Home Delivery
You have the right to choose where and how to give birth and, of course, who will be your companion during childbirth.
A home birth is a birth that takes place at home, out of your choice and with your pre-planning. You have the right to give birth securely with a professional midwife who has been lawfully certified and has sound experience and expertise. These can be home midwives or doctors specializing in gynecology and obstetrics.
If you are considering this option or wish to give birth at home, there is a way and a protocol that enables you to do so securely. Please be aware that, according to the Ministry of Health, recognized and authorized hospital delivery rooms are considered safer for both the mother and the fetus. Currently, there is a wide range of hospital delivery room options, and the midwifery team is dedicated to offering you a natural childbirth experience in a comfortable and home-like environment as much as possible.
Choosing home birth
Studies have shown that women choose home births for a variety of reasons, including:
- A preference for a more intimate experience with family members in a familiar and convenient environment.
- A desire to minimize unnecessary medical interventions.
- A wish for greater control over the birthing process, particularly if they had a negative hospital delivery experience in the past.
- The aspiration for a natural birth, which may include giving birth in water.
Home birth can be an empowering experience for individuals and couples. Choosing a home birth allows you to create a pleasant environment that is suitable for you, so that you are surrounded by familiar faces and your feeling of security increases. Home birth allows you to tailor your birthing experience to align with your personal preferences, cultural background, or religious beliefs.
To enable a secure home birth with professional accompaniment, the Ministry of Health established the home birth protocol (Hebrew). When choosing a home birth, the midwife will provide continuous support throughout your pregnancy. This professional companionship, coupled with ongoing emotional support, can greatly benefit you during the pregnancy and childbirth process.
It is important to clarify that this protocol applies to healthcare providers (physicians and midwives) rather than the birthing mother. In essence, you have the freedom to choose your home birth approach, but if you choose a home birth midwife, they should follow this protocol. The protocol outlines patient suitability for home birth, including contraindications, specifies certified home birth practitioners, provides guidelines for home birth conditions (preparing the house for delivery), and offers instructions for labor and post-labor care for both you and the baby. The goal of this protocol is to ensure secure labor as well as the health of both the mother and the baby.
Who is allowed to conduct home births
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Midwife
A midwife registered at the Israeli midwives’ registry who has at least three years of experience in a recognized delivery room in Israel and who has participated in at least 10 deliveries where an experienced midwife was present.
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Physician
A physician specializing in obstetrics and gynecology who holds a license and an expert certificate in Israel and who practices or has practiced obstetrics in a recognized delivery room in Israel for at least three years.
For convenience, in this article, we will refer to the professional healthcare provider as the "midwife" and to the baby as the "newborn.”
In addition to their experience in obstetrics, midwives are required to complete resuscitation courses for adults and newborns and maintain an annual refresher in the subject. They must also be familiar with the Ministry of Health’s updated protocols and act accordingly.
The required conditions for home birth
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1The pregnancy
It is necessary to document pregnancy follow-up according to Ministry of Health protocols. This includes a required pregnancy screening, with gestational diabetes ruled out during the current pregnancy.
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2The delivery
Takes place between weeks 37 and 42 of pregnancy. Starting in week 41, it is crucial to undergo a biophysical profile test with a normal score (a test required for all pregnant women after the 40th week of pregnancy). It is called an overdue pregnancy.
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3The mother
You should be healthy with a normal pregnancy, be over age 18 (between the ages of 17 and 18, a parent's consent is required), and present to whoever accompanies the labor the letter that summarizes the medical and obstetric history.
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4The fetus
It should be a singleton pregnancy, with the baby in the head-down position, and the weight estimation should be between 2.5 and 4 kg.
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5The birth location
The house or the location at which you have chosen to give birth should be appropriate for home births, spacious, with heating options. Additionally, the delivery room of a hospital should be within reasonable driving distance, so if required, you will get to the hospital in 30 minutes from taking the time of decision to go to a hospital.
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6Informed consent
You will have to sign and confirm that you received all the information about the process and the situations that may arise in a home birth.
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7Professional liability insurance
The protocol recommends that a midwife conducting home births be insured with professional liability insurance. You are entitled to ensure this, and if she is not insured, she must inform you and explain in depth the implications of her lack of insurance.
Conditions that preclude a home birth according to the protocol
Obstetric history
Previous pregnancy-related circumstances can affect the present pregnancy, delivery, and well-being of both you and your baby and are considered riskier for home births. For example, outstanding bleeding after a past pregnancy, a caesarean section, or uterus scarring due to surgical interventions performed in the past (for example, a caesarean section).
Your medical background
Medical conditions in your past or in your current pregnancy that may affect your health or your baby’s health during pregnancy For instance, a woman who uses drugs or is in a drug withdrawal process may have a uterine defect (a bicornuate uterus, for example). If necessary and according to your medical background, the midwife will ask you to be examined and bring a medical certificate approving a home birth.
Current pregnancy
Medical conditions in the current pregnancy that are related to you or to your fetus and that may affect your health or your fetus health during the pregnancy or delivery, for instance: suspicion of eclampsia, intrauterine growth restriction, maternal anemia (hemoglobin less than 10gr), and more.
When should you transfer from home birth to the hospital
Some conditions that are related to you or to the delivery process and occur during or after delivery necessitate further assessment and treatment at a hospital.
Your medical condition
- The labor is not progressing.
- Your temperature is rising.
- Tears requiring stitching in the hospital.
- Unusual hemorrhage.
- Unusual fluctuations in the fetal heart rate.
- The placenta is incomplete.
Your baby's medical condition
- Birth weight (after weighing) of less than 2.5 kg or over 4 kg.
- The newborn is suffering difficulty breathing, low body temperature and so on.
If you choose to transfer to the hospital at any point, the midwife is obligated to do so. The midwife possesses the expertise, training, knowledge, and experience necessary to identify potential complications and make informed decisions, including the option of transferring to a hospital when necessary. During a home birth, the midwife must be attentive to the process, monitor the progress of the labor, and simultaneously attend to the fetal heart rate. If a hospital transfer becomes necessary, the midwife will accompany you to provide ongoing support and furnish all the essential information for full-spectrum medical support.
The protocol outlines the necessary equipment that the midwife must have on hand during a home birth, both for the care of the newborn and yourself. Furthermore, it provides instructions for recording and completing reports during and after delivery, along with the documentation you should expect to receive from the midwife following labor.
The midwife’s role during pregnancy
The process usually starts in the pregnancy’s second trimester. The goal of the accompaniment is to deepen your acquaintance with your needs as a birthing mother and as a couple.
During your meetings, the midwife will conduct a pregnancy follow-up and talk to you about your fears of labor and possible complications. She will guide you according to each stage of pregnancy, prepare you for the next stage, and direct you about stages of labor, possible ways to alleviate pain during labor, preparing the house for labor or birth in water, preparing you for breastfeeding, and more. The midwife will instruct you on how to identify the early signs of labor so you know when it is probably starting.
The midwife’s role during labor
When your labor starts, the midwife will arrive at your house with all the necessary equipment for labor. She will monitor the progress of labor and listen to the fetus’ heart rate at a frequency suitable for the stage of labor. As required, she will monitor your vital signs and help you cope with pain, whether with water (a swimming pool, shower, or bath), massage, relaxation exercises, or guided imagery. Everything, of course, is according to your wishes and whatever helps you. After the baby comes out, the midwife will assess their adaptation for life outside the uterus, make sure they breathe well, and later, after detaching the umbilical cord, weigh the newborn. Afterwards, she will check whether there is a tear in the perineum or the vaginal tissue and stitch it up, if necessary.
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Support and assistance
The midwife will support you emotionally and guide you and your partner throughout labor.
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Treating the newborn
Following your consent and in alignment with the Ministry of Health's guidance, the midwife will provide the newborn with vitamin K and administer preventive eye treatment using erythromycin 0.5% ointment.
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Supervision
After labor, the midwife will stay and keep an eye on your recovery and the condition of the newborn for several hours.
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Initial guidance
The midwife will guide you on breastfeeding and the initial care of the newborn, teach you to identify unusual post-labor conditions, and in which cases you should seek medical assistance.
The midwife’s role after labor
The midwife will arrive a day after labor to check on your condition and the condition of the newborn, to guide you, and to answer your questions.
The Ministry of Health’s protocol requires that a pediatrician examine the newborn within 24 hours of birth. The baby must be taken to the hospital during this time for the examination, to register the baby with the Ministry of Interior, and to have the baby's hearing screened.
A woman who prefers not to go to the hospital can arrange for a private pediatrician to visit her home. Some pediatricians offer private home visits and can be scheduled to arrive after delivery for a baby’s examination. If you are considering this option, it is important to make the necessary arrangements before delivery.
Registration at the Ministry of Interior: the midwife will provide you with a signed declaration confirming you are the natural birth mother of the newborn and that the labor has been conducted according to the Ministry of Health’s protocol. Both parents have to go with these documents (and both of your identification cards) to register the baby at the Ministry of Interior. Complete the registration within 10 days of labor.
The midwife will provide you with information about the importance of performing newborn screening tests for early detection of diseases and how these tests are performed.
Hearing screening test
As babies grow, they move more, and then it is more difficult to perform the test. Therefore, we recommend performing it within a few days of labor. The test is important and easy to perform. Ask for a referral and inquire about how to schedule the test at the nearest medical center.
Hepatitis B vaccine
Where you did not go to a medical center within 24 hours of labor, the Ministry of Health recommends vaccinating the newborn within 24 hours at a family health center (Tipat Halav).
Screening tests for metabolic diseases
Some midwives arrive home to perform this test and tell you how to submit it - by courier mail or by delivering the test to the neonatal department at the nearest medical center.
Maternity grant
A maternity grant is a payment that is paid to you to cover the initial expenses following delivery. The amount is fixed, it is a one-time payment, and it is transferred to your bank account after the Ministry of Interior receives a notice about the delivery from the Ministry of Health. In a hospital, the procedure is performed without asking for it and without sending any confirmations. In a home birth, you will have to send the midwife’s declaration or a confirmation that she has been present at the labor and that it was conducted in accordance with the Ministry of Health’s protocol. The declaration can be handed in at the district health bureaus of the Ministry of Health. The National Insurance will pay the maternity grant after getting the Ministry of Health's report on the home delivery.