I’m not ready. Here’s why. (Hint: it’s not the toilet paper)

  • © Budda | Dreamstime Stock Photos & Stock Free ImagesFinishing the kids’ Purim costumes.
  • Keeping the car clean.
  • Prepping mishloach manot in advance.
  • Writing a letter to my kids.
  • (Trying) to keep the sink empty.
  • Refilling toilet paper.

Just a few falsely empowering things I’ve been doing over the last week in case I have to leave everything behind to dash to the hospital. Like if there’s enough toilet paper in each bathroom, and contractions start, everything will be totally ok. No one will need for toilet paper. Giving birth will go 100% fine.

Welcome. This is an honest post.

I’ve spent the last few months in a constant battle with the fears and anxiety I feel related to the fact I have to give birth in the hospital this time. I don’t care to go into how stupid it is, how unfair it is, how ignorant it is. This is the situation. It’s happening.

And I’m not ready.

I keep half-joking but totally-seriously saying to my husband, ‘when I’m gone, know that the kids’ costumes are in that corner’ or ‘when I’m gone, make sure they take the mishloach manot for their ganenot on Friday’ or ‘when I’m gone, the gifts for the kids are in this bag, bring them to the hospital so the baby can ‘give’ it to them.’

Is that weird? A little controlling? A lotta crazy? I’m honestly asking, I’m new at this.

Last time my son was over at the neighbors for about an hour before we brought him into our bedroom to meet his sister. We all slept in our own beds a few hours later. I tossed my laundry in the basket and it didn’t matter it wouldn’t get done for a little while. I was there. I could take care of it whenever. The toilet paper figured itself out, too.

The thought of leaving your family home to give birth to your new family member is so bizarre to me. Is that weird? Talking to most other people, it certainly seems I’m the weird one. I don’t get how, if all things are aligned correctly, feeding off the empowerment bestowed on you within your safest place is a problem. Am I that anti-social? I just don’t get how spending all that time in a public place is the best idea for a newborn. Or mother. I don’t want people I don’t know or trust talking to me or looking at me while I’m getting it done. Is that really so crazy?

I’m not ready for that. I’m not ready to have to act on an establishment’s universal rulebook. I’m not ready to have to politely decline or frustratingly accept.

I’m not ready to clear my head of negativity and it’s holding me back.

The good news is I started dealing with it today. Maybe I can turn this around in time. Putting myself out there is the opposite of my nature. Maybe that’s the key.

Maybe the toilet paper will start refilling itself.

New Israeli home birth restrictions delayed.

An update on the Israeli home birth restrictions situation:

Health Ministry delaying delivery of new restrictions on at-home births

The health ministry has yet to complete its labor on a new policy restricting home births. Responding to public criticism which followed Haaretz’s recent disclosure of the new restrictive guidelines, the ministry’s medical authority has decided to freeze implementation.

The health ministry has canceled a meeting scheduled for Tuesday at which the new guidelines were to be authorized.

Apparently, a Bar Ilan professor of bioethics named Professor Noam Zohar took the issue to task, writing to the Ministry about how unethical the decision process had been. They hadn’t consulted with home birth experts at all. Which is what is meant to happen now.

I like that he acknowledged an obvious “institutional and economic conflict of interests, since revenue accrued from low-risk births in hospitals is an important income source for hospitals.”

Stay tuned…

Home birth and the PKU test.

Because it doesn’t seem that many people know about this, and it’s unnecessary for more home birthers than just us to have that millisecond of freak-out when receiving the phone call, I’m sharing this information with the Israeli home birthing masses:

If you’ve birthed in a hospital, you know that before you are discharged, your baby receives that torturous PKU test. That’s the one where they prick his foot (or feet, in both my cases) and draw blood to fill out a card which is submitted for a universal PKU test. By the way, PKU stands for phenylketonuria, which is: A genetic disorder in which the body lacks the enzyme necessary to metabolize phenylalanine to tyrosine. Left untreated, the disorder can cause brain damage and progressive mental retardation as a result of the accumulation of phenylalanine and its breakdown products.

Yikes.

Anyway, after a hospital birth, before discharge, your newborn would get the test and you’d be told if there’s a problem, you’ll be called within a week, and if there is no problem, no phone call.

In my home birth three weeks ago, our midwife Joyce did the PKU test when she came to check up on the baby and me on day 3 (same day the hospital would have). Then we mailed the card to the Tel Hashomer hospital, same as Ein Kerem hospital would have done. That’s where all the PKU checks in the country get tested, and from there, reported back to your local area.

So when my husband got a phone call a week later, there was a definite millisecond of, um, what? But we were told the test was clear – they just needed to follow up on some details.

After double-checking to make sure we understood the phone call correctly, we now know the process:  after a home birth, because there was no automatic recording of the birth or its details, they need to check up with the parents to get it all clearly.

So if you do it at home, mail the PKU test, and get a phone call even though it came out clean – yeah, breath, that’s about right.

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!

Registering your newborn after home birth.

In Israel, when you give birth in the hospital, the hospital takes care of the bureaucratic paperwork fun-time, otherwise known as getting a teudat zehut number for your newborn. They submit the papers which go to Misrad Hapnim to get processed for a birth certificate and ID number.

But when you do a leidat bayit – home birth – unfortunately, it’s not that simple. Both parents and the newborn have to shlep to Misrad Hapnim to get processed. We wanted to get this out of the way before Pesach starts because you can’t register your baby at a kupat holim until you have an ID number.

In the Jerusalem area, only the Misrad Hapnim in the center of town can do this processing; Gilo does not (even though the phone help line claims it does). Apparently Beit Shemesh can too.

The good news is, you don’t have to wait on the long lines that everyone else does. There is a separate office for registering newborns, which you can go directly to.

So, as someone who shlepped out to get it done on day 5 of newborn life, here’s what you need to bring so you don’t have to come back:

  • A copy of your midwife’s license
  • The midwife’s תצהיר מיילדת form, which she has stamped by a lawyer
  • The midwife’s טופס תיעוד לידת בית
  • Both parents’ teudot zehut
  • Proof you were pregnant; a printed ma’akav herayon will do (though he didn’t look at it)
  • The write-up from your visiting pediatrician/family doctor (though he didn’t look at it)

I made copies of everything and handed over the copies (but brought the originals). I also brought the טופס אומדן גופני של הילוד but I don’t think you need to.

A catch: You have to provide a name for the child. We happened to already have decided on the name, so we gave it, even though we haven’t officially named her at the Torah yet. But I suppose you could give a temporary one and change it if need be…

All in all, the whole thing took under an hour, including parking in Mamilla and walking to and from the office.

The only creepy thing was the large stack of תעודות פטירה – death certificates – sitting in a pile on the office windowsill next to me.

Rude awakening.

Ventured outside today for the first time since Bebe was born. I hated having to get in the car with my five-day-old daughter to drive into the center of Jerusalem and visit, of all places, Misrad Hapnim (ahem) (and here’s why). The idea of city-center air up her nostrils alone makes me sad.

But really, the biggest and most unfortunate shock is leaving the comfort and safety of your home after a healing house arrest and… risking your lives by car.

How many times in a 30-minute drive can carelessness happen around you? Cars crossing over you to turn, rocks hitting your window from a construction site, U-turn in the middle of a highway, a driver stopped in the middle of the road to chat with another driver…

And that’s just when my eyes weren’t down to avoid facing it all.

Well, it was a nice five-day vacation. Now back to my mommy-newborn cocoon.

On the sixth day…

And on the sixth day, man… And on the seventh, they rested (sort of).

Our baby girl was born in our home this past Friday, just in time for Shabbat.

The labor took less than a third the time it took with Koala, and she beats her brother by 150 grams at 2.85 kilos – and way more hair (if that was possible). And baby girl shares her Jewish birthday with Zayde and cousin.

And so far, her utter chillness is making it really easy to write all this down…

 

Homebirth in Israel.

UPDATE (April 2011): After this post was written, down the road, for my second child, we did a home birth in our apartment in Tzur Hadassah. I’ve got more info on the subject now from firsthand experience and am happy to share:

At this point, I’ve dipped my toes into the third trimester and thus far have read a lot of too much research, visited two Jerusalem hospitals and met with one home birth midwife.

Needless to say, the water’s cold.

I’m caught in this tiring cycle of not knowing whether I should do the home birth thing or not. I mean, I do know I should, but between all the reservations of the people around me and the looming status of ‘first pregnancy’, my birthing confidence is crushed.

I figure, maybe if I can hear from women who have done it/do it, as opposed to just midwives and people who are anti, I could feel better about making a confident decision. Because either way, I feel confidence is key and I need to find it in myself within the next 10-12 weeks.

So… if you’ve been there, done that, labored through it at home, feel free to chime in with a comment about the following (or you can email me if you’d rather):

  • Where did you do it? Where did you live? House, apartment?
  • Did you use a midwife and doula?
  • Was your husband/partner into it? What kind of a role did they play at home?
  • What did you do about pain relief?
  • Did you check into a hospital after?

I’d love to hear thoughts from women who have given birth in Jerusalem hospitals, too. I realize it’s a very realistic situation that I could end up choosing to be in a hospital or end up needing to be in a hospital. Talking to women who are satisfied with their experiences either way and are willing to share can really help me at this point. Unfortunately, there aren’t many Israeli birthing stories on the web, at least that I could find.

I guess the problem is right now I’m so open minded, I don’t have any direction.