Oh, just another childbirth.

Here’s what I felt more than anything after the birth of my fourth nearly two months ago: so, so grateful.

I’ve felt very lucky to have had mostly positive experiences in pregnancy and childbirth, even if at times there has also been frustration, stress, and fear. My heart goes out to women and their partners who have experienced true trauma, pain, fear and loss – I don’t take for granted that the road for me has been smooth.

That said, here’s a little word on my most recent childbirth.

After Nettles was born, I realized something. All three of my previous births had turned out to be a good indicator of the child’s personality, which we only came to know deeply later on. I don’t know if that is some kind of hindsight bias, but reading the old birth stories and knowing my kids now makes it clear there is some kind of correlation.

If that proves true for number 4, then perhaps we can say that she is a ‘tachlis’, no-bullshit, in control and chill kind of person. That’s how it was.

We learned from Nettles that chances are it would be pretty quick this time too. So we went in prepared. Once again, I could not have a home birth unfortunately. This birth was like Nettles’ but with much less intensity.

I woke up at 3:30 am with a contraction and a cool head and, waited for two more – about twenty minutes later. Then I woke up huz. Next, called our midwife/doula, who promptly came over. She checked me out – 8.5 already.

“You must have been walking around in labor the last few days!”, which, if you know my work life, is probably just generally true for the last two years.

We had to make a call. Last time, I was 9.5 when I got to the hospital. Would I make it that far this time?

So the options were – drive and make it, drive and birth in the car, or stay home to birth and go by ambulance after. We chose the first.

We made it… calmly out of the car, calmly to the ward, calmly responded to 35734896 interview questions. I will point out, once again, the antibiotics situation was bullshit and I would have been better off at home with the proper antibiotics through an IV as needed, but I’m at peace with it.

Within three hours, in time for sunrise, my biggest by by a pound – 3.5 kilo – baby girl was out and into my arms (one after the other – first time I grabbed the newborn myself!). I had an absolutely lovely and encouraging midwife at Hadassah Ein Kerem. Don’t underestimate the value of excellent bedside manner.

One thing is for sure: when it’s the fourth, a major thought going on during pushing is ‘shit, I am TIRED.’ Like, existentially tired.

Like – I had to buy a seven-seater car tired.

Like – I have so many children now I have to keep track, tired.

Like – yeah I’m so tired but I’m actually also in control and calm and can think this through clearly, tired.

But it ends.

And when it was over, I looked at her and thought, so – is our experience symbolic of your personality?

We’ll find out.

Meditation, procrastination, a hot cup of coffee: the birth of my third child

<The background on why we went to hospital instead of another home birth>

For me, the key to labor, much like – spoiler alert – the key to early parenting, is to take each minute at a time. That is probably my number one piece of unsolicited advice to all procreational people.

So I had assumed that last Friday and Saturday, in my 39th week of pregnancy, would be a lovely time as any to give birth since I’ve managed to do just that during the weekends of my last two 39th weeks. And I actually felt like things were moving, all throughout those two days – even though it would stop, and I’d sigh, and consider how frustrating it would be to have to face my obgyn for a post-term check.

By Saturday night nothing was doing so I waved my huz and potential babysitter brother goodbye as they left for drop-off at the train station. And not 15 minutes later, as Murphy would have it, I realized… oh. I called them back, we ate a pizza, I took a shower and figured I’d attempt a nap since I probably had a few hours.

Except I didn’t have a few hours, because after the shower it got quick. And my gut told me we should go before the contractions got worse – the horrendous car ride is one very clear memory I had of my first birth in a hospital. We gathered our stuff and headed to the car.

One thing I had prepared differently, in anticipation of a hectic hospital birth, was meditation material. A week or so before labor, I had expressed my concern and received advice related to hypnobirthing and mindful birthing. I read a lot about both and practiced my own little exercise, mainly breathing and clearing my mind, based on a color meditation I found online. So when we got in the car with a 20+ minute ride ahead of us and contractions 5 minutes apart, I took out the earphones and started “breathing in the color red.”

It helped. I wouldn’t say it was easy (extra pain radiating down your thighs because you’re sitting upright instead of moving, anyone?), but I felt focused and the pain was managed as we made our way down the windy Jerusalem hills.

As soon as we parked, I jumped out the car to be able to stand for the next one. And the next one, and next one on the way to elevator. We ran into a midwife coming back from a coffee run so she took us into the maternity reception area.

“How are you feeling?” they always ask you. I guess I didn’t seem that bad; I answered her. Next thing I know she’s looking up at me wide-eyed.

“You’re 9.5!”

First I heard 6.5 and then I heard… “What?!”

“You’re 9.5. Let’s go.”

So about 2.5+ hours after I called the huz back home, the two of us plus midwife were stunned as we rolled me into a labor room, seconds from pushing.

Yeah, too late for walking, so I was laying on a bed being wheeled into the next room. On the way out, another midwife called to us to stop.

“You forgot your coffee!”

My midwife called back that she couldn’t really take it right now. The very concerned coffee-holding midwife brought it over and looked from her colleague to my husband, who were both steering the bed.

Then she did something – that even then, in that moment, in my head, I was already laughing about – she looked at me.

And handed me a size-large, steaming, fresh cup of Hillel coffee.

And lord bless me, I’ve been here over nine years, and my first thought was: Only in Israel.

So I’m carrying my midwife’s coffee on the way to the labor room, distracted by a new meditation of ‘don’t start a contraction – don’t start a contraction…’ Maybe there’s a new childbirth method in this somewhere.

We get in and I shove the coffee back at the (now very decaffeinated) midwife as we begin the end.

Another midwife started fumbling to get the IV inside me – remember I needed antibiotics at least an hour before birth? – and cranked it on high drip.

Whatever it was, it wasn’t enough. They said I did get the whole unit. They said it might have been for a total of five minutes.

Whatever it was, minutes later, after a total of 3 hours in active labor, I gave birth to our daughter.

Just under 3 kilo, and 3 for 3 with a head full of dark black hair. Bless the midwife, who knew my deal, she put my newborn straight on my stomach, I wrapped my hands around her, and we locked eyes.

As the rest of the room whirred around to record details and whip out paperwork we hadn’t had time to deal with before (my bra hadn’t even been unhooked for feeding!), huz and I could not get over how quick it was. From when we left the house to when we met our daughter, in under an hour and a half.

In a way, each time I’ve done this, I’ve became more and more in awe of my body. In a way, you’re attached to it, and in another way, you’re two separate entities. Most of the time I think we hang back and watch it move, walk, talk… while we’re actually up here; thinking, feeling, being.

And then when it matters most, when everything else is brushed aside in the urgency of the moment, you are your body, and that’s how you know you’re made from something amazing.

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My home birth story: Israel, Tzur Hadassah, apartment, bedroom.

In the months leading up to labor and childbirth, I think we all spend significant time organizing our expectations, fears and hopes.

For this birth, my expectation was it would be at least slightly easier than last time, my fear was that it could become complicated due to complications from last time, and my hope – that I would deliver my baby at home.

I’m still in shock that this birth went so smoothly… That my expectations turned out to be low, my fears unrealized and my hopes – reality.

Dealing with stigma

There’s a lot of stigma around home birth. That’s actually an understatement, of course. Which is why for almost the entire nine months, I told not a soul that we were planning it, save for a friend who did it herself and recommended her midwife to me last time (when I contemplated a home birth).

Since my first birth, it was something I wanted to do. I didn’t want my time spent arguing about it, defending my choices or getting annoyed by people who would object. I totally understand that it’s not to everyone’s taste, and something not everyone agrees about – and I would never judge someone for not doing it themselves. But there was no way I was going an entire pregnancy having to hear from other people. So I kept it hush (which I recommend to anyone who thinks they’d be in the same position).

There are tons of articles and blog posts dedicated to explaining how home birth is as safe – if not safer – for healthy women with normal pregnancies. So I don’t have to go into all that here. We fit the criteria for home birth – and yes, there are criteria. Proximity to Ein Kerem hospital (20 minutes), weight of the baby (over 2.5 kilo), health of the mother (no diabetes, etc), week of pregnancy (over 37), etc. And then there is a list of events that could happen at the start of a home birth that are an automatic transfer to the hospital. Trust in your midwife – and her confidence – are key to feeling good about it from the start.

Why home birth?

It pretty much comes down to two reasons: flexibility and after care.

For my first birth, I labored at home as long as I could before transferring to the hospital. It slowed things down. Being in the hospital seriously limited my freedom, though I will say I was grateful to have access to a strong shower for my pain management. When it came to the last period of labor and pushing, being stuck on my back (and monitored) was a major factor in the physical damage done, which is unfortunate as I was not in a high risk situation. It also ranged from disconcerting to frightening to be surrounded by so many people in such a small space. There were a lot of directions given and voices heard and it’s a time when you need to hear your gut clearer than anyone else’s.

The aftercare at the hospital was disappointing for me. No one checked me thoroughly before I left, and I was in for a shock for the next two weeks as to how to heal. Most of the time there was spent making me nervous and insane over my baby eating every 2 hours. It was a frazzled experience on top of the natural hecticness a first birth provides. The time I was alone was depressing and scary. Feeling like a sick patient was also depressing and scary.

Hadassah Ein Kerem tries really hard to promote as natural and positive a birth as possible – it wasn’t all bad. There were warm nurses and cold ones. Friendly midwives and serious ones. Look, it’s an institution and it has to run on efficiency. I definitely get it. But if I don’t have to get it, why make myself?

So this time, I was determined to be in as much control as I could. I spent the months leading up to this birth arming myself with confidence, an amazing midwife, and the drive to make it happen. And of course, a tiny bit of cautious expectation that it may not happen in the end.

How it went down

If this had been my first birth, the story would have gone very differently. Perhaps it would even be told over a sleepless 36 hours… The fact is, my active labor this time was relatively quick, partly due to ‘laboring’ in advance for a few weeks with a couple false starts. I’ll take 10 hours over 36 any day.

The timing couldn’t have been more perfect – it started on Friday morning when I woke up after 6, and baby girl was born at 16:38, about two hours before Shabbat. Those two hours meant we could quickly contact my family overseas, while not having enough time to let people in Israel know – which meant we spent most of that Shabbat in a tight little family cocoon in our own home, the four of us, getting to know each other in our new family structure.

Now, to get down to the ‘dirty’ details. I’m not going to get into anything spiritual or enlightening about mother earth and the spirit of the birthing room and planting placentas. It’s not who I am. But I will say: the major difference between doing this in the hospital and doing it at home is mother’s comfort, security and flexibility to sit, stand, move, groan, do whatever she needs to do to get baby out in the smoothest, quickest, most natural way possible.

And that’s exactly what I did. And the truth is, I employed the same two tactics I used at the hospital – mostly standing and leaning on the bed during contractions or letting hot water numb my lower back in the shower when it got bad.

The hardest parts went by quickly; another thing that made it smoother was that I was able to move along without interruptions – no bumpy, windy, drive to the hospital. No wait at the reception for transfer to a room. No sitting around waiting for the IV to finish. No tap on the shoulder to get back on the bed for fetal monitoring. No ‘requesting’ that I stay on it just another 20 minutes. Just another half hour. No walking in to check on dilation and note the time and how long it’s been.

At home, it just kept going. It was a train that wasn’t stopping. And that wasn’t scary. It was going fast but it wasn’t bumpy. I was the force moving my baby into the world. There were no hills. When the midwife felt it was necessary, she checked the baby’s heart with a Doppler device for a quick few seconds. Maybe it was a total of four times in the three hours of active labor and birth.

Another thing about the home birth atmosphere: there were just three people in the room – my midwife, my husband, and myself. It was quiet and I trusted every person there; no one was a stranger. No cold hands. No foreign voices.

In the hospital, I was attended by a midwife, her student, and at times, an OB-GYN employed to scare me into moving faster. That, along with my midwife-doula and husband. Try navigating a complicated physiological process for the first time with that many people watching you and barking commands.

It affects the effectiveness of what I call ‘animal mode.’ There was a point for me, both times, where it’s just me and my body. My mind had submitted, save for the little bit left to process what people around me were doing and saying. But other than that, mind caves to body’s physical power and innate knowledge of what to do. In the hospital, when I went into animal mode, I was a scared animal – frightened by threats, intimated by people standing over me. At home, I was a strong animal. Aware amongst the quiet. Able to hear myself be. Able to process what directions the midwife confidently passed to me. There was no confusion. There was only a leads to b leads to c. That’s the kind of natural spirit we are born with to make this happen. And it’s that natural spirit that gets squashed in so many life situations.

And that’s what made it amazing. By choosing to do this at home, me and my partner gave my mind and my body the confidence and the power to do it the way I was born to do it.

Post birth

It all happened so much faster than any of us – me, husband or midwife – had imagined. The doula didn’t even have enough time to get there before baby was born. So when baby was out, on my chest, all we could really think about it was: Whoa. This happened?!

But reality actually set in pretty fast; the adrenaline-riddled shock of newborn on your chest wears off quickly the second time. I held her there and a million thoughts went through my mind, ranging from amazement to stitching to Shabbat to family back in the States.

Meanwhile, the midwife worked on the rest of birth that we tend to forget about: last contractions, placenta, uterus, stitching, blood, clean up – you know, the stuff left out of the fantasies. Midwives are meant to stick around for another couple hours to take care of mom, check out baby, make sure baby feeds, clean up the room and fill out the paperwork.

And a celebratory Coke, in our case.

Myths dispelled

There are a lot of myths surrounding home birth. I’m not going to go into dispelling all of them, but there are two that stand out for me.

The first is that if you’re the type of person to contemplate a home birth, you must be some sort of crazy hippie earth mother. I can tell you, I am not that. And somewhere deep in me, I wondered: who am I? Why am I into this?

And the reason is – because this has nothing to do with hippie earth. This has to do with you and your baby. Your needs and desires and concerns and cares. Where you – a human ready to birth their offspring – feel is best to bring your child out. It’s not about lighting candles and singing koombaya songs. There is childbirth, and there are accessories to birth. And this home birth, for me, in its entirety, was about childbirth.

The second myth is a bit simpler: messiness. Before doing this myself, I was constantly trying to visualize what the birthing room (which was our bedroom) would end up looking like. Blood all over the walls? Plastic sheets over the bed? Wet rags soaking in pots of hot water? Everything in black and white, like we’re watching the 1800s on TV?

But honestly – home birth wasn’t messy at all. A couple of small mats on the bed, supplies spread out on counter tops, and otherwise – your un-ironed shirts hanging from the closet door or the same old dirty laundry in the corner of your room if that’s how you usually play.

Part of the midwife’s role post birth is to make sure that everything is cleaned up. I don’t even remember her doing it but I can say a couple hours after my baby joined the outside world, you’d have never of known that my bedroom had been used to deliver a baby. It looked, smelled and felt the same it had when I woke up with contractions that morning.

The team

Who makes up the home birth team? Here’s how it went for me:

  • Midwife: In Israel, only one midwife is required for a home birth (in England and Australia, it’s a team of two). I used Joyce Butler, a known name from her decades at Hadassah Ein Kerem and doing home births in Israel. She’s from Matta, which is about 20 minutes from Jerusalem and 10 from Tzur Hadassah. She was also my doula with  my first birth at Ein Kerem (where she is recognized by much of the staff). I highly recommend her, whether as doula or midwife or prenatal caregiver – her practical attitude, her confidence and her experience are at exactly the right balance. One of the best things about her is the way she got on terrifically with my husband. Joyce’s phone number is 02-5337637; feel free to contact me if you want more of a recommendation.
  • OB-GYN: This may seem obvious, but it’s important to keep up with your regular OB-GYN doctor and all the necessary tests. Only the doctor can give you the referrals and prescriptions you need for tests and vitamins; a midwife cannot. And while many would agree that not all the scans and ultrasounds are necessary, there is a standard that should be held to. It helps if your doctor is midwife and home birth-friendly, of course. Mine wasn’t unfriendly; from the start we learned that he ran his own birthing clinic for 30 or so years in the United States before moving to Israel. His clinic was actually managed by midwives. We still didn’t mention home birth to him until very late in the pregnancy, however. But after running it by him, his all-systems go (and my normal pregnancy) made us all the more confident.
  • Doula: To be honest, I really felt that I didn’t need a doula this time. Knowing myself in labor, and how I do with pain, I felt what I needed was another pair of hands at most. But also knowing that we have a child to think about – which was really my husband’s job – having a doula on hand wouldn’t be a bad idea. It’s also something that the midwife will require. Joyce recommended a doula-in-training from Ein Kerem who we met with twice before the birth. We totally jived – her laid-back nature and calm energy appealed to me. Unfortunately, on the day of the birth, things went so quickly she couldn’t get to my home in time to attend the laboring, but she was around right after the birth to help with aftercare.
  • Pediatrician: I prepared to have a visiting family doctor come to the house within 24 hours of the birth. We used Dr. Leora Uriel, who has a clinic in Shaarei Tzedek and works at the Maccabi clinic in Beitar Illit. She does house calls for home birthed babies privately. The cost is from 400-500 NIS and usually includes the first visit within 24 hours, and a follow up within the week.
  • Partner: We wouldn’t be in these messes without our partners, right? My husband is my support, and even though this time he couldn’t be as hands-on as last time – after all, we had another child to take care of this time – he was there when it mattered and once again, we did great work together.

Supplies you need for home birth

There isn’t much you need at home to do a home birth. The official home birth supplies check list might vary depending on your midwife, but at the core of it, it’s essentially:

  • hot water at the ready (urn or kettle)
  • a small bucket or big bowl
  • space heater or some heating source in the delivery room
  • disposable mats
  • flannel receiving blankets
  • Vitamin K drops for baby
  • newborn diapers
  • sanitary pads

The midwife brings all other equipment – from disposable utensils to emergency kits.

Other things I recommend:

  • Have coffee, tea and easy to eat snacks ready for the team.
  • Plenty of water bottles/liquids in the room for after birth, when mother needs tons of fluids. Keep a cup with a straw; easier to drink from when mom is lying down with baby on her.
  • Have your hospital bag packed and ready. You never know, and you won’t have time if you need to transfer.
  • And of course, have your camera on hand for those first new family moments created in your own home!

Telling home birth stories

When looking for home birth stories from other women in Israel, I didn’t really find much on the internet. Actually, most of the stories I did find came from the U.K. For other women who are exploring the option or want support, I think it’s important to share our experiences. Please feel free to leave your story (or a link to it) in the comments!

The Hadassah birthing experience.

In the end, we went to Hadassah Ein Kerem for the birth. It was an issue of confidence and although I think I still would have preferred a homebirth, I can say with 20/20 retrospective vision that I’m comfortable with our experience – it was positive, it was successful and… it was lucky, as these things are all about good timing. Weekend birth, slow night, calm staff, relatively empty maternity wards.

As I found when I was researching hospital vs homebirth, there isn’t much information about hospital experiences in Israel from mothers here. In short, here’s how I happened to find Hadassah that night:

  • We left for the hospital as late as possible, as suggested by many. Laboring at home is just always going to be more comfortable and conducive to progressing as you’re not strapped to fetal monitors or constricted by IVs. When we were advised by our midwife/doula to go, we left, sneaking out of our building at around 5pm on Shabbat day. A neighbor was sitting outside and gave us a thumbs up.
  • When we got to Hadassah, it was eerily silent in the labor ward. I was in and out of the kabala in about twenty minutes or so. There was no one else there.
  • I got a really nice labor room in the back of the floor. It was a newer room than the one we were shown on the hospital tour. Wood-looking floors, dim lighting, decent bathroom.
  • The midwife on duty was great and actually knew my doula (who is actually a homebirth midwife and used to work at Hadassah). The second midwife who came later as the shift changed (they change at 3pm, 11pm and 7am). was rougher around the edges but also knew my doula which helped a lot. She even consulted with her professionally, midwife to midwife,  towards the end.
  • The fetal monitoring was overkill, but you’re supposed to expect that from a hospital experience. It actually wasn’t as bad as I thought it would be, but still, it got annoying. That was the biggest point of conflict.
  • A student midwife was in attendance with my second shift midwife, and I was able to refuse her doing much to me. They tried to give me a hard time but in the end I was able to make my point.
  • We expressed our desire to go as natural as possible, and they were great about respecting that. The baby was placed straight onto my stomach after a very short rub down. No cord was cut as requested, so the placenta came fairly easily. My husband was actually asked if he wanted to cut the cord, which we hadn’t even considered, so it was pretty cool he got to do that (though a little scary when the baby kicked his foot up right next to the scissors just before he was going to cut).
  • We were very lucky with the rooming situation. I was worried about not getting rooming in – or a room at all, as I’ve heard happens – but after the birth the midwife came in and told me rooming in was ready for me. I was ecstatic, and even moreso when I discovered I wouldn’t be having a roommate – in fact, I didn’t have an overnight roommate the entire stay (two nights) and my husband was able to illegitmately stay over with me (kinda reminded me of college a bit).
  • I don’t think the aftercare was that great. That might have been the most disappointing part. I was never checked except for a doc poking around my stomach for about five seconds before I was discharged.
  • The nurses are trained to help you with breastfeeding, but they ‘did’ more than they ‘showed.’  I saw two different actual lactation consultants over the two days, who were great, but they have an hour in the morning each day and if you miss that, you miss it. I came home confused and frustrated, and ended up seeing a friend who is also a breastfeeding consultant.

Next time, who knows… Maybe I’ll get that homebirth.

This is how we do it.

The following are a few excerpts from an email I wrote to my birthing class instructor explaining how the birth went in my view.  By the way, I highly recommend the class I took (or taking a class at all – it’s not all superficial breathing, but more about awareness). I also recommend having a doula there. It’s not just for you, but also your partner, who is generally not an experienced labor coach. If you’re interested in who I used for either of those, just be in touch.

I just wanted to be able to tell you that the birth was really a positive, wonderful experience for us… Everyone’s first questions – whether they have had kids or not – are “Was it painful? How long was your labor? Did you take the epidural?” and I am starting to realize they may not be comfortable with the answers I give…

Was it painful? I guess, but not nearly as bad as I would have thought… Aside from the fact that I barely remember the pain by now… And the midwives couldn’t believe I was in labor. They kept going back and forth about how relaxed we were. And we really did feel relaxed and organized. We had a system down and it just worked.

How long was the labor? Well, it was about 36 hours from start to finish, but the time flew, I barely realized… I really did take one contraction at a time, like you said. That break – the fact that there is always a break – really did keep me going.

Did I take an epidural? I didn’t even consider it… I didn’t even remember it was an option… My main methods of pain relief were: hot showers – amazing! Remembering to take one contraction at a time… Trying new things when one position wasn’t working… The education we got from your class was a huge help in understanding what was going on and what should be going on. My husband was an amazing source of support and ‘pain relief’…  I have no idea how we could have done it without having a doula there. Sure, we would have done it, but it would not have been as smooth and relaxed.

So if anyone asks what made the birth successful (as opposed to, ‘was it painful,’ etc?) I would say:

  • Taking a course!
  • An amazing, supportive, informed partner.
  • An experienced doula.
  • Not expecting any one way going into it, but being prepared mentally for the general experience.
  • Going to the hospital as late as possible!
  • Hot showers. Water crisis be damned (though I did shut it off between contractions… we’re in Israel after all).