Childbirth is a healthy, normal life event for most pregnant women and their babies which is not always best managed in a ‘house of sickness’ (Bet Cholim). A birth center is an alternative birth location in a home-like setting, where midwives can provide continuous, supportive and wholesome care to low-risk pregnant women. In birth centers, midwives hold to the “wellness” model of birth, which means that interventions are only used when medically necessary. In Israel, private midwife-led birth centers are independently operated and not affiliated with any hospitals. However, in 2017, all midwife-led birth centers were forcibly closed by the Ministry of Health (without explanation), and ever since, there has been a grassroots legal battle to permit them to re-open. According the American Association of Birth Centers, approximately 0.3% of births in the USA take place in birth centers, where midwives provide care. Although this percentage is small, it is significant for those individuals looking for alternatives. Israeli women likewise wish to explore birth centers as an option for their birth.
Since I trained as a midwife in the UK over 20 years ago, it has been a dream of mine to work in a birth center. It is a place that affords the midwife a chance to operate in a low tech setting with one-to-one midwifery care and provides great job satisfaction. As a homebirth midwife, caring for women at a birth center, there are certain advantages. All the equipment that is required is already in place, one doesn’t have concerns about the client buying the correct supplies or the home not being prepared. The pool and correct hosing are all ready to go. In a birth center, prenatal appointments are attended on the premises and that saves the midwife from some of the travelling to see women in their homes. On the other hand, all the birth preparations and clean-up fall on the midwife which is time consuming for her (as compared to the homebirth scenario where the client’s partner does the majority of it).
For the client, a birth center birth offers a calm and peaceful venue for her birth with a caregiver that she knows, trusts and feels comfortable with. Additional benefits for the birthing mother include not being rushed by hospital timetables, not being subjected to routine hospital interventions, being together her baby at all times and being cared for in the most loving and holistic way that matches her needs. She can have all the advantages of a homebirth without dealing with any of the logistics.
In July 2021 the Israeli court battle was won allowing midwife-led birth centers to re-open, thanks to the dedicated volunteer organisations Zechuti Laledet and Nashim Korot Laledet. I had decided in advance that if the result in the courts was positive, I was going to open and run a birth center where I live. I was just itching to fulfil my long-term dream. Living in an area where homebirths are popular and where several Yishuvim are considered too far from a hospital to be safe location for a homebirth, I knew I would be fulfilling a demand in the natural birthing community. My Yishuv is a 25 minutes’ drive to the nearest hospital, so I was reassured that I would have plenty of clients looking to birth with me.
Nonetheless, until the concept was proven, I decided to start small. There is currently uncertainty regarding updated protocols being written by the Ministry of Health to regulate birth centers. It didn’t seem wise to invest significant sums of money into a place only to find that something might disqualify it under the new regulations. Therefore, for now, I decided to take baby steps and see how the process unfolded. In due course, however, I would love a purpose-built premises for the birth center, ideally large enough to include a pre-natal clinic and a second birth room. Taking all factors into consideration, I looked for a short-term rental of a furnished unit which I would then stock with the necessary equipment.
I succeeded in finding just the place and I was thrilled to have a good excuse to purchase extra medical supplies, bedding and towels. I ordered my own birth pool with disposable liners (from Waterbirth Israel) and brought in a birth ball, birth stool and a comfy recliner. I added a nursing pillow and an essential oils diffuser, some treats in the fridge and a small shower stool. I ordered underpads for catching messes, an electric warmer for the baby’s blankets, gentle fairy lights to provide a calm ambiance and plastic-backed sheets to protect the beds. I thought of every small item that a woman might need during and after her birth and I stocked it in the birth center. The Binyamin Natural Birth Center in Kochav Hashachar was born. It opened its doors in November 2021 and is currently the only midwife-led birth center in Israel.
The adverts went out, and the clients have started to come in. All potential clients are carefully screened for suitability for an out of hospital birth before we go ahead. Current homebirth protocols are adhered to in order to maintain safety for mother and baby. I attended three births there in the first two months of operation and I have another three booked in the upcoming months. Each birth taught me its lessons and I am tweaking how I run the center each time.
I am hopeful that the year 2022 will see consolidation of the government’s support of women’s choice regarding their place of birth. Furthermore, there is more work to be done to ensure that the new regulations will be practical and helpful for other midwives looking to follow my lead. I pray that we will see many new independent midwife-led birth centers opening around the country to increase women’s birth choices and to bring Israel in-line with most of the developed world. It is time for our government to stop babying women and let them make their own choices around their place of birth.
- Martin JA, Hamilton BE, Ventura SJ, et al. Births: Final data for 2010. National Vital Statistics Reports. 2012;16. Available at: http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_01.pdf.