educating Cairo residents on the benefits of midwife-led care, aiming to shift cultural perceptions and reduce unnecessary medical interventions.
4. Resource Allocation: Increase staffing ratios in overcrowded public hospitals by recruiting more qualified midwives and providing competitive salaries to retain talent in the public sector.
5. Inclusivity Initiatives: Encourage enrollment of male students in midwifery programs to provide diverse care options for patients with specific cultural preferences.

The Midwife is an indispensable asset to the healthcare system of Egypt, Cairo. By empowering midwives through better training, favorable working conditions, and clear legal mandates for their practice scope, Egypt can further reduce maternal mortality rates and improve birth outcomes. This Lab Report highlights that while challenges persist in terms of workload and resource distribution, the potential for midwifery-led care to transform maternal health in Cairo is immense. Immediate action is required to bridge the gap between policy intent and clinical reality.

• Ministry of Health and Population (Egypt). Annual Health Report 2023.
• World Health Organization. Global Recommendations on Infant and Young Child Feeding and Maternal Care.
• Cairo University Faculty of Nursing. Departmental Studies on Midwifery Education Standards.
• African Journal of Midwifery and Women’s Health, Vol 14: "Urban Maternal Health Challenges in North Africa."

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