September 14, 2004

Maternity care in Israel

Last week I was in Israel which was fascinating. I am sure that I have learned as much from the midwives, doctors, childbirth educators and doulas in the two groups I facilitated as they have from me and each other. Both groups were lively, interested and willing to take on new ideas. There was lots of discussion and many questions, as it became apparent that birth and midwifery care in Israel have both their own style and substance.

There were many interesting issues that arose. Everyone in Israel has private insurance to cover their needs within the health care system. Maternity care is provided by both doctors and midwives and is based in hospitals. All pregnant women receive their pregnancy care from doctors and there is a heavy emphasis on tests and technology. Pregnancy is confirmed by ultrasound around 6 weeks (and the last menstrual period may even be adjusted at that point), followed by regular ultrasounds to assess fetal development over the following months.

Women meet a midwife for the first time in labour. Perhaps that is one reason why parents don’t phone the hospital when labour has started - they just arrive at the labour ward and expect to have a baby soon after. They will phone their mothers, however, and it is common for a whole family to arrive, laden with food and ready to witness the labour and eventual birth. I gathered that crowd control was one skill that midwives needed to develop!

Labour is usually managed using “Active Management of Labour” principles. Vaginal examinations (VEs ) are undertaken regularly and steady progress is expected. I was told of women having a VE from several different midwives over the course of the labour and rupturing membranes and oxytocic drips appear to be standard procedure for almost every woman. I mentioned the issue of the potential for vaginal examinations to raise anxieties in women, especially those who have had some form of sexual abuse, and this appeared to be a completely new thought. It seems that discussion about sexual matters is not generally on the agenda, perhaps another result of doctors managing pregnancy care rather than midwives.

There were many stories of intransigent doctors who were rigid in their management of labour and very unwilling to listen to midwives. There are always some, though, who are more open and more prepared to use evidence based principles to guide their care. Some midwives also shared stories of collaborative care successfully negotiated with their medical colleagues, and it seemed that watching “alternative” approaches, such as an all-fours birth position, was the best way to get the message across.

The workshops were held in the Tel Hashomer Hospital - a vast campus in Tel Aviv that is the major centre in Israel for medical care and also education. Their maternity unit has on average 900 births per month - that is around 30 babies born every day! Epidural use is high (not surprising in this kind of “factory” setting) and the midwives are normally looking after 3 or 4 women at a time. They are keen to help women achieve natural births whenever they can and their labour rooms are well equipped to do this. I’ll do another Diary entry about their new Birth Centre and the political scene for midwives in Israel at a later date.

Overall, birth is very medicalised, an interesting mix of American and British ideas. This probably reflects the educational background of the obstetricians to some extent, as they have a very firm grip on the way that services are provided and maternity care is carried out. Home birth is a possibility in some areas and I’ll look at specific birth practices and midwifery options in my next entry.

Posted by andrea at September 14, 2004 05:43 PM

Comments

Dearest Andrea,
I'm writing to tell you how much I enjoyed the workshop that I attended at Tel-Hashomer. I often assist in "natural childbirth" and I found your ideas, and comments enlightening and thought provoking. I've been reading "Empowering Women" and only wish that you lived here so I could study an entire program with you as oppose to only the seminar and my self study with your book. I hope you enjoyed Israel, would love to have you back again soon.
Sincerly, Lauren Inbar

Posted by: lauren on September 26, 2004 10:58 AM