Setting
The Taiz Houbane MCH Hospital is located in the Taiz suburb of Houbane in Yemen. Since the outbreak of the war, Taiz city has harboured one of the most active Yemeni frontlines. The Hospital serves citizens inhabiting or displaced to the Taiz Governorate (pre-war population of 3.1 million). It is the only facility in the governorate providing comprehensive emergency obstetric and neonatal care (CEmONC) services free of charge, including basic obstetric care, blood transfusions, caesarean sections and other surgical management.12The facility also provides antenatal care (ANC), family planning services, paediatric care and malnutrition treatment for children under five years of age. The maternity department is divided into a unit for intrapartum care and clinics for ANC and family planning. The intrapartum care unit is split in two wings and is staffed at daytime with a total of two gynaecological specialist doctors, two non-specialized medical doctors, three nurses and eight midwives. During weekends and nights (17-08 hours), the staff composition is identical to daytime, except for only one specialist doctor on duty. All staff are nationals recruited from Yemen, and supervised by an expatriate specialist in obstetrics and gynaecology. The total bed capacity is 45, with 12 low-risk pre-labour/labour beds, six high-risk pre-labour beds for women with severe complications and 27 post-labour beds. Midwives attend to the labouring women, nurses primarily care for the post-partum women, and doctors have responsibilities for both. Hence, if one woman in each labour bed, the birth-attendant-to-labouring-women ratio is approximately 1:1.5 in daytime and 1:1.6 at nights and in weekends (birth attendants include both doctors and midwives).