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Thursday, August 14, 2014

Giving Birth in Shaarei Zedek Hospital of Jerusalem, Israel (a guest post)

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Thinking of having kids in Israel?

It’s okay if you’re not.  Lots of people make aliyah before they even get married; others come long after their kids have grown up and left home.  (See When is the Right Time to make Aliyah?  Any time is the right time.)

But if you are thinking you may have kids here, read on.

I had all four of my children in Canada, two with conventional hospital births and two with home births assisted by a midwife.   So no sabras for me.

But I’ve always been fascinated by childbirth alternatives, especially those committed to empowering women and helping them make sane choices.  And I’ve always loved and supported the (hard, and often thankless) work of doulas and midwives. 

I’m thrilled to find out that there are some good ones learning and working in all parts of Israel.

This guest post was written by Chana Katzman, a doula currently working in Jerusalem, who offers her perspective on just one of the many possibilities for childbirth in Israel:

More pregnant women choose to give birth in Shaarei Zedek hospital, Jerusalem, than any other hospital in Israel. They must be doing something mothers like.

In 2012, there were more than 15,000 births in Shaarei Zedek. This figure does not include any births related to their taking over the management of Bikur Cholim hospital in late December 2012.

“…the more caesareans a woman has had, the greater the risk of complications in subsequent pregnancies and deliveries…”

In 2013, the combined total of the two locations under their management was over 20,000 births! On average, there were 41 births a day in Shaarei Zedek alone, not including Bikur Cholim.

Shaarei Zedek's magazine reports that the cesarean rate in 2013 was 11%.

Professor Samuelov, the director of the department of obstetrics and gynecology, emphasized that "This is one of the lowest cesarean rates in the country, and the reason for it is that Jerusalem is a very supportive environment for normal birth. We provide assistance and ideal treatment for women who desire to give birth normally, and ensure ways to do it safely. We have a lot of experience, and we have the knowledge and ability to prevent cesareans in certain cases. We make it possible to have a normal birth even after two cesareans, for breech presentations and for twins, something that isn't accepted in most places."

As Professor Samuelov notes, "Jerusalem is a very supportive environment for normal birth" because many pregnant women in Jerusalem "desire to give birth normally". Why is this desire stronger and more common in Jerusalem than it is in other parts of the country? Apparently, the reason is that more women in this locality belong to ethnic groups with a high birth rate. Simply, avoiding an unnecessary cesarean is much more important to mothers who intend to have many children than it is to women who don't, because of the increased rate of complications in subsequent pregnancies for women with a previous cesarean.

“…a very supportive atmosphere for normal birth…”

Professor Samuelov explains that his department tries hard to keep the cesarean rate down in order to give pregnant women what they want most. In order to do this safely, Shaarei Zedek provides top-quality medical care, including a carefully supervised trial of labor after two cesareans, and breech births in selected cases.

Supplying what women want means that more pregnant women choose to give birth in Shaarei Zedek hospital, which increases its income, since Israel's National Insurance Institute pays hospitals very well for births. The fact that Shaarei Zedek officially observes the Sabbath also helps the hospital to attract religious women who have a high birth rate. Two out of three pregnant women in Jerusalem choose one of the hospitals under their management, and only one in three choose one of the Hadassah hospitals. Attracting a greater market share of births is what keeps Shaarei Zedek's finances in good condition, while the two Hadassah hospitals are having great financial difficulties. As a childbearing woman, you are likely to benefit from choosing a hospital that doesn't have to cut back on services to patients.

The high birth rate itself provides an incentive to the hospital to keep the cesarean rate down, because the more caesareans a woman has had, the greater the risk of complications in subsequent pregnancies and deliveries, even if they are delivered by repeat cesarean. Obstetricians in Jerusalem have seen more of these complications than doctors in other places because they serve a population with a high birth rate. Providing the option of regular birth after one or two cesareans for women who want large families prevents a lot of risky high-order repeat cesareans, the kind of surgery that doctors in Jerusalem would rather avoid having to perform.

Presumably, the director of obstetrics in Shaarei Zedek terms Jerusalem "a very supportive atmosphere for normal birth" due to the combination of its high birth rate and competition between the local hospitals.

If it is important to you to participate in decision-making, Shaarei Zedek is very amenable to this. On a recent tour of the delivery suite, without being asked, the midwife leading the tour mentioned the importance of involving the mother in decision-making.

“…only 55% of all women giving birth in Shaarei Zedek request an epidural… In comparison, in hospitals in the center of the country, 80 to 90% receive epidural…”

Dr. Abulafia, a retired obstetrician who worked in Shaarei Zedek, in an interview for Shaarei Zedek's magazine, described the differences between the mother's participation nowadays and in the past: "The involvement of the childbearing woman has changed noticeably. The accessibility of information, the calculators in the internet, the great variety of medical tests and the modern equipment for imaging and surveillance, have all made the mother into a real partner. In the past it was the doctor who knew and understood, and the patient put herself in his hands. Today, pregnant women come to us with a great deal of knowledge, and this obligates the doctor to keep updated in order to be able to answer any question."

Shaarei Zedek's magazine also interviewed the head midwife, Chava Chacham. She too addressed the topic of the mother's participation: "In the course of the pregnancy, the couple is exposed to a lot of information. In many cases, they ask to be participants in planning the course of the birth and make special requests. We advise mothers to share her desires with us when she arrives at the delivery suite so we can coordinate expectations together. Some women are interested in delayed cutting of the umbilical cord, others request not to bathe the baby immediately. We respect every request. Our staff believes in the autonomy of the childbearing woman's decisions, and we will do whatever is possible to answer her requests openly and in cooperation. As long as the birth proceeds safely and there is no medical problem, the decision is in the hands of the woman giving birth. There are some women interested in an epidural, others prefer that we decide for them. Many women choose to give birth naturally, and in order to help them to carry out their wishes, some of our midwives took continuing education courses in yoga and relaxation - techniques that help reduce both tension and pain."

“…staff of top midwives means a higher likelihood that childbirth will remain normal and uncomplicated…”

What this means for you as a childbearing woman is that on any given shift, there are likely to be some midwives who enjoy supporting natural birth, and you can probably get one if you request this. If you don't say anything about your preferences, your midwife may presume that you would like her to recommend when she thinks you would benefit from an epidural. The head midwife of Shaarei Tzedek advises you to tell the staff in the examining room what approach you prefer, natural birth or epidural. If you follow her advice, they will be able to assign a midwife who is most appropriate for you. This will enable both you and the midwife will find the experience as rewarding as it can be.

Only 55% of all women giving birth in Shaarei Zedek request an epidural, but 80% of all first-time mothers get an epidural. In comparison, in hospitals in the center of the country, 80 to 90% receive epidural. One of the reasons for the low rate of epidural usage is that Shaarei Zedek serves a population with a high birth rate, meaning a high percentage of the births there are not first births.

Shaarei Zedek has its own nursing school. Of all departments in a hospital, the quality of the nursing staff is most important in the delivery suite, because medical care during normal uncomplicated childbirth is provided by midwives, not doctors. Having a staff of top midwives means a higher likelihood that childbirth will remain normal and uncomplicated.

You can choose to give birth on their birth stool, which makes the birth more modest and faster and may also be more comfortable for you.

“…the best neonatal special care available in Israel, and among the best in the world…”

Until recently, Sharei Zedek had three maternity wards with 134 beds. In early 2014, they opened a fourth maternity ward in their new building, with an additional 40 beds. The new ward offers full rooming-in, in which the baby is next to his/her mother almost all hours of the day, including at night. Babies in full rooming-in are taken to the newborn nursery for examinations four times a day. Every mother receives instructions how to care for her baby on her own, but if she wants a short break, she can bring him to the nursery. All three pre-existing maternity wards have partial rooming-in.

Shaarei Zedek also moved its neonatal special care unit to the new building in early 2014. The new unit has 70 beds, enough to handle expected growth in the next few years, as well as the most advanced equipment available today, including things that no other hospital in the country has. Although the old unit had only about 35 beds, almost immediately, the new unit began to care for an average of 50 babies at a time! Two reasons could be contributing to this sudden increase: more mothers whose babies were likely to need special care decided to give birth in Shaare Zedek and/or more babies born elsewhere were transferred here to get the best neonatal special care available in Israel, and among the best in the world.

As a birth doula in Jerusalem, I provide plenty of information on my website http://doulajerusalem.chanakatzman.com that can help you have the birth you want in this locality. Learn more about your options in Jerusalem and your rights in Israel to participate in any medical decisions that may come up during your birth at http://doulajerusalem.chanakatzman.com/en/givingbirth-jerusalem/.

Article Source: http://EzineArticles.com/8616258

[photo credit:  Tatiana Vdb via flickr]

Tzivia / צִיבְיָה


2 comments:

  1. The Shaare Zedek "magazine" (really a promotional brochure) from which Ms. Katzman quotes contains an article that shamelessly pushes the epidural as the default option. I discuss this at length in a Times of Israel blog post: http://blogs.timesofisrael.com/selling-the-epidural-at-shaare-zedek/.

    One point that I make in my TOI post is that Shaare Zedek markets its labor analgesia options differently to different "markets." Low-tech pain relief is presented as a viable option to secular women who generally have fewer children, while the epidural is marketed aggressively to religious women who can be expected to make use of the service repeatedly.

    ReplyDelete
    Replies
    1. Thanks for pointing this out, Julie. Interesting, and disappointing. Here's a clickable link to your article at the Times of Israel blog - I hope others will check it out, too.

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