New Home Birth Rules Okayed by Obstetrics Board Despite Criticism

Ministry of Health publishes revised rules, after the original regulations prompted a barrage of criticism late last year.

A draft version of new home birth regulations has gotten a nod of approval from the Health Ministry's National Council of Obstetrics, Gynecology and Neonatology, despite critics' claims that the proposed rules are designed to discourage home births. The Ministry of Health published the revised rules recently, after the original regulations prompted a barrage of criticism late last year. And they were approved by the council on Friday, even while some council members took part in a demonstration against the rules at the same time.

The revised version still contains some of the provisions that sparked an uproar when the first draft version was published some five months ago, and some members of the council - an umbrella organization of childbirth and postpartum professionals - still claim that it discriminates against midwives and harms the rights of birthing mothers.

One controversial requirement that remained in the new version stipulates that those midwives authorized to attend home births, who were already required to take an advanced resuscitation course, will now have to practice resuscitation techniques at least once a year. Also, the guidelines for home birth conditions remain unchanged. These require that the venue of the birth be no more than 30 minutes from an authorized delivery room in a hospital and that the room where the birth takes place is at least 10 square meters large.

"The requirement to have a room that is appropriate for a birth, where there are certain sanitary conditions, makes sense," said Michal Bonstein, the head of IMAHI, the Home Birth Midwives Organization, "but people live their own way, and the mother should have freedom of choice. It is possible to make recommendations, but not to present them as absolutely essential requirements."

Another section that remains unchanged, despite the anger of critics who argued that it was intended to limit the option of giving birth at home, relates to the body temperature of the woman giving birth. The rules prohibit home birth when the mother's temperature is higher than 37.8 degrees, if she's close to giving birth. In addition, despite vehement opposition, a regulation remains in force stipulating that women must come with their newborns to a hospital within 24 hours after giving birth, so that they can get their childbirth allowance, get their babies' hearing tested and register the infant with the Ministry of Interior. "How can they force those who give birth at home to get to a hospital within a day in order to be hospitalized and receive a grant, while women who delivered in a hospital can be released within two hours?" asked Bonstein.

Both the old and new drafts also prohibit operation of a birthing clinic that is not a medical institution. And while the original version required home childbirth professionals to have malpractice insurance, which does not actually exist in Israel for home births, the the new version simply states that "one who provides care should have some kind of professional malpractice insurance."

A revision that was at least somewhat welcomed by home birth advocates lengthens the amount of time between when a woman's water breaks and when she must be hospitalized, if she hasn't yet given birth; the old rules gave her a six-hour window, the new rules allow for 12 hours. Nevertheless, this is still a shorter time period than the 24 hours that are standard in many countries.

Dr. Avner Shiftan, an obstetrician at Poriya Hospital in Tiberias who also assists with home births, believes that the Health Ministry's objection to home births is purely economic, and is due to the existing budget allocation method. Hospitals in Israel, some of which are owned by the Health Ministry, receive a fixed sum of NIS 11,232 for every birth that takes place within their building.

Yael Engelhart