A woman planning to give birth at home will have to obtain a letter from her family doctor testifying that she is both physically and mentally sound, under new regulations being drafted by the Health Ministry that many believe are aimed at curtailing home births.
The letter would have to be submitted to the midwife or doctor attending the birth before the home birth can take place.
"As if the witch hunt against midwives [who attend home births] weren't enough, now every woman who wants to give birth at home will have to prove her sanity," complained Ruti Karni Horowitz, executive director of the Childbirth and Postpartum Professional Association. "Pretty soon nursing mothers will have to obtain a certificate of good conduct from the police."
The new regulations, which will replace earlier regulations from January 2008, also demand that the home be no more than 30 minutes from a hospital, to facilitate a quick transfer if necessary, and that the room in which the birth takes place be at least 10 square meters large, so that three people can assist the mother. These requirements alone are likely to cause a sharp drop in home births.
Those authorized to attend home births, who were already required to take an advanced resuscitation course, will now have to practice these techniques at least once a year, rather than every two years. In addition, no home birth can take place if the mother has a temperature of more than 37.8 degrees Celsius, and the attending midwife or doctor must return to examine the mother 24 hours after the birth.
Two new items are also being added to the list of problems that would require the mother to be taken to a hospital: if the placenta is not expelled within an hour, and if there is no active labor within six hours of the woman's water breaking.
The latter requirement infuriates Karni Horowitz.
"While it's true that the water breaking increases the chance of infection, the home birth approach holds that this risk increases in the hospital, which is an infectious environment," she said. "If there is no sign of infection, like a fever, there's no reason a woman must go to a hospital within six hours."
The new regulations include instructions for treating the baby if the mother refuses to be taken to a delivery room even though her medical condition requires it.
The ministry strongly recommends that parents bring all home-birth babies to a hospital within 24 hours of the birth. Most woman who give birth at home do this in any case, since this is a condition set by the National Insurance Institute for receiving a birth grant.
The new regulations reiterate the ministry's long-standing position that "In general, births in the delivery rooms of recognized, licensed hospitals are to be preferred."
"There is strong opposition to home births within the medical establishment in general and in the Health Ministry in particular," said Dr. Avner Shiftan, an obstetrician at Poriya Hospital in Tiberias who also assists home births. "This opposition is not based on scientific evidence, since most research doesn't point to any more complications in home births. The reason for the opposition is economic, given the current funding method [for births]."
Israeli hospitals, some of which are owned by the Health Ministry, receive NIS 11,232 for every birth.
While home births in Israel are still very much the exception, they seem to have tripled in less than 10 years. The Health Ministry does not collect numerical data on home births, but Shiftan has been collecting information from 18 midwives and three doctors who perform them. In 2003, they reported 258 home births, he said, but by 2010, the number had jumped to 735.
Home births are not covered by the national health insurance plan and cost the parents between NIS 4,000 and NIS 5,000.
The new regulations come on top of numerous others that already restrict home births. For instance, such births are precluded if the mother is obese, if a multiple birth is expected, if the fetus is estimated to weigh less than 2.5 kilograms or more than 4 kilograms, or if the mother suffers from any of various medical conditions, including heart problems and alcoholism.
The Health Ministry said the new regulations are still only a draft, but were written by experts in the field in conjunction with the ministry's medical and nursing administrations and the Israel Society of Obstetrics and Gynecology.
It added that it indeed believes hospital births are preferable, since even a normal birth after a normal pregnancy can develop complications that require immediate medical intervention.
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