Palestinian birth practices: Accounts from dayat (traditional birth attendants) in Palestine

This blog is a compilation of knowledge gathered from various research studies conducted by Laura Wick and others at the Institute of Community and Public Health of Birzeit University for the Women’s Health and Development in Palestine. The research involved interviews with birthing people and dayat to gain first hand accounts of birth practices in Palestine.

What is a daya (plural: dayat)?

The Palestinian daya is an integral part of the culture and society who carry out services in the community related to pregnancy, childbirth, and postnatal care. Childbirth at home was attended by dayat (the Arabic term for what has come to be known as “traditional birth attendants”. Dayat have existed for centuries and have been present at the births of most Palestinians until recent decades. However, upon the creation of the settler colonial state of Israel, hospital births were encouraged. This was “supposedly” to decrease infant mortality rates, whilst simultaneously being a means of surveillance to control the number and registration of Palestinian births. By 1993, approximately only one third of births took place at home according to the World Bank.

Relationship of pregnant person to daya

Home birth with the daya was a family and community event. In most communities the daya was highly respected, of the same gender and social class as the birthing person, and lived in the same locality, which facilitated the process of support during childbirth. Pregnant people in focus groups reported how much they appreciated being well acquainted with the daya, that they respected their privacy and intimacy, that the surroundings for birth were familiar, and that they didn’t have to leave their children when they were in labour or worry about getting to the hospital on time. 

In general, the pregnant person knew the daya very well and they trusted and respected them. They appreciated the daya for being attentive to all of their needs and for taking such good care of them. When describing what they liked about the daya, they put great emphasis on their availability, their commitment to their work, and the emotional and psychological support given. They mentioned that the daya talks “sweet words” and comforts them.

When the dayat were asked about their decision to choose this vocation, many said that they responded to a need or a 'calling', where often the 'gift of God' was handed down within families from one generation to the next, and where the daya believed that their services on earth would earn them a good life after death. They were motivated by a humanitarian or religious desire to serve their people. In the words of one, "I like the work; I like women, and I wanted to lessen their pain."

First stage of labour

The daya rarely uses vaginal examinations to record the progress of the cervical dilation unlike hospital maternity care, they instead observe the movements of the birthing person, the colour and perspiration of their skin, their breathing and sounds. Therefore they are skilled in assessing how labour is progressing, without increasing the risk of infection with frequent internal examinations and interrupting the rhythm of labour.

The daya combines old methods and new “suggesting synthesis rather than competition and adaptation of beliefs and practices to new realities” . Massage (tamlis), herbal treatments (a’shaab), spiritual healing with the Qur’an (‘illaj bil-Qur’an) and cupping (kassat hawa) are some of the indigenous practices still used by dayat.

The birthing person can eat and drink when desired and is encouraged, in particular, to drink herb teas with sugar (usually sage or cumin) in order to maintain good energy levels to strengthen surges and to avoid dehydration. The herbs used during childbirth to strengthen the contractions are sage (mayramieh) and cumin (kamoun), prepared in an infusion with sugar. The birthing person is often given dates (tamr) to eat, as the example in the Qur’an where Allah instructs Maryam (experiencing strong pains during her pregnancy with Isa) to eat dates to ease her discomfort. The verse says “and shake toward you, the trunk of the Palm tree, it will drop upon you ripe fresh dates”.

Second stage

Before the actual birth, they prepare the perineum by massaging with olive oil. When the head is crowning, the fingers of one hand support the perineum while the other hand exerts gentle pressure on the head of the fetus to prevent perineal injury. The birthing person is encouraged to breath out and not to push hard. The dayat do not do episiotomies and they report very few perineal injuries.

Third stage

At the birth of the baby, the daya usually stimulates the baby to breathe by rubbing the back, flicking the feet, or wiping or suctioning the mouth. Most dayat practice delayed cord camping by either waiting for the cord to stop pulsating, the placenta to be delivered, or the baby to be rested. Most of them clamp the cord with artery forceps and a sterile plastic cord clamp but some still use two pieces of string which they have boiled. Traditional dayat also use salt water to disinfect the cord of the newborn. One of the dayat claims that she has rarely seen an infection with this method, “The cord withers like a flower without water”.

After the placenta is born, they examine it to ensure it has been fully birthed. One described the placenta as looking like “the web of a spider”. They help the new parent to initiate breastfeeding but not necessarily within the first half hour. They remain with the new parent on average for 1-2 hours after the birth and check for uterine contraction and bleeding. About one third of them give the baby sugar water or herb tea (anise, chamomile, or fennel tea) to drink or rock candy (sukar faadi) to lick after the birth in addition to the new parent’s colostrum. Approximately one quarter of the dayat rub something on the baby’s skin, either olive oil, salt and water, or a combination of the two.

Postnatal healing

Some of the traditional foods given after childbirth include chicken soup or rice pudding with raisins, nuts and cinnamon (irfeh). Fenugreek (hilbeh) and anis (yansoun) are used to increase the milk supply. The daya regularly massages the baby’s body with olive oil when visiting the new parent in the postpartum and swaddles the newborn.

Reflections

I find it beautiful and certainly not a coincidence that many of the practices of the dayat are shared by birthworkers and doulas across several cultures, past and present. Some of these practices include; intuitive observation to ascertain labour progression, massage, spiritual healing, breathwork, delayed cord clamping, hot foods for postnatal recovery, baby massage. It is also reminiscent of my own and many other birthworkers experiences to see that dayat responded to a need or ‘calling’ to this work. The hospitalisation of birth in the Palestinian context is complex and not something I chose to focus on in this blog. However what is clear, is that traditional birth attendants have had to mobilise to fill the gaps left by fragmented and inaccessible services. Birthwork is inseparable from reproductive justice and it makes sense that dayat were motivated by a desire to serve their communities. Most importantly, relationship building is a key component shared by dyat and doulas of all cultures. Trust, mutual respect and continuity of care are at the core of this work.

Right now we are witnessing attempts by the settler colonial state of Israel to completely destabilise health infrastructure during the ongoing Palestinian genocide. The quote below from Wick’s 2010 paper highlights the important role dayat have, and will continue to play in the struggle for liberation. 

“the Israeli childbirth policy aimed to phase out gradually the home birth attendants by not registering younger ones to replace the old. All women were encouraged to give birth in the urban public hospitals, and hospital fees were reduced to a minimal sum as an incentive. However, the role of the daya was not replaced when birth was institutionalized. Women came to the hospital and gave birth in crowded conditions with midwives and physicians whom they didn’t know, and returned home a few hours later without any immediate postpartum care in the hospital or in the community. When the first intifada (uprising) broke out, access to these urban hospitals was frequently compromised by checkpoints and curfews, and many women once again reverted back to the care of community midwives and dayat.”

I acknowledge that Palestine comprises various cultures, religions and histories so there are many practices that were not captured through these small-scale studies. I also want to highlight that academic sources should not be prioritised over those with direct lived experience. I urge you to listen to the voices of Palestinian birthworkers, healers and storytellers to continue learning.

Sources

Wick L. Traditional Birth Attendants in the West Bank: An Assessment of System Building and Training Needs. Birzeit: Institute of Community and Public Health, Birzeit University, 1999.

Wick L. Checkpoints on the Long Road to Palestinian Women’s Health. Birzeit: Institute of Community and Public Health, Birzeit University, 2010.

Wick L. Birth at the checkpoint, the home or the hospital? Adapting to the changing reality in Palestine, 2002.