[Conditions of midwifery practice in Tunisia rural areas and maternal transfer]

This survey analyzed the conditions of midwife practice in rural maternity hospitals and their influence on maternal transfer in a sanitary region of northwestern Tunisia, an underprivileged region where transfer rate is the highest in the country.

The study concerned midwives in 8 rural maternity hospitals. The survey included the files of 1,065 women transferred to the regional maternity hospital over a one year period.

The hospitals surveyed operated without a gynecologist. Conditions of practice varied from one hospital to another and had a clear influence on transfer rate.

Our findings illustrated the importance of certain remediable insufficiencies including technical facilities, the level of midwife supervision, physician responsibility within the sanitary area, and assignment of gynecologists to the rural hospitals where a large volume of activity occurs. Improvements can be made in use of maternity hospitals to reassure women and midwives.