In honor of the fact that, in Israel, August has the most deliveries of any month, I thought I’d be proactive and make June birth month. This week we’re reviewing different birth options.
In true researcher fashion, with each child, I gave birth in a different hospital (not planned, actually, but cool, right?) This obviously helped me on my journey to discovery of birth options in Israel, as I am asked the question “Where should I give birth?” often.
But the answer is not so straightforward because it really depends on what type of birth you want, where you want to be and when you give birth. Most importantly, the answers may change. When I began my research on low-risk deliveries in Israel for my Master’s degree, almost 20 years ago, birth in Israel looked very different. I spent countless hours pursuing possibilities to bring freestanding birthing centers to Israel. I went to the Knesset with Nashim Korot Laledet, met with the Head Nurse from the Ministry of Health, conducted research and spoke to many people. I’ve since moved on from my lobbying days to change birth in Israel, but I’ve seen many positive changes along the way.
So let’s review what our options are as of today. Keep in mind, that unlike other countries, in Israel, the pregnancy system is separate from birth, meaning when you go to the hospital to have your baby, you will be attended by the midwife and/or doctor on call (unless you choose a private doctor, sort of, but more on that later).
If you live in Jerusalem, you will need to register at one of the three hospitals (Hadassah Ein Karem, Hadassah Har Hatsophim, and Shaare Tzedek (which includes Bikur Cholim) around week 30. If you don’t register, the hospital reserves the right to send you to whichever hospital is on duty at that time if they are too busy.
Anywhere else in the country you can just show up in labor. Which hospital you will choose will depend on the following:
- Geographic proximity to your home and/or family (parents to be helpful, or existing spouse and children)
- Type of delivery you would like (see below)
- If you are in ambulance (will take you to nearest hospital). Meaning that if you planned to give birth in Laniado’s birthing center but you went into labor at your in-laws’ in Ofakim, the ambulance will not drive you to Netanya, but rather to Soroka Hospital in Beer Sheva.
In the hospital, midwives attend the overwhelming majority of births, and they work on shifts, meaning that just because the midwife was with you the whole night, if 7 am comes and you’re still in labor, you will be assigned to another midwife. I have seen, however, on many occasions, that midwives will stay the extra minutes to deliver a woman if birth is imminent. In addition to the midwife, there is a gynecologist on call if there are complications. Depending on the hospital, the doctor will sometimes do an additional intake on you and also be involved in the delivery. This changes greatly among hospitals, so ask on the tour.
Hospital birth with private doctor
It is very common in some circles in Israel, to hire a private doctor for delivery. In some instances, the reasoning is quite clear. For example, if the woman would like a VBAC, or vaginal birth after cesarean, or delivery a breech birth vaginally (without c-section), she would be recommended to choose a private doctor because these are deliveries that are not the norm and need a professional with specific experience in these areas. Women who are having repeat c-sections often hire a private doctor because they want to know who is doing the surgery. You do not, however, have to hire a private doctor for a c-section, and the doctor on duty will perform the operation on the day you have been given. Do remember, however, that even if you hire a private physician, you will still go through the regular triage labor room, and be seen and attended by a midwife, prior to the doctor’s arrival. Cost varies greatly so each doctor needs to be approached individually.
Hospital birth with a hired doula
Doulas are not part of the internal hospital system, but you can hire one privately who will come with you to the birth. Most often, doulas will want to meet with you a once or twice prior to delivery. The price range varies, but now that supplemental kupah insurance will give you reimbursement for most, if not all, of the cost, it is more of an option for most families.
Hospital birth in a nested natural birth room
After Misgav Ladach, the birthing hospital, closed about 15 years ago, an influx of women looking for natural childbirth options surged into the mainstream birthing environment. Some women chose home births, while others sought to bring more flexibility to the regular system. To this end, many hospitals now have what I have termed nested natural birthing centers, a suite of several delivery rooms that often offer baths/jacuzzis, natural birth equipment, and most times, midwives who’ve been trained in natural childbirth. Check out your local hospital to see if they have these rooms if you’re interested.
Bear in mind:
- You will need to go through the regular system triage room (cheder kabbalah) before you get to the natural delivery room.
- If all their rooms are currently occupied with other births, you will not have access.
- You may risk out if you have any factors that don’t meet their low-risk criteria: ruptured membranes, high blood pressure to name a few.
So ask the hospital before you’re in labor what their criteria are to deliver in those rooms so you are prepared for a change of plan.
Birthing Center within a hospital
To my knowledge there are two hospitals with complete, and separate, birthing centers, within them: Laniado hospital which has a separate birthing center where you can meet one of the groups of midwives ahead of time, and Hadassah, where, for a fee of 3,800 NIS, you will meet with one of the midwives before delivery, and one of them will deliver you. Tel Hashomer has a natural birth room, where one of the staff will deliver you if you meet the criteria, and there is no additional charge.
Freestanding birthing center
An inside joke as this doesn’t exist yet. There are several home birth midwives around the country who have built individual bungalows where women come to them to deliver. This is as close to freestanding as we have right now in Israel. Most home birth midwives have a relationship with a nearby hospital if they need to transfer during labor.
Each year, several hundred women a year plan to deliver at home with a certified midwife and it is certainly a safe, possible way to have a baby, if you so choose, despite the face your gynecologist may make when you tell him. There are many types of providers, protocols, and practices among the group of homebirth professionals, so you need to shop around for what’s right for you. My friend just delivered her tenth child at home, with a doctor in attendance. Click here to see a list of homebirth midwives in Israel (in Hebrew). Ashira Gross is another homebirth midwife practicing out of Jerusalem.
Now that Bituach Leumi has finally granted women the ability to get their ‘birth money’ or ma’anak leida, even after delivering at home, there is no need to rush off to the hospital after delivery. It was the case that if you wanted this money, you would have to go off to stay in the hospital in order to collect. This is no longer the case, so stay home if you so choose. Just remember that you will have to get the necessary paperwork to register your baby with the Ministry of Interior and do the necessary checkups for infants on your own.
Unplanned home birth
Even though many wouldn’t write this as a “choice”, I include it because it does happen, a lot, especially after multiple births. If you are caught in an unexpected maelstrom of labor pains, as my niece was last year, and unable to make it to the hospital, calling Mada (101) is a perfectly acceptable option. They deliver babies all the time, have very experienced staff and all the right equipment, so, if needed, have your partner dial, and focus on the labor. An ambulance ride and delivery will be covered by kupat cholim.
For additional resources about birth in Israel, check out the following sites: