hospitals have to insist them to use the health information system and be evidenced based practice for example information technology. 

Thank you, Dr. Lina, for the outstanding question

I do believe that improvement of midwife practice needs collaborative measures from all healthcare and policy-making stakeholders (including, government, JNMC, JNC, NGOs, Private and military sectors .., etc.), at the national level.  Regarding the malpractice, I think the role of the quality and patient safety department or team is very essential; still, patient's safety is everyone's responsibility.

Malpractice will only thrive in an environment where there is no, or very little supervision of employees and no penalties for unprofessional practice. I do not know the nature or the source of the malpractice (nurses or doctors?) but there may be a need to do some research to first find out where the problems lie and then intervene. there may be a need to train and retrain staff in keeping with best practices as well as sensitize the population as to what they are to expect and demand. Do you have "Patients' Rights"? 

In the Netherlands we have good experience with protocols, made by all parties involved  together in a working group (including patients/patientorganisations). Protocols concern not only what to do in a certain situation, but also who does what in the chain of health-care workers. F.i. formulate criteria to send a pregnant woman to a higher level of care (obstetrician), and how to send her in a way that problems or increase of problems can be prevented. Next to making protocols audits on cases with an undesirable outcome, involving all parties involved as well, are very instructive if not meant to condemn the one who made a mistake/did something wrong.

There is something I need to correct. I am not attached to Mona Campus; I am now retired, from The St Augustine Campus, The University of The West Indies,Trinidad and Tobago. Please make the necessary changes. Thank you. 

At my hospital, we hosted midwives from other counties to come observe and learn best practices. Perhaps you could start a program like that?

What are your education requirements? Licensure requirements?

In the mid-1980s, two public community colleges

began offering three-year diploma midwifery education programmes sponsored by the Ministry of Health (MOH). These two programmes have been

responsible for producing the majority of midwifery graduates

until 2002, when the first and only university-based, four-year

bachelor of midwifery programme was established in one public

university, unfortunately, they stopped this programme later on.

Although a handful of degree-educated nurses undertake a Diploma of Midwifery programme all other midwives are educated through what is referred to as‘Direct Entry Midwifery’(DEM) programmes,that is, programmes that do not

have an undergraduate nursing qualification as a prerequisite for entry to the course.

There was another time when our midwives went as a group to another country to train lay midwives. That was very successful because the midwives got to learn in their own setting under real circumstances with the equipment and tools that they have to available, snd learned to recognize emergency situations and how to handle them in their own setting.

Interesting question.  What do you see as the possibilities in the next decade for improving birth practice?

This is a huge question.  The middle east is so diverse.  Having been to N. Africa as well as Saudi in the Gulf as a midwife, there are similar problems but very different worlds and contexts. I do not think that nursing in general is respected in the middle east for the great contributions that nurses bring.  There is still a hierarchy mentality of the nurse being a helper under the physician's decree rather than the nurse being respected as professional in her field.  Maybe if nurses were involved on interdisciplinary teams and their authority to double check physicians, pharmacists and others were taken seriously...

Beside the legal matter, and the hierarchy in hospitals that more or less are seen regularly, there are also: 1- The sense of self-acceptance of midwives as a vital position is influenced by the society's belief about higher status of a doctor than a midwife. 2- (believe or not) the financial status and privileges of doctors influence the common groups to create more respect or trust to doctors, in some culture. 3- The unsolved gender issues have impact on the trust of families to doctors rather than midwives (majority of women are midwives, and the number of male doctors are more than women) in most cultures. 4- The fear of hospitalization and death among pregnant women in less educated societies, or developing states are higher, and non-confident women do not trust to another women, because they are raised by the mentality of "men are much higher & better" logos. As a result, the issue is a combination of recognizing and valuing the midwife-career, plus valuing and trusting to a gender (in some cultures). This issues seems more twisted in the conservative societies that have less number of baby-boy births.