Labors of love

Options have increased for women who want to give birth in hospital with minimal medical intervention.

By AVIGAYIL KADESH
Newborn (photo credit: Courtesy Shaare Zedek Medical Center))
Newborn
(photo credit: Courtesy Shaare Zedek Medical Center))
‘I think every woman has the God-given talent for childbirth, and I feel strongly that she has to have a good support system in a place that supports natural birth,” says Rivka, 31, who recently gave birth to a baby girl at the Natural Birthing Center at Hadassah University Medical Center in Ein Kerem.
Opened four years ago, the center consists of two birth rooms equipped with a kitchenette and seating area, baths, a Jacuzzi, aromatic oils and items to assist in easing labor, such as a large exercise ball known in this context as a birthing ball. The patient is tended to by a specially trained staff midwife with whom she has drawn up a birthing plan beforehand.
If she changes her mind about a non-medicated birth or if complications arise, the same midwife will accompany her to the regular delivery room – an event that happens about 10 percent of the time and mostly for first births, according to Hadassah midwife Nancy Novick.
“If you come to us because you want natural birth and more personal service, there’s no requirement to do it that way till the end. We have wide boundaries,” she says.
This service costs NIS 3,500 and is available only to women classified as low-risk. That may be out of reach for many mothers in a city with high birth and poverty rates, but for women like Rivka, it is actually a money-saver. She birthed her three older daughters at home, at a cost of about NIS 5,000 each, because the medical insurance system does not cover birth outside a hospital. In addition, many of the women who use the center would otherwise hire a private birth doula at a cost of NIS 1,000 to NIS 2,000.
Novick explains that the Natural Birthing Center “is in between a home birth and a conventional hospital birth. It provides a much larger safety net in a homelike atmosphere.”
“Natural” is defined as avoiding medical intervention such as continuous monitoring equipment, epidural anesthetic, an intravenous line and episiotomy. This “physiological” approach is gaining popularity among Jerusalemites of all cultures, according to Novick.
“We had to address the issue of a more hands-on experience for women who were doing it without the usual epidural, and we weren’t able to do that kind of work in the regular delivery room because there isn’t enough staff,” she says.
According to Prof. Simcha Yagel, head of obstetrics and gynecology at the Hadassah Medical Centers, 6,442 infants were born in 2012 in Ein Kerem and 4,566 at Mount Scopus. Both numbers increased by about 100 from the year before, making the alternative of more personalized service increasingly relevant.
All the women interviewed for this article are English speakers, but Novick says this does not reflect the demographics of Hadassah’s Natural Birthing Center (which offers guided tours every Tuesday at 3:30 p.m.).
“We thought we’d get a lot of Anglos, but it’s not that way at all,” she says. “We get a large spectrum from all walks of life, from Mea She’arim residents to Christian Arabs. It’s a real big cross-section of women just looking for more personal care or those who did not have a good previous childbirth experience.”
Of the four Jerusalem hospitals – Hadassah Ein Kerem, Hadassah Mount Scopus, Bikur Cholim and Shaare Zedek – Ein Kerem is the only one that offers a natural birthing center with a midwife dedicated to each patient. However, the others generally are flexible in allowing obstetrics patients to bring in a hired doula and to use alternative pain relief and relaxation techniques in the labor and delivery rooms.
In fact, says Aliza Adar Levine, a nurse, midwife, doula trainer and herbalist, the Jerusalem hospitals have been avant-garde in this area.
“In the 1990s, people used to go to Jerusalem to give birth because they could get VBAC [vaginal birth after C-section] and other options such as no automatic IV, that were revolutionary. Now this is fairly standard around the country,” she says.
When Levine came to Israel in 1984, the nowdefunct Misgav Ladach was the go-to hospital for intervention-free childbirth for low-risk patients.
“Since then, I’ve seen great shifts in public interest and in hospital policies as a result of that shift,” Levine says. “I’ve witnessed complete changes. Initially the hospitals were hostile to doulas, and now doulas are very welcome and treated as part of the team. All the comfort measures alternative medicine has to offer are open-heartedly received. If something is not available, at least it’s not condemned.”
She recently gave a basic herbology seminar to midwives from Hadassah Mount Scopus, at their request.
“Mount Scopus is often the choice for more highrisk births, and they still wanted to know about this,” Levine relates.
THE BUSIEST maternity ward in Israel is at the Shaare Zedek Medical Center. The projected number of births this year is 15,000 – plus another 6,000 at the downtown Bikur Cholim, which Shaare Zedek acquired at the end of 2012.
“Our midwives are trained to accommodate the medical needs and preferences of the laboring woman,” says Pnina Mor, a senior midwife at Shaare Zedek. “Any woman who is considered a low- risk pregnancy can be on a birthing ball, in the shower or walking around. We don’t make them [low-risk patients] lie in bed, and we do intermittent monitoring. But the first condition is that it has to be a low-risk birth.”
Any discernible health problem with the fetus or the mother, or other conditions such as a multiple or premature birth, puts the woman in the high-risk category, and she must be continuously monitored during her labor, which necessitates staying in bed.
To whatever extent possible, any laboring mother can choose to have the lighting in her room dimmed, listen to music from Shaare Zedek’s CD library or from her own and have a doula present. “Women can deliver in any position or in a birthing chair,” says Mor, who has a doctorate in nursing. The hospital also offers alternative methods to deal with post-childbirth pain, such as homeopathic remedies if the woman so desires.
In light of this trend, two years ago Beit Shemesh resident Shaindy Reich established BirthLite, the only store of its kind in Israel. Branches in Jerusalem’s Geula neighborhood and in Beit Shemesh and Bnei Brak stock items such as birthing balls to use at home in the early stages of labor, as well as aromatic oils for aromatherapy or massage.
“Mint and eucalyptus are very popular,” Reich says.
Among her customer base of mainly religious women, “there is growing awareness of empowering women with messages and information of how birth doesn’t have to be about getting an epidural,” she says.
Music is an increasingly requested item, Reich adds. She sells CDs of classical music mixed with nature sounds, in addition to Layda B’ahava (Labor with Love) by Modi’in Illit resident Surele Lobenstein, an EFT therapist and home-birth advocate.
“Music can really relax everyone in the room, including the staff, and makes a more pleasant atmosphere,” says veteran doula and doula trainer Sarah Goldstein. She offers her clients MP3s of piano, flute and Jewish relaxation music, and she recommends a new CD, Movements and Life, featuring original songs and vocals of local music therapist and mother of three Miriam Leichman.
“Miriam made a beautiful, positive, encouraging CD that is great for before and certainly during labor, with words that came from her perspective of her births,” Goldstein says. “She even has one song titled ‘I Can Do This,’ to let women know that birth is doable. It really enhances that feeling.”
Yoga and meditation instructor Gisele Gordon is on staff at Shaare Zedek, and she has trained some of the hospital’s nearly 100 midwives in the mindfulness breathing relaxation (MBR) technique to use with laboring mothers.
“No other hospital in Israel has this,” says Mor. “If a woman is having a hard time and doesn’t want an epidural – or even if she does – Gisele or one of the trained midwives goes into the room and manages to relax her with this unbelievable technique. We’ve had women completely dilated and looking like they’re sleeping because it relaxes the body totally. Relaxation is known to make the birth faster.”
Mor stresses that women should consider their experience no less “natural” if their plan for zero medical intervention proves difficult to follow.
“If she didn’t want an epidural and decides to take one, we will support her decision to make it a positive experience. She can have a normal birth with the help of a painkiller,” she says.
ARIEL KIRSCHNER, 25, had her second baby at Shaare Zedek 18 months ago without medication. With her first birth, she relates, “I really wanted natural, but I got too nervous and the pain was terrible, so I ended up taking an epidural. I was actually very proud of myself because there is a big stigma that you’re strong only if you have natural, but I knew I did the right thing.”
Goldstein was her doula and let her make up her own mind about medication. She does not believe this decision makes the critical difference between a positive and negative experience.
“I find that many women are traumatized or disappointed with their birth experience, even when they may have taken an epidural. Their disappointment is more due to their privacy not being respected, not being informed about what the next procedure was or the lack of emotional and physical support,” says Goldstein, citing a large US survey, “Listening to Mothers,” which supports her observation.
Goldstein asks each client, in their initial meeting, what things relax her when she’s nervous – a hot shower, music, encouragement, a massage. During labor, these methods will be employed while the mother is encouraged to move her body in different positions.
“Birth is meant to be active because it helps the labor progress and helps the baby descend,” says Goldstein. “Different positions allow gravity to help the pelvis open more, such as squatting. My joke is, you’re not going to go to the bathroom lying on your back, so you’re not going to push a baby out on your back, either.”
Reich says that customers at BirthLite have been asking her to stock birthing pools for home births. Underwater birth is not permitted at Jerusalem’s hospitals, though Bikur Cholim has bathtubs in which a mother can labor.
Shaare Zedek’s Mor says, “If someone brings her own little pool, we’ll fill it and let her labor in it, but the water gets cold and we don’t want the baby to come out in cold water. We do let her labor in the shower until the last minute, and we think that is more comforting.”
Emma Afterman, 31, recently gave birth to her firstborn in Hadassah’s Natural Birthing Center and labored in the Jacuzzi for part of the time.
“It was really helpful in relaxing me throughout the process up to a certain point. After that, we used all different kinds of positions,” she says. “For me, the most important aspect wasn’t the room itself but the level of service they provide, particularly that you have the same midwife with you throughout the entire process. That was important to me, especially since I could organize to have an English-speaking midwife and make a birth plan with her, and I could be in contact with her before the birth if I had questions. She really listened and gave a great level of support, which added a lot to the fact that I had a natural birth,” says Afterman. “I was open to [medical] intervention if necessary, but she gave me the strength to keep going.”
Goldstein advises women who want to give birth naturally to prepare in advance by eating healthfully and exercising – “crucial ingredients for a healthy pregnancy and less complicated childbirth,” she says. “Positive thinking and tefilla [prayer], feeling God is going to help them make a huge difference. The goal is a healthy baby and a healthy mother, but the process is also important.”