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Last update - 00:00 01/08/2008 Why are hospitals opposed to women giving birth at home? By Rina Rozenberg Tags: hospital, Israel Each year, about 150,000 babies are born in Israel. Hospitals vie over the mothers, tempting the women with posh delivery rooms, private midwives and even hotel suites. But the big money is not coming from the expectant mothers, it is coming from the state. "The condition that makes the most money for hospitals is birth," said Shlomi Friedman, who is promoting an amendment of the Birth Allowance law and fighting injustice in the National Insurance Institute's treatment of mothers based on where they give birth. "They make NIS 8,000 per birth, which generally doesn't involve complications." And that is one reason the hospitals do not want Israeli women to give birth at home. Obstetrician Avner Shiftan points out that encouraging home births would save the state heavy costs on hospitalizing birth mothers, but hospitals hate the idea. "Hospitals have rigid costs, such as construction, buying equipment and salaries. The fewer mothers come, the more income they lose," he explained. Advertisement One way the state discriminates against home births is through birth allowances. The allowance ranges from NIS 470 to NIS 1,489, depending on how many children the mother has. But she only gets it if she gives birth in hospital. No hospital, no money - unless she shows up within 24 hours of the birth and stays for at least 12 hours. The reason the state discourages home births, incidentally, is because to support them properly, as The Netherlands does, for instance, it would have to invest massively in support systems. The cost of home birth Home births are also an industry. A private midwife costs between NIS 4,000 and NIS 5,000, including three to four prenatal visits to check the mother's progress, two visits after the birth and, of course, the birth itself. Just meeting the prospective midwife to see if there is "chemistry" costs the prospective mother NIS 250, though if they close the deal, that sum comes out of the final bill. If the mother winds up in hospital, the private midwife comes as a doula (nonmedical assistant, providing mainly emotional support). But the mother has to pay the full fee anyway - even if the midwife does not join her in the hospital at all. A home-birthing mother also has to pay for accessories, from hygienic pads to nylon sheets for the bed. There is also another cost: By law, a newborn must be examined by a pediatrician within 24 hours of birth. The health maintenance organizations cannot do it, because the newborn does not have an ID number yet. If the birth mother goes to a hospital emergency room for the examination, she either has to pay about NIS 600 (for arriving without a doctor's referral) or undergo 12-hour hospitalization (in which case the National Insurance Institute will pay), according to Michal Bonshtein of Israel's Home Midwifery organization. Saving the state NIS 8,000 is costly. If a mother wants neither hospital nor home birth, there is another option: Some midwives provide guest rooms. It is like a home birth, but without having to clean up or worry about the neighbors hearing the screams. The law governing birth allowances was enacted before the Basic Law on Human Dignity and Freedom, with its implicit right to equality. "In the 1950s, the state preferred women to give birth at hospitals because of unhygienic conditions at home," Friedman explained. "But that isn't relevant any more. Home birthing isn't a crime, so why should one woman get a birth allowance and the other not?" Everyone pays social security and should be entitled to equal treatment in return, Bonshtein argued. Women should be entitled to choose to give birth at home and receive part of they saved the state back, she added. Naama Barzeli had her first child at home, mainly because she felt hospital births were unnatural. But she had her second in hospital, because she could not afford the luxury of a home birth again, she said. The first time around, she went to the hospital a few hours after the birth to get her birth allowance. But as she tells it, she then spent five hours going from office to office, bleeding and carrying her newborn, without achieving a thing. And she had to pay NIS 500 for the visit, too. Be prepared The hospitals' position is clear enough, but what does the Health Ministry think about a woman's right to choose her maternity venue, and to receive a birth allowance? Well, the ministry urges women to give birth in accredited hospitals. But it realizes that some women do not want to do so, so it has issued clear directives. Only a midwife with three years' experience in an accredited delivery room, or a doctor who specializes in obstetrics and gynecology and has delivered babies in an accredited delivery room, are authorized to assist at home births. Also, the midwife or doctor must have both professional liability insurance and third-party insurance coverage. The ministry has also set clear directives regarding the initial medical condition of both the mother and the fetus. Home births are only legal if the mother had a pregnancy without complications, if she has a single fetus in a specific presentation, and if the pregnancy is no more than 41 weeks along. A woman choosing to give birth at home does so primarily because she feels it is the right thing for herself and the baby. One reason is that this enables her to choose a midwife in advance and not worry about midwives changing shifts, as happens in hospitals. Another reason is to be with the baby constantly from birth: In the hospital, the baby is taken away for tests and measurements. Dr. Gil Tadmon's first son was born in hospital, but he and his wife chose to have the second at home. Tadmon, who is about to finish his internship as a pediatrician, said that having experienced the hospital's approach, they preferred to go another route the second time around. They were disturbed by the fact that for the first three days of the baby's life, they were not the ones in charge; they only "took possession" from day three. "As a doctor and parent, I feel it's problematic," he said. "The baby spends most of its first two days sleeping, and by nature, the mother should be highly attentive to him, not be in another room with no connection to him. Sometimes parents come home on the third day with a baby they don't know." Dr. Shiftan said that "like any other product, birth should be examined by criteria of quality and through comparison shopping. In this case, home birth isn't only a good product, it's an excellent one. Research shows that it's as safe as giving birth in a hospital, even more so." Hospitals argue that is because home births are only permitted if the pregnancy is without complications. But Shiftan said that even when comparing the data for low-risk pregnancies alone, the proportion of women needing cesarean delivery is lower for home births than at hospitals. A U.S. study from 2005 found that the rate of medical intervention and mortality from planned home births in low-risk pregnancies handled by accredited midwives is the same as at hospitals. But these results only apply in the case of women and fetuses at low risk who have fast access to medical care and receive intervention when indicated, said Prof. Mark Glazerman, director of the Helen Schneider Comprehensive Women's Center at the Rabin Hospital's Department of Obstetrics and Gynecology. "Hospitals were founded to care for the sick," said Glazerman, who is also a professor of obstetrics and gynecology at Tel Aviv University. "Pregnancy isn't a disease and birth isn't care, and indeed, most births can be handled at home by a trained midwife. However, any pregnancy, even the simplest and most normal, can develop complications in a second and turn into an event requiring skill and infrastructure, which is why in the West, most births are carried out in hospital." The choice is not between risk and total security, Glazerman stressed. It is a choice of relative risks - and the woman must decide at what risk to give birth, he said. Around the world, he noted, 1,600 women a day die in childbirth. But most are in the Third World. In Israel, most women give birth in hospital. In the West, Holland is the exception: Some 30% of women elect to give birth at home. "Holland's success is the result of an efficient system of diagnosing high-risk births, high-quality training for midwives and the availability of medical teams to treat birth mothers at home throughout the 10 days after the birth," explained Glazerman. Israel does not have that kind of infrastructure in place. If the medical establishment wants to support home births, it has to make the investment. If not, Glazerman said, it must set up deliverly rooms to meet the needs of women who would rather have given birth at home. Bookmark to del.icio.us   Top dog An Israeli plan to use DNA to track dog feces was noted by the NY Times Magazine. Linking with the left An Israeli Arab party met a leftist Palestinian faction led by a convicted terrorist.   1.   Unfair Analysis 05:15  |  Proud Israeli 01/08/08   2.   home birth vs hospital 06:45  |  lu 01/08/08   3.   Unfair Comment 09:06  |  HomeStork 01/08/08   4.   There Should Be NO Homebirths! 09:09  |  Antigonos 01/08/08   5.   We did NOT feel our children were taken from us at Meir Hosp 09:35  |  Army MD 01/08/08   6.   My kids were all born at home 10:57  |  tsipora 01/08/08   7.   Why doIsraelis have to turn everything into a 11:39  |  L A 01/08/08   8.   Lucky you were Tsipora 11:59  |  Daniel 01/08/08   9.   Hospital birth is dangerous 16:26  |  Judy Slome Cohain 01/08/08   10.   Your Article on Midwives in Israel 23:13  |  Dave Kaminer 01/08/08   11.   ignored in hospital 09:36  |  tamar 26/12/08   12.   simply untrue 13:38  |  Dr. B 26/12/08   13.   homebirth 01:11  |  Ilana Shemesh 27/12/08   14.   Israel needs to join the enlightened world 01:27  |  Ilana Shemesh 27/12/08

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