Health Ministry agrees to ease rules on home births

Although the Health Ministry opposes home births, it has just issued detailed guidelines that make it easier to deliver in one’s own bed while at the same time protecting the rights and health of the baby as much as possible.

“It’s a compromise,” Prof. Arnon Afek, director of the ministry’s medical branch told The Jerusalem Post on Thursday. “We prefer that women give birth at hospitals, where all the equipment and qualified personnel are, instead of having a trained midwife deliver the baby alone, but there is a demand for it among some women, and in ideal circumstances it is considered safe. There are home births in Western countries around the world,” he said.

Until now, the regulations were much more restrictive.

Afek did not know of any lawsuits pressing for more liberal rules on home births, he said, but there have been requests from women and queries by lawyers.

“We worked on the regulations for months. The team included Prof. Prof. Vaclav Insler, chairman of the National Council for Gynecology, Neonatology and Genetics, ministry physicians and legal experts.”

He called the reform “a revolution.”

“We believe that it is safest to deliver in a hospital, but we can’t deny that some women prefer to have their babies in a non-hospital setting at home.

We tried to provide the best solution and bridge the two positions,” continued Afek.

According to ministry estimates, in an average year, between 400 and 600 women give birth at home by choice.

As the National Insurance Institute (NII) gives special grants to women only if they give birth in a hospital or if they immediately afterwards go to the hospital, as in the case of women who unintentionally deliver elsewhere because they did not reach the the delivery room in time. Women who intentionally have their babies at home may not receive them.

The NII allocation is NIS 1,695 for new mothers, NIS 763 for a second baby and NIS 509 for every additional infant.

Afek could not predict how many more women would choose to deliver at home due to the new regulations, which had not been changed since 1976 and were initially set during the British Mandate in 1926.

Only a professional – a registered midwife or obstetrician who has undergone special training in neonatal resuscitation – may deliver babies, and only at the home of the woman giving birth. Afek explained the latter limitation by stating that the ministry did not want midwives to delivery babies at their own homes or other residences that would be turned into mini-home- hospitals. The woman’s home must not be more than 30 minutes away from the hospital, and the home delivery room must be big enough, clean and have electricity, water and other necessities.

Of course, in an emergency in which a woman suddenly goes into labor, a paramedic or anyone else who is present is allowed to deliver a baby.

As it is not easy for midwives to obtain insurance to cover every eventuality in home births, the guidelines stated that if the midwife lacks insurance for this, she must inform the woman who commissions her that she has no coverage.

The new regulations state that home births must be prepared in advanced and are approved only if strict criteria are met.

This includes having the fetus in the head-down, rather than the breech, position and in the 37th to 42nd week of gestation; the estimated birth weight at 2.5 to 4 kilograms; a declaration of good health by the woman, who must be at least 18 years old; written documentation of her medical history; documentation of a previous ultrasound of fetal systems; and that the mother does not have gestational diabetes.

In addition, the home must be equipped with a delivery kit; sterile, disposable gloves and a suture kit; a portable suction equipment; oxygen balloons; a sphygmomanometer for measuring blood pressure; saline solution and infusion equipment; catheters; a baby scale; and a thermometer, as well as sterile pads, test tubes and other paraphernalia.

A home delivery may not be performed, the regulations state, if the mother has an active infectious disease or a chronic disease that would affect the fetus or delivery, if the woman previously had a delivery with complications, if she took narcotics, or if she previously had a stillbirth that could affect the present pregnancy.

Women with a multiple pregnancy or those with a fever over 37.5 degrees Celsius may not be delivered at home.

When a baby is delivered at home, the midwife must give counselling on basic baby care, and the infant must be taken to the hospital two to seven days afterwards to undergo blood tests to determine whether it has certain diseases.

“One of the most important things is the requirement of the midwife to explain every aspect of the potential risks of and conditions for home births,” Afek said.

Asked whether midwives are permitted to deliver babies outdoors – as in the Red Sea with dolphins swimming alongside, as some women have done – Afek declared that this was forbidden and discouraged, but that women could not be forbidden by law from doing it themselves.