Bringing birth back to basics

To hear women talk about it, St. Joseph sounds more like a fairytale than a hospital. Here they revere the natural process of birth and a woman's ability to give life; it is possible to give birth in water; medical intervention is used only when necessary; and the rate of cesarean births is about- 10% (compared to 18% to 20% in other Jerusalem hospitals, and in the US in 2016, 31.9%). Could such a place really exist? In does, and women in Israel have taken notice. St. Joseph is the only Catholic hospital in east Jerusalem. The maternity ward opened in 2015, primarily to serve the area's Arab and Palestinian populations. Sister Valentina was a nurse at San Gerardo Hospital in Monza, Italy, and a midwife in Milan's Mangiagalli Hospital before entering the Sisters of St. Joseph. Eventually, Sister Valentina received a phone call asking her to come to Jerusalem to head St. Joseph's burgeoning maternity ward. “As a sister of St. Joseph, we are available to move to other countries if the congregation needs us,” she explained. Sister Valentina continually espouses the model by which St. Joseph operates, to respect the natural process of labor as much as possible. Pregnant women who are not high-risk are able to move around the delivery room, do exercises or use the pool – whatever helps them to feel more comfortable. At the moment of birth, the woman is not obliged to stay in bed lying on her back, as most other hospitals would have her do. She can choose the position that feels the best for her. Nor are there any routine episiotomies. After being born, the baby stays with the mother, skin to skin, breastfeeding as soon as possible, often immediately. Of course, St. Joseph is a hospital and must work within the bounds of medical protocols. For prolonged pregnancies that have gone beyond the normal gestational period, inductions are generally recommended. But the staff waits before proposing such action. “WE DON'T tell a woman what she has to do, unless there is a real danger for mother or baby,” Sister Valentina said. “If there is time and no risk, I'm happy to say that all of our doctors know how to wait. I always tell the women to express themselves. It doesn't mean just because you're in a hospital that the hospital has to decide for you.” From the time St. Joseph's maternity ward first opened its doors, Sister Valentina has been training the midwives in the style she learned in Italian hospitals. She shows them videos about how Italian midwives work to respect and promote the natural process of labor. St. Joseph Department of Obstetrics director Dr. Samir Asfour is fully supportive of this woman-centric birthing style. The methodology comes from the top. “I don't want to be in competition with other hospitals in Jerusalem,” she said. “I'm not saying that we are better. I have good relationships with midwives at Hadassah Mount Scopus. We are working for women and we have to work together. Our workload is much less than theirs. I know midwives from other hospitals who are wonderful, but the load and the structure don't allow them to give the right care. It's not because they don't want to.” WOMEN INTERVIEWED for this article who gave birth at other Jerusalem hospitals often told stories that were, at best, not ideal, and at worst, traumatic. Helene Goodfriend, a 33-year-old Beit Zayit resident, wanted a home birth for her second child, but a preexisting condition prevented this. After giving birth to her first child at Hadassah University Medical Center in Jerusalem's Ein Kerem, the thought of going back filled her with anxiety. “It was somewhat traumatic at Hadassah,” she recounted. “I was forced to be in positions that were very uncomfortable. I didn't want to succumb to that again. I heard about St. Joseph when I was over 40 weeks. It was a blessing that I found out about it when I did. I really wanted to give birth in a birthing pool. At Hadassah, you can labor there, but you can't give birth, unless it is in the natural birth center, which is very expensive. That was a huge thing for me. To not be in the pool when you're actually pushing the baby out sounded really painful. “So I went to go visit St. Joseph and the second I walked in – carrying all of this tension because I didn't want to give birth at a hospital and get an epidural – it all went away. Meeting the staff, seeing the equipment and the space, it didn't feel like I was in a factory. I could tell that the staff really cared about the birthing women's wellbeing and experience. It's not about getting the baby out and moving on to the next. They want to help the woman work through her birth... Birth should not be traumatic, it's the natural way that every person comes into this world.” Goodfriend described how Sister Valentina held her hand throughout the tour of the maternity ward and also during birth. She was made to feel safe. “She cared about me. At other hospitals, they pressure you. If you go over 40 weeks, they want to induce you. At St. Joseph, they told me that if you go over 40 weeks, they're required to say that it becomes more dangerous for the baby, but ultimately it was my right to wait if that's what I wanted. I love that they put the decision in my hands. I've heard so many horror stories of women at other hospitals getting episiotomies without being asked first. They just cut or poke without asking for permission. Women should have the right to decide what happens to them when they're in labor.” Much in the way the former Misgav Ladach hospital is fondly remembered for its nurturing style of childbirth, Goodfriend described her experience in the birthing pool at St. Joseph as empowering, one of ease and care. When she was in labor, the midwife made suggestions about changing positions or going into the shower. Responding to Goodfriend's experience at Hadassah, the hospital's spokeswoman stated, “The obstetrics departments at Hadassah's hospitals in Mount Scopus and Ein Kerem are among Israel's leading obstetrics departments, in terms of professionalism and experience of its teams of midwives, nurses and physicians, as well as enabling a personalized, emotional and positively impactful birth experience for each woman. In Hadassah's delivery rooms, the woman is given the choice to define her labor, choose what position to labor in and decide on the labor room's atmosphere. “A woman can also choose to give birth in the 'natural delivery room,' where the same midwife remains with her throughout the birth and provides natural methods for pain relief. After the birth, the mother can choose rooming-in, when the baby remains in the room day and night, or partial rooming-in, when the baby is taken care of by the nursery's professional, dedicated staff during the night. “Childbirth doesn't begin at the birth itself. We offer mothers-to-be and their partners preparatory birth courses in the language of their choice, tours of the delivery rooms and the department, and – for the first time in Israel – personal meetings with a midwife to discuss the woman's preferred birth experience, as part of the Let's Talk program. “We are always open to constructive criticism and to entertaining new ideas to learn and improve.” NONE OF St. Joseph's staff are Jewish, but that made no difference. In fact, Goodfriend was the first Israeli Jew to give birth at the hospital. One could say she sparked a trend, as more and more Jewish women in Jerusalem want to give birth there. “It's getting more popular now because people are sick of having terrible experiences at the other hospitals,” Goodfriend added. “I have heard countless horrible stories from close friends of mine who went to other hospitals. A woman should not be terrified of giving birth. It's holy and beautiful.” With the increase in Jewish women giving birth there, St. Joseph has become an unlikely haven of coexistence. “When I first heard that St. Joseph was in east Jerusalem, I was a little wary,” Goodfriend continued. “But when I got the tour, it felt very safe. Nobody made me feel uncomfortable. When I was in labor, I chatted with one of the Arab nurses about our personal lives. She told me about her community and her birth experiences. We could have been from anywhere. It really didn't matter because we were relating to each other as mothers and as women.” Sister Valentina echoed this sentiment. Regardless of religion or background, she said, the staff serve with the same love and care. There is a sense of freedom at St. Joseph that is reﬂected in having every delivery room equipped with wireless monitors. Goodfriend described her first birthing experience with a monitor hooked up in a way that required her to stay in an uncomfortable position. “I was in active labor and my contractions were very close together and really strong,” she recounted. “I was forced to sit in positions that were extremely uncomfortable for me. I kept moving with each contraction and the nurse was screaming at me, telling me that she couldn't get a reading because I wasn't sitting up straight. She wouldn't put me in the delivery room. She finally gave up and let me go, but it took a very long time for that to happen and it was really traumatizing because it felt like she was forcing me to be in pain.” The wireless monitors at St. Joseph allow the midwives and the birthing women to move around with ease. This adaptability extends to the food given to new mothers and their families after birth, as St. Joseph adjusts to the needs of its Jewish patients. The hospital does not have a kosher kitchen, but it tries to provide kosher food for those who request it. “What is beautiful in our hospital is that we live here,” Sister Valentina explained. “We are not here because we are employed by the hospital; our lives are dedicated to this service... If you keep good relationships with your staff, it makes a difference. It doesn't mean we have no conﬂict at all, but we treat each other with respect. The staff is then able to serve people in a better way. If you treat people well, then they will go and treat others well. I believe this.” With four midwives on duty at all times and fve delivery rooms, the aim is to keep a good patientto-staff ratio. There are 10 doctors and residents onsite until 3 p.m. every day. After that, the hospital maintains one specialist and two residents, and another specialist on-call for obstetrics, neonatology and the operating room. Violet Shmuel, a 33-year-old Jerusalem resident, chose to give birth to her second child at St. Joseph after suffering from a negative experience at Bikur Cholim. Shmuel was planning a home birth with her first child, but the baby was breech. “They told me that I had to agree to an epidural and an episiotomy or they would give me a cesarean,” Shmuel recalled. “I didn't want any of those things, but they said if I didn't agree, they would force me to have a C-section. Then they couldn't figure out where to put the needle in for the epidural and while they were discussing their options I began pushing, unnoticed. When they fnally realized that I was actually giving birth there was no time for an epidural. “There were many people in my room the whole time, which was horribly embarrassing. The door was open, there were strangers coming in and out. I didn't know what was going on; it was a really stressful and high-pressure environment. When they fnally noticed I was delivering my baby, they picked me up and put me on a gurney on my back. I was screaming because I wanted to push myself up into a better position. They freaked out and threw me onto my back again; I couldn't push [like that]. “The baby was in distress because she was stuck halfway out, and I kept begging them to let me get up so I could finish pushing her out. I finally kicked out of the stirrups and pushed myself up, ripping the IV out of my arm. I was able to push her out, but the fact that they kept trying to intervene in painful ways made it so much worse. Then they took her away from me and wouldn't tell me where she was or let me see her. I was so traumatized by that, I didn't put her down at all for months afterwards.” Asked to comment, Bikur Cholim's marketing director responded, “We are a hospital, not a factory. This was one woman's experience and is not indicative of the feedback we receive from the surveys we conduct all the time.” THE HOME birth Shmuel wanted can cost upwards of NIS 5,000. But she and her husband were prepared to save up rather than risk another traumatic birth experience. “I was done with hospitals. I wanted a sweet, easy, peaceful, loving, quiet experience with no strangers,” Shmuel described. A friend told her about St. Joseph's approach to birthing. “I sort of blew it off, but then I had a whole fiasco trying to find a midwife and I started to reconsider my home birth. Then I was told again about St. Joseph's new maternity ward and that it's very natural-minded. I thought it sounded amazing, so I called Sister Valentina, who is bubbly and angelic. “I asked her lots of questions because I didn't want to feel that I was doing something unethical by taking resources that had been allocated to Palestinians. I also didn't want to feel unsafe... I was in a place where I was trying to figure out how to trust again. We look Jewish. My husband is Israeli, and I was afraid about waltzing in there looking the way we do. I went in with that mentality and Sister Valentina came and met us at the entrance for a private tour. She told us about the beautiful births she had experienced, introduced me to all of the staff, and showed us every room in the maternity ward.” Shmuel ultimately opted for St. Joseph and now looks back on that as one of the best decisions she ever made. There was a feeling that they were doing something important, she stressed. “I've always believed that if we are ever going to have peace in this country, it will come from women working together and that's what you see there. There are Muslim and Christian staff members who welcome everybody in a real way. They hadn't interacted with many Jews before they met us, so I felt a bit like an ambassador. We were only the eighth Jewish family to give birth there.” It is perhaps fitting that this beacon of a shared society comes from a place where new life is nurtured and welcomed. “We are not a big hospital, so we can keep a familiar atmosphere,” Sister Valentina said. “We love natural birth and one-to-one care and we want to work in that way. Our staff and these families who are coming to us are doing something great because they meet each other without seeing any differences. Our staff is Muslim and Christian. I see in them that we can live together without problems.” “There is no secret,” she insisted. “Taking care of relationships and seeing people as people – this is the way. To give birth is to give life.”

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East Jerusalem’s St. Joseph Hospital takes a woman-centric approach to birth

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