Influencing childbirth in Saudi Arabia: Roa Altaweli

Today we want to Shine the Light on Dr Roa Altaweli – an inspirational midwife from Saudi Arabia. Although Roa is well  known to many, we wanted to tell the rest of the world about her amazing career, her creativity and her leadership. If you want to be inspired….then read on!
‘I love being a midwife and would like others to love this profession as much as I do’.

Dr Roa Altaweli is the first midwife from Saudi Arabia to obtain a PhD. Roa was born in Jeddah, she is a registered nurse and midwife, and has worked as a midwife at National Guard Hospital in Jeddah and as a teaching assistant at Dar Al Hekma University.

Roa decided to pursue a academic career and obtained a Postgraduate Certificate in Advanced Practice of Midwifery from King’s College London and then a Masters and PhD in Midwifery at City University, London.

Roa now works as a Clinical Director of Nursing at East Jeddah Hospital, Saudi Arabia. She is. a founding Board Member and Vice-Chairperson of the Saudi Midwifery Group and a member of a Saudi Ministry of Health initiative called the Optimizing Maternal Mortality and Healthcare Advisory Team.

I hope that midwifery education in Saudi Arabia can be as strong as in the UK

Roa says. “I love being a midwife and would like others to love this profession as much as I do. My aim is to empower women to have natural childbirth in Saudi Arabia and help in the development of direct-entry midwifery courses that prepare competent, qualified midwives.”

And Roa certainly takes ’empowering women’ seriously, by keeping connected to women and childbirth.

‘Due to the limited and trusted  Arabic resources about natural childbirth I created ‘Rahmah Birth’  in April 2016 to increase the awareness of natural birth, for women in Saudi Arabia and around the world.  Rahmah (my mother’s name who passed away January 2014) means Mercy in English. My mother always believed in natural childbirth and gave birth at home to my older brother Khalid who passed away in November, 2016. I dedicate this work to her and my brother.
Instagram @rahmah.birth
twitter @rahmahbirth
facebook page rahmahbirth

We are amazed that Roa has any spare time – but she does, and then she likes to paint. Her work is beautiful – and she’s allowed us to share a few of her masterpieces with you!


Roa’s 5 Top Tips for midwives considering studying for a PhD

1. Love midwifery, and keep practising as a midwife

2.  Participate in teaching students, women and families.

3. Update your self with evidence based article reading

4. Communicate with other midwives

5. Remember there’ll be hard times. You’ll need courage and resilience to continue!

A family affair – the story so far!

‘I saw your Dad this morning walking William in his pram‘ – a regular call to Anna, as she skids into school to collect 4 year old Betsy. It seems much of the Ribble Valley spots this Grandad, as he treads the country lanes with the boy, And William is often in the arms of his Daddy too – as Anna and I work and plan for the exciting times ahead. My, we need all the help we can get!  It’s been a few weeks since we launched our site, and the beginning of our journey working together as a mother-daughter midwife team. Bringing our experience and knowledge together has been a joy, lots of fun, and the whole family has rallied round to help with childcare, chauffeuring, and cooking! It’s all coming together, and we’re delighted.

Helping others to shine…

In short, our commitment and drive is to optimise maternity care so that mothers and babies have the best start to family life. We feel we can do this by supporting those who serve childbearing women, in their daily work. We want to be a conduit to help future and current midwives to shine, to succeed in their work and careers – to fulfil dreams, whatever they may be.  As midwives we’ve both had enormous opportunities to develop, and we will always be thankful for that. We remember vividly those who guided and inspired us. We have also experienced difficult times, and we equally remember individuals who made our hearts sink. We have learnt from both experiences, and these are shaping our future plans.

In the meantime, we are keen to spotlight individuals who are trying to make a difference, or who have a story to tell, to help others. Check out our previous blog posts for ‘Shining the light on’ and ‘In conversation with’ features, and if you feel you’ve want to share your work or ideas, please get in touch, we would LOVE to hear from you…..


And Anna’s #SundaySummaries have been a HUGE success. Hmmmm… you may be wondering what all the fuss is about, and here’s an explanation. As busy mother and daughter midwives, we’ve often been left in the dark when it comes to keeping up to date at work, on general matters relating to maternity care and midwifery. As the editor of The Practising Midwife, Anna keeps reasonably well-informed on current national and international issues, so she decided to synthesise relevant topics into snappy,, bite-sized sections, and deliver them to all subscribers of this website.

The response has been overwhelming.

‘Congrats to you both. Another very current and interesting summary update of events. Love the format that you use, current info delivered in simple yet informative format, much easier to read than a journal, and very up to date…….’

‘I just love the layout and content of your page. All I need now is a few hours to read through it all. Well done’

‘Needed to message you this week as I’ve been working nights and feel like I have been away from news and updates that I usually read . The adjustment of the body clock and finding the time to even look things up even on my beloved Twitter has escaped me this week. The opportunity to see all of the reports means I’m back in the loop!.  I’m back to nights tonight and I’m planning to tell everyone about this great resource…’

Over the summer, we’ll be sharing some more exciting news with you. We’re BURSTING to tell you! We’ve been collaborating with student midwives, midwives, doulas, obstetricians, leaders and many more – so stay with us if you can!

Have you signed up?

We’d love to see you on Facebook too!



Indie’s India – a guest post

Indie’s message to the world, for International Day of the Midwife 2017


Indie Kaur is a consultant midwife at the Royal London Hospital, and is currently on sabbatical working in Hyderabad, India, at the Fernandez Hospital. This hospital is owned by the inspirational obstetrician, Evita Fernandez, who is working tirelessly to develop professional midwifery programmes in her region.  More about Evita, and her campaign, below!

We keep in touch with Indie, and recently saw this post on Facebook. We asked her if I could repost an adapted version of  her words here, as we are in awe of the work she is doing, and the ground-breaking  progress taking place in India.

It is now April in India.

I have been here for 3 months now. I must admit I love the sunshine despite this intense heat. All this sun, yet Indian mothers seem to be vitamin D deficient. The weather fluctuates between 33 to 42 C. I am on a journey, which is exciting, as I believe it will be a slice towards influencing professional midwifery services in India. But it is also frustrating. I am a professional midwife with over two decades of experience. However, I am unable to practice in this country due to the complexities and bureaucracy within the government, which by the way does not accept midwifery as a separate unique profession. Accountability within one’s sphere of practice therefore, is not accomplished.

It was the 1902 Midwives Act, which introduced training and supervision for midwives in England and Wales, outlawing uncertified and untrained (bona fide) midwives. However this legislation didn’t eliminate traditional birth attendants, as fewer midwives were available in rural areas. After 1910, all women were expected to have a qualified medical practitioner in attendance at the birth of their baby. Uncertified midwives were forbidden to attend women in childbirth without the direction/supervision of a medical practitioner. The newly registered midwives were initially required to have a 3 months training, which increased to six months in 1916 and a year in 1926, with the model of calling the doctor in difficult cases. The proportion of births attended by qualified midwives increased steadily and by 1930’s is almost all practicing midwives had received training and continues to have legislation changed. Today in the UK direct entry midwifery is a three year programme, and for registered general nurses it’s eighteen months.

Human rights violations

There are some similarities in India today to the 1920’s in the U.K. There are traditional birth attendants in rural India, and no professional midwives based on the International Confederation of Midwives (ICM) core standards. In the public institutions where the majority of women give birth, there are masses of vulnerable women, birthing in appalling desensitized environments. There is lack of dignity, respect and there are violations of basic human rights like privacy. They are cared for by health care professionals who are a mix of nurses, unskilled birth attendants (dais) and auxiliary nurses (erroneously called midwives) who lack the knowledge and training. The challenge lies in India urgently recognizing the need for professional midwives.

Evidence and choice

The place in which majority of women give birth in the UK has changed considerably over 100 years; following the Peel Report in 1970 birth went from home, to maternity institutions – hospitals. The Changing Childbirth Report in 1993 suggested that women should have a range of options of place of birth. The philosophy behind birth centres in the U.K is the provision of a safe environment for healthy women to give birth in outside the hospital, where the medical interventionist model dominates. The Birthplace Study in England clearly highlighted that healthy women, who gave birth in a midwifery led unit (MLU) had significantly fewer interventions, including substantially fewer intrapartum caesarean sections. The study also demonstrated that for healthy women, giving birth in a midwifery unit was as safe as hospital, for her and her baby. This gives women choice in place of birth, and allows doctors to focus on medical complications. 

In the UK, MLUs (also called birth centres) continue to be sustained because there is a midwifery profession which is autonomous and accountable, and has been embedded into the healthcare system for more than a hundred years. However, in India, there are some birth centres run by midwives certified from overseas to help a rising tide of women demanding midwifery led support during their birth.  Would it not benefit all childbearing women in India, to have a baseline cadre of professional midwives? Why does the government and the Indian Nursing Council not accept midwifery as a separate autonomous profession?

Visionary leadership

I am working in a tertiary referral perinatal center, with over 8000 deliveries per annum, providing clinical leadership to our midwives in the antenatal and intrapartum areas of care. I am lucky to work with a visionary leader Evita Fernandez an obstetrician, who understands the value of professional midwifery and how it can influence maternity care including reducing the mortality and morbidity rates in India. She launched an in-house professional midwifery education and training (PMET) programme in August 2011. Had she waited for bureaucratic approval, we would not have the rich data we have collated over the years of the impact of professional midwifery support on birthing experiences and outcomes.

Our professional midwives in Fernandez following our ‘train the trainer workshop’ conducted last year have recently trained health care professionals in the rural districts. We travelled to Nandyal (300 km) in April and four of our midwives trained health care professionals in obstetric emergencies drills of shoulder dystocia, pre-eclampsia, postpartum haemorrhage and neonatal resuscitation. The workshops were well received and the positive feedback from the participants was very encouraging. The medical director of the hospital that hosted this workshop, that very night, had a case of eclampsia, which was dealt with efficiently by the nursing team who had attended the workshop. A mother’s life was saved and long-term morbidity averted.

My friends – this is going to change outcomes and indirectly save lives of mothers in India.

Unlearning poor practice

Recently in Fernandez, the midwives experienced a Lotus Birth, as one of the mothers opted for this experience. The concept of listening to mothers and supporting them through their birth choices was strongly demonstrated with this mother’s request. The mother experienced lots of telephone calls from her family and friends constantly asking if she had had her baby. I was her point of contact and she felt assured with a daily phone conversation. When she  came in spontaneous labor the midwife who had helped her birth her first baby was also available. This made the woman more happy and added to her comfort and feeling of safety.  The midwives in Fernandez are learning to understand women and “unlearning” the need for repeated vaginal examinations. They are discovering the value of spending time with women, watching and listening while they understand the signs of progress of labour, without a vaginal examination. The mother raised the question of having a vaginal examination. She was comfortable and relaxed when we said ‘No’ and encouraged her to mobilize. She was relieved and had planned a water birth. The lights were dimmed and the clock on the wall turned off. When she relaxed, her contractions picked up after she had her supper and her older child slept. Her waters broke spontaneously, the intensity of her contractions increased, and she was ready to use the birthing pool. The cephalic pole was 2/5th’s palpable on abdominal palpation. She was four cms dilated with a thin well-applied cervix. She entered the pool and as she submerged into the water, she sighed with relief. The room was silent and her husband supported her with fluids. The midwife listened to the fetal heart and was completely in awe. This was a first water birth experience for her and the mother.

The environment was surreal and she chanted her mantra, adding a spiritual dimension to her labour. She birthed her baby in water just after midnight. The baby was brought up to her, took his first breath and cuddled up to his mother. Her placenta soon birthed and we kept it with her in a bag rubbed with rock salt and ”tulsi” which is an Indian herb with medicinal effect. This was also very rewarding for me. In my role as a consultant midwife in London, I have been steered into a managerial role. This “hands-on” clinical exposure filled me with deep satisfaction. I realized then how much I missed the clinical involvement and the rapport midwives develop with the women they help birth.

Midwife Jyothi Rapelli showing positions in labour to a mother

On the road!

The road trips in India are exciting. One encounters a variety of challenges- from a mix of good and bad roads, with cows and goats crossing over. Evita and I travelled 575 kms to The Krishna Institute in Karad, Maharashtra. I contributed to the driving under Evita’s beady eye, who in the passenger seat (obviously NOT her favourite position) ensured I learnt the rules of driving in India! I had to endure comments such as “This is India where majority of drivers do not stay in their lanes and do not warn you either when they cross. So watch out and yes- please hoot” The horn was used often enough to warn the driver ahead that I was going to overtake him….and yes, I was also reminded – ”You do not overtake two vehicles at a go”. Despite this, we survived the drive and arrived in the small university town. The hosting team was amazed and impressed that two women drove all the way themselves. We were treated as minor celebrities!
On our arrival, we visited the labour and delivery wards. We were impressed with the efforts the team was trying to make, to improve the environment of birth. The workshop on Respectful Maternity Care was initiated under the Safe Motherhood Initiative, a programme spearheaded by the Dean of Nursing Studies. The next day, was spent in a think tank session to discuss practical action plans with time lines. Evita presented on birth experience and Human Rights in Childbirth, which is an urgent need for India. I highlighted the role of a professional midwife and her impact in supporting mothers, advocating and evidence behind positions in labour. 

Evita Fernandez speaking to the trainee midwives


The success of this workshop lies with the conviction of Evita as an obstetrician endorsing the need for professional midwifery in India. We complimented each other’s roles. I shared my experience as a professional midwife in the UK, and now in Fernandez working under my sphere of professional accountability. We emphasized the strict need to adhere to the core clinical competencies as endorsed by the ICM. We both shared the challenges of working with a multi-disciplinary team and how it was worth every effort to work with protocols. We emphasized the need for drills and for doctors and nurses to work with respect for each other’s professional roles.  All of this is needed if we wish to offer woman centered care in a high volume setting, such as their hospital, which has a 350 delivery rate every month.

I am now back in Hyderabad and attended my first Indian wedding. I was fortunate to have a personal dresser within our team with her immaculate dress sense, draped me in my sari. I felt elegant, sophisticated and stood tall at the reception. The hospitality and rich culture is amazing and the work reaps rewards. I can see the change evolving with the team. It is an ongoing journey and the decision to be a role model in India for a year has been the right path for me.

I shall keep you posted soon.


Dr Evita Fernandez campaign for professional midwives can be found here Professional Midwifery Services PROMISE – please donate to the cause if you feel able. Below is a link to an article by Evita, and an award winning video explaining more about the need for professional midwives.

Dr. Evita’s response on the article “Midwives back: Women opt for intimate home settings to give birth”