Tuesday, February 17, 2009

Homebirthing in Israel

An interesting article on home birthing in Israel was published in the Israeli newspaper "7 days" last Friday. Planned home births used to be extremely rare to nonexistent in the past decades, but apparently, there is a new wave of mothers who feel that giving birth at home, for various reasons, is better for them and their babies.

Women describe feelings of helplessness, loneliness and frustration as they find themselves face-to-face with an uncaring establishment which routinely messes up perfectly normal births simply because they "ought" to progress faster, or because giving drugs for pain relief is more convenient for the delivery room staff.

In 2006, around 350 Israeli women chose to give birth at home. In 2007, this number nearly doubled. A research of the trend was recently published - the first of its kind in Israel which focuses not only on the risks attributed to home births, but on why mature, educated women would choose such a seemingly risky option.

"Epidrual is very convenient for the staff," - says one of the women who participated in the research, - "When one midwife is in charge of three rooms, she doesn't have the time, energy or desire to face women who scream, curse and lose control. It's easier and more pleasant to deal with a calm woman who pushes when being told." (translation mine)

Another reason for the many unnecessary interventions is rooted in doctors' fear of lawsuits. "They take a healthy woman, who arrives at the hospital to give birth, and tell her 'let's induce and give an epidural', and in ten minutes turn her into an intensive care patient with an i.v. and a needle in her back and a catheter for urine and blood pressure checks and monitoring."

That is precisely the attitude I experienced in the first hospital where I arrived, the day before I had Shira. The number of invasive checks and pressure to have various interventions were simply unbelievable - especially considering that the doctor himself admitted, when pressed, that I will most likely have a natural, straightforward birth within the next 24 hours if simply left alone. But they were in such a hurry to get it over and done with, that they got me in the delivery room without even saying anything, and then told me matter-of-factly "we're going to give you pitocin." We grabbed our belongings and made a narrow escape, but think of all the women in a similar situation who didn't.

When we refused pitocin, the doctor raised an eyebrow and asked, "why?"; can you see how backwards this is? There should be a better reason to mess up with a normal and natural birth process than why not!

Hospital authorities and Ministry of Health officials don't tire of warning against home births, and insist that hospital is the safest environment for mother and baby.

"Do we pressure women to get things going and don't allow natural processes to take place? In a way, yes. That's the price Western society pays in the effort to have a minimal number of complications and deaths."'

In order to register for the financial benefits she deserves by Israeli law, a woman who gave birth at home must present herself and her baby in a hospital within 24 hours after giving birth. Hospitals receive thousands of dollars from the government for each birth, even if it actually took place at home - while women don't get any refund for the expenses of home birth. Thus, a home birth is something not any Israeli woman can afford.

"The establishment is simply against home births," - comments one mother, - "that's why it tries to financially reinforce hospital births. We saved money to have a birth at home. It was an amazing, warm and loving experience. Many women think that home births are primitive. I believe that a hospital birth, with the methods they use, is truly primitive."


Brittany Ann said...

This is true in America as well. In some states, women (or midwives attending home births) can be sued for choosing this option. Oftentimes, family services is called in to investigate abuse after a home birth, even after a completely normal, healthy, routine home birth has occurred.
This all happens despite the fact that medical experts have documented evidence that home birth is no more dangerous (if not safer) than a hospital birth for mother and baby.

Thia said...

It really is hard to comprehend that the same people who tell me it's "okay" to kill my unborn child (abortion) are so concerned about how I birth him/her.

Thuis en onderweg said...

Dear Anna,

this is an interesting topic. I gave birth at home and would do it again, if the Lord allows us to.

In our country about 30 % of all births are home births. Of the women starting labor at home and wanting to have a home birth, about 52 % actually gives birth at home, which means that in fact about 60 % of the pregnant women start their labor at home. About 68 % of the women giving birth at home do have one or more older children.

In the countryside the number of homebirths is higher than in the cities.

Research in our country shows that the chance of catching some infection is greater in the hospital than at home.

The safety of homebirth might depend as well on the care taken of the mother after birth. In our country, women are checked frequently during the first few days by the midwife during their homevisits and most of them do have an other woman at home(specialized in assisting new mothers during the first 6 - 8 days). Helping relatives, unfortunately, is not so common anymore.

Home birth does not have a greater risk of infant mortality in comparison with hospital births. In fact, the chances of acquiring an infection or other illness are higher in the hospital setting.

I think giving birth at home, when possible, is the most natural thing to do. In fact, the majority of people who have lived on this earth so far were born at home :-), since there were no hospitals.



Mrs. Anna T said...

"the chances of acquiring an infection or other illness are higher in the hospital setting."

As someone who has worked in a hospital, I heartily second what you said!

BellaMama said...

This is why we went with midwives for our firstborn-but we got the "bad" ones. 2nd child we went to the hospital with a "certified nurse midwife"...it was still a hospital, though we skipped the majority of induction methods. So, with our 3rd born and next 3 children, we decided to have them at home "unassisted". Just me and hubby and God. We educated ourselves extensively on problems that might come up and made our decisions when we would go to the hospital. I have had a painless labor, but 3-10 mins of birthing pain is nothing for the absolute thrill of putting your life in God's hands and HE bringing you through it!

I would wish this for everyone, but I know each is different & can only hope that they are pleased with the decisions they've made.

Alycia said...

I am delighted to hear that home birth is becoming more common in Israel, and I hope and pray that it will one day be better supported by the government.

My two (so far!) babies were born at home in the U.S., and I can't imagine doing it any other way in the absence of complications.

It saddens me that many women do not have the option of home birth because of financial concerns. It is difficult to find health insurance plans that will cover home birth even in those states where it is legal.

Thank you for bringing this up, Anna.

Gombojav Tribe said...

So strange isn't it that medicated birth was heralded a triumph of feminism? And yet if a woman uses her CHOICE that feminists are so big on, to have a natural birth at home she comes against so muc opposition.

I just blogged about this cultural childbirth.

Rachel said...

I live in Minnesota USA and my insurance covers birth by a licensed midwife, whether in a hospital or at home. I have had two homebirths, with two different midwives. Insurance covered basically everything, except for supplies. Because it's billed as "usual and customary" my midwife might receive more than $4000 from my insurance, but we only have to pay $3200 up front, meaning we get back all we paid in and the midwife is able to keep more. This only makes sense to me (and it should to insurance companies) because the cost of homebirth is so much lower than a hospital birth. My insurance would mostly have to pay around $10,000 for a birth in a hospital without any interventions or complications.

sara said...

I had a midwife-assisted (a certified nurse midwife) homebirth with my second child and hope to with the baby I am currently carrying as well. The level of pre- and post-natal care was excellent and the experience was vastly superior to my first birthing experience during which a "cascade of interventions" led to a c-section.

Bethany Hudson said...

This is similar to the situation in the United States in the 1970s. Thank heavens, since then we have come a long way, and now in addition to hospital births with MDs, we also have homebirths, hospital births with midwives and midwife-run birthing centers which can transfer to a hospital in case of emergency. I will be delivering at a birth center with this pregnancy, and I'm so excited and grateful for this opportunity!

Frankly, I am so tired of the frear-and-smear campaigns surrounding natural birth. If pitocin and epidurals were necessary to have babies, then the human race would have died out an awfully long time ago. I am grateful to medical interventions in cases of emergency, but why should I have an OB-Gyn treating a normal pregnancy when he or she is likely to be seeing pathology everywhere--even where there is none! I had that experience with my first, and I am grateful that I had the presence of mind to switch providers and the blessing of a normal, healthy, pain med-free birth--even though I did end up with pitocin.

Final point: the whole over-pain-medicating route often leads to unnecessary C-sections, particularly in the United States. For one or two babies, this is fine, but if you're planning to have more children than the average 2, you're going to be in trouble with repeat c-section after repeat c-section. After 3, most doctors will pressure you into sterilization. After four c-sections, you can even run the risk of death from a ruptured uterus. I feel very passionately about letting first time mothers--especially those who are praying for large families--about the very real dangers of unnecessary c-sections and the likelihood that they will get just such an unnecessary c-section in an average American hospital simply because the doctor has employed too many interventions and doesn't trust her body to give birth. Down the road, those interventions could pose some serious health risks!


Anonymous said...

As you pointed out in an earlier post, babies are individuals in their own right. A baby that requires urgent medical care after the birth needs to be in a hospital. I dread to think of the number of deaths and disablements that result from the mother's decision to give birth at home because of their own prejudice against the medical establishment and science in general.

Ways of Zion said...

Wow, that is terrible. Our 2 girls were both born at home and you simply cannot compare those births to the terrible time I had in hospital (induced). Home births are on the rise here....so nice to see!

Anonymous said...

I have a homebirth and I didn't lose control or yell.

Gombojav Tribe said...

For Anonymous above,

Families do not choose homebirth out of a prejudice against the medical establishment nor science.

I think it's a big misconception that homebirthers are naive, uneducated women who don't know what they are doing.

"So far, the largest and most complete study on the comparison of hospital birth outcomes to that of homebirth outcomes was done by Dr. Lewis Mehl and associates in 1976. In the study, 1046 homebirths were compared with 1046 hospital births of equivalent populations in the United States. For each home-birth patient, a hospital-birth patient was matched for age, length of gestation, parity (number of pregnancies), risk factor score, education and socio-economic status, race, presentation of the baby and individual major risk factors. The homebirth population also had trained attendants and prenatal care.

The results of this study showed a three times greater likelihood of cesarean operation if a woman gave birth in a hospital instead of at home with the hospital standing by. The hospital population revealed twenty times more use of forceps, twice as much use of oxytocin to accelerate or induce labor, greater incidence of episiotomy (while at the same time having more severe tears in need of major repair). The hospital group showed six times more infant distress in labor, five times more cases of maternal high blood pressure, and three times greater incidence of postpartum hemorrhage. There was four times more infection among the newborn; three times more babies that needed help to begin breathing. While the hospital group had thirty cases of birth injuries, including skull fractures, facial nerve palsies, brachial nerve injuries and severe cephalohematomas, there were no such injuries at home.

The infant death rate of the study was low in both cases and essentially the same. There were no maternal deaths for either home or hospital. The main differences were in the significant improvement of the mother’s and baby’s health if the couple planned a homebirth, and this was true despite the fact that the homebirth statistics of the study included those who began labor at home but ultimately needed to be transferred to the hospital."

[Dr. Lewis Mehl, “Home Birth Versus Hospital Birth: Comparisons of Outcomes of Matched Populations.” Presented on October 20, 1976 before the 104th annual meeting of the American Public Health Association. For further information contact the Institute for Childbirth and Family Research, 2522 Dana St., Suite 201, Berkeley, CA 94704]

Anonymous said...

I think it's important not to over-generalize about either method of giving birth. I gave birth twice in hospital, and both times I had a positive, intervention-free experience. My doctor, whom I loved (and who was very anti-induction and c-section unless absolutely necessary), and the nurses were content to let me progress at my own pace and, since I was up-front about not wanting an epidural or other pain medications, they didn't even make me have an IV. I walked, showered, wasn't required to be attached to any monitoring devices, and in fact I never even got near the bed until it was actually time to deliver.

It's definitely important for a birthing couple to be their own advocates against unnecessary interventions, but I think it's letting the pendulum swing too far to cultivate a belief that giving birth in a hospital is inevitably going to be a negative experience. I think it can also contribute to a dangerous perception that doctors don't really know what they're talking about, and that their advice can be ignored according to the preferences of the individual.

Anyway, all this to say that not all hospital births are oppressive, invasive, or overmedicated, nor are all home births calm, serene, and uncomplicated. In the end, whatever results in a healthy baby and mother is what's best.

Tamsen said...

I'm actually glad my 2nd daughter's birth went so quickly, there was literally no time for the doctor to push for interventions. After the awful experience with my 1st daughter, I was ready to fight for a natural birth if I had to.

Melissa said...

As my husband and I don't have any children yet, and I'm not pregnant, I really cannot comment on the birth process. However, my husband is in the medical field, and he's always said that unless it is an emergency one should never use drugs during the birth process. Anyway, we've decided than when I am pregnant, we will opt for either a birth center or a home birth.

Anonymous said...

The solution is not to give birth at home. Sure, women have done it for millenia and the human race has survived. Not all the women and babies survived, though; the death rate for both mother and infant was much, much higher than today.

I personally know of a few cases where a newborn baby was very, very lucky to have been born on hospital premises rather than at home. A few minutes can make the difference between a healthy baby and one that will suffer life-long complications, or worse. Sure, most babies are fine, but who can predict which one won't be? As a poster above stated, babies have rights too.

Unless you live 5 min away from a hospital (and I mean 5 min in traffic, not at midnight), I think it's quite irresponsible to give birth at home. You are assuming your baby will be fine and taking a huge risk.

I agree that hospitals are far from perfect, and contribute to the huge ratio of c-sections today.

The solution, imo, is not to flee hospitals, but to transform them. Lots of public pressure is needed to revotionize maternity wards into homey birthing centers. This would be the best of both worlds.

Anonymous said...

In certain parts of Alaska I believe the percentage of midwife births was 26% even with hospitals close by and most insurances cover the costs.Some are at home and some are at midwife run clinics. I had both of my children at hospitals but the idea of a midwife assisted birth sounds pretty cool. Look at the women in the bible they didn't have hospitals, they had midwives. I do think though in the case of complicated pregnancies one should go to a hospital.Holly

Mrs. Anna T said...

"I walked, showered, wasn't required to be attached to any monitoring devices, and in fact I never even got near the bed until it was actually time to deliver."

That was my experience in the second hospital, the one where I gave birth. I didn't get near the bed at all until it was time to push. Instead, my husband relaxed on the bed while I showered or hopped up and down on the birthing ball. *smile*

I didn't mean to claim a hospital birth will always be overloaded with unnecessary interventions. But the amount of interventions and drugs being used excessively in hospitals is, undoubtedly, a fact.

Linda said...

It's exactly the other way around here in Holland.... homebirths are the norm, and only if you have complications you are allowed in hospital on government's expenses.

When all is well and you still REALLY want to, you can give birth in a hospital, but you have to pay for yourself.

I was so scared something would happen at home, and I really wanted to give birth in a hospital, but I couldn't afford the bill. Luckily for me, my midwive thought it was 'enough' of a medical reason that my waters contained meconium for me to go to hospital for free.

I was so relieved....*lol* Everyone is different, that shows ;)

greetings from the netherlands!

Mandi said...

Lots of things to keep in mind.

1. We all want what is best for our children and ourselves. So don't judge others' decisions.

2. Every mother, every home, every midwife, every hospital is different in some way.

3. Homebirths used to be the only option. Infant mortality used to be 50%.

4. Medical advances are something to be incredibly grateful for. First world infant mortality is less than 1%.

5. Midwives, doctors, mothers, all have access to information, technology and medicine that no previous generation did. This means that a hospital birth today and a homebirth today cannot be compared to homebirths 10, 50 or 1000 years ago.

MarkyMark said...


Being a guy, I don't know much about pregnancy; it's not like I'll have to deal with it any time soon, hehehe...

Seriously though, I have a question or two. Doesn't an epidural entail adminstering a pain killing drug to the birth mother? Isn't it also true that some of this drug finds its way to the baby? Isn't it also true that the EFFECTS of the epidural on the baby are possibly serious? Is it any WONDER why there are more home births in Israel?! Come on!


Coffee Catholic said...

The only reason I eventually submitted to the vaginally-administered drug that would help dialate my cervix was because the research showed that medicated induction only really works well if you're *already* in labor. And I had been in labor for far too long and was not progressing at all. Thus I figured that at this point in time it made sense to have the vaginal drug inserted to my cervix and to have an epidural to help me relax so I could hopefully release the baby. I had begged for a c-section because I feared for myself and my baby after 4 days of non-productive labor but had been denied. So it was either the vaginal pill + epidural or suffer for who-knows-how-much-longer.

The pill did help dialate my cervix but only to about 3cm. They put me on the epidural and broke my water which caused me to have hard-core contractions. (I allowed them to break my water because, like I said, I had labored naturally for long enough and felt I needed a bit of help.)

These contractions were so powerful that I was in awe!! But when I asked if my cervix was fully dialated I was told no and that I couldn't push yet. Ok, fine. So I did my best to breathe through the contractions and relax and resist the overwhelming urge to push. And uh... my body was pushing anyway! Regardless of my input!!

So anyway they said matter-of-factly, "We're going to give you sintocin to make your contractions stronger."

I was like, WHAT?! WHY?! I was having seriously powerful contractions without a fully dialated cervix!! HELLO! Were they trying to kill me or something??

But before I had to lock horns and fight off the sintocin it was discovered that the baby was not recovering between contractions and I asked for a c-section and, thank GOD!, they agreed this time. Finally.

BUT had my labor progressed normally I would have remained at home and given birth in the birthing pool without painkillers or with gas-and-air as my pain killer.

Jana said...

Mrs. Anna,

This article could not be truer! I live in America and had the same hospital experience you described. I was perfectly healthy and the baby was in no distress but I was a week late for my due date. The doctor had scheduled an intervention two months before my due date just in case. When my water didn't break "on time" he came charging in and did it for me. He insisted on my having an epidural which stopped my contractions cold. Now that my water broke we had to get things moving. I ended up being forced into a c-section (during which my epidural began wearing off). I was unable to help my baby for the first few weeks with out a family member helping me. I was in unnecessary pain for months following the surgery. We are also now thousands of dollars in debt unnecessarily. To be honest, I'm afraid to have any more children though I want them. The experience was awful. Though I may not be ready for the home birth option, I will do as you did next time and leave any doctor or hospital who forces my body and baby into their time schedule!

Laura said...

In my country (New Zealand) there is definate choice, and we also have a third option, birthing centres, which enable women to birth at a place that is not as invasive as a hospital, but gives some women a sense of security because it has all of the equipment necessary. All birthing is pad for by the government, and our midwives are very qualified. Unfortunately, as is elsewhere, homebirth seems to get 'bad press', for example if something goes wrong in a home birth the media makes a big deal of it, yet the same does not happen if somethign goes wrong with a hospital birth, meaning that there is a false perception that homebirth is unsafe. It is becomming a lot more common though.