Vol XXVIII: I am trying to understand the specifics of home births. Does the mother receive maternity payments if she gives birth at home? What are the rates of c-section in home births versus birthing centers versus hospitals?
By RACHELLE OSERANrachelle and babies(photo credit: )Rachelle Oseran is a Lamaze Certified Childbirth Educator with 23 years of experience working with pregnant and postpartum women. She is also a fitness professional certified by ACE (The American Council on Exercise) and a certified prenatal and postnatal exercise instructor. She co-directs Great Shape Exercise Studio at the Jerusalem YMCA.
Rachelle also teaches Lamaze childbirth preparation classes and can be reached at www.childbirtheducation.co.il
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Vol XXVIIIQ: I am trying to understand quality of care in different environments. Here are my specific questions:
1. Does the mother receive maternity payments if she gives birth at home?
2. Is there any statistical difference in mother and baby safety in home births versus birthing centers versus hospitals?
3. What are the rates of c-section in home births versus birthing centers versus hospitals?
I will stop there for now...
A: Thank you for asking the questions that are on the minds of most women and their partners who are considering out-of-hospital births. All women are entitled to receive the maternity payment from the National Insurance Institute when they give birth. However, protocol is such that, for a woman who gives birth at home to receive that payment, she and her baby need to go to a hospital within 24 hours of giving birth and stay there for 12 hours.
While this is not "law", it is "protocol" that is currently practised. In a Knesset debate on "The right of freedom of choice in childbirth" that took place on 29th July, 2008, the NII was given the directive to rethink this practice. Until this practice is changed, women who give birth at home who do not follow this protocol will not receive their maternity payment.
With regard to the safety of homebirth versus birthing centers versus hospitals for mothers and babies, we need to compare apples with apples. When comparing low-risk, planned homebirths attended by a qualified midwife, the results are the same as with birthing centers and hospitals regarding maternal and fetal morbidity and mortality. The exception to this is in Holland. "In the Netherlands, where around one-third of babies are born at home under the care of a midwife, outcomes for first babies have been shown to be equivalent to, and outcomes for second or subsequent babies have been shown to be better than, those of babies born to low-risk women in hospital." (Sarah J. buckley, MD, "Gentle Birth, Gentle Mothering" - One Moon Press, 2005) quoting a study published in the British Medical Journal.
According to the Cochrane Database, "In some countries almost all births happen in hospital, whereas in other countries home birth is considered the first choice for healthy and otherwise low-risk women. The change to
planned hospital birth for low-risk pregnant women in many countries during this century was not supported by good evidence. Planned hospital birth may even increase unnecessary interventions and complications without any benefit for low-risk women...."
The rates of cesarean sections vary in different countries. I assume that you are asking about Israel. Again, we need to compare similar factors. The c/s rate of home births in Israel is 3%. The c/s rate at Tel Hashomer Hospital's birthing center is 6% for first-time mothers and 1% for women who have given birth previously. Hospitals have a cesarean section rate of 19 -25% (depending on the institution), though they also deal with high risk pregnancies. Although it is difficult to obtain a hospital c/s rate for low-risk pregnancies, I would assume that it is substantially higher than the c/s rates of home births and birthing centers, because
induction/augmentation and epidurals which are widely used in low-risk births in hospitals greatly increase the need for cesarean sections.
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Vol XXVIIQ: Do you do homebirth deliveries in Israel? Or know of someone I could contact who does. I need to find out the legalities for homebirthing in Israel while on a tourist visa. What paperwork is needed and how to go about obtaining it. I have tried contacting many "officials" and I can't seem to get anyone to respond. Any help or direction would be great.
A: Thanks for your question. I am not a midwife so I don't do home births. I am a childbirth educator and I prepare women for home births (as well as hospital births). Over the past few years I am seeing more and more women in Israel choose to deliver at home. Home births are legal here if they are attended by a certified nurse midwife (CNM). According to a wonderful and experienced home birth CNM in Israel, Shayne Bergner, (gotmansh@netvision.net.il)
"The midwife provides a summary of birth along with a sworn affidavit that she is the midwife and verifies the birth details in the document. The woman then needs to go to the Ministry of Interior with a copy of the midwife's license to practice, the midwife's birth record and affidavit and a letter from the pediatrician who performs the well baby post partum exam (there are several friendly pediatricians who provide this service for a nominal fee). Both parents need to show passports or Israeli ID cards and be present with the baby to register him/her.
Once they have completed this process they receive a birth certificate which they can use to obtain their foreign passport and report of a birth abroad from the embassy. Without this document they will not be able to leave the country. The process is simpler than it sounds. All of the ministry offices now have experience registering home births and it is usually a smooth process. In rare cases, they may ask for an ultrasound or proof of pregnancy (such as prenatal records) but this is extremely rare and only when their suspicions have been aroused."
I hope this helps.
Rachelle.
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