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Week by Week

Elisheva & Akiva

Elisheva Chava 6 June 1992 3.065 kg Jerusalem, Israel

Akiva Yoel 19 June 1994 3.500 kg Jerusalem, Israel

Before I tell about my two births, I want to explain some things about giving birth in Israel. Planned home births are illegal. There are no birth centers (at least not officially!) but there are maternity hospitals. Babys are delivered in hospital. Midwives officiate unless there are complications. Medicine here is socialized, so most things are free or inexpensive. Mother and Child clinics exist throughout the entire country to provide regular checks by a nurse for expectant mothers and for babies up to age 2 (about), as well as all infant and toddler immunizations. There is even a doctor there who performs regular checks on the infants. One can hire a doctor privately for delivery and he/she is allowed to deliver at the hospitals to which he/she is "attached". At one hospital in Jerusalem, there is also a private midwife option, the option I took for both births and will again, G-d willing, for my next one in May '98. The difference between a private midwife and taking whoever is "on" is that your private midwife doesn't go off-shift, doesn't take care of other patients, and knows you well enough to know what you want, and what you don't. It's worked very well for me.

Please keep in mind that I'm writing about births which took place 5.5 and 3.5 years ago. I remember a lot, but I'm sure there's a lot I've forgotten. Also, I'd like to add that since my second child was born I got divorced, and my current pregnancy is with my new husband. More on that below.

I think that I went into my first birth pretty well prepared. My husband and I took a childbirth preparation course. I also attended a detailed lecture/lesson on breastfeeding with a certified lactation concsultant. I had the books "What to Expect When You're Expecting", "Womanly Art of Breastfeeding" and read them thoroughly. I was seeing my OB/GYN, visiting the Mother and Child Care Clinic once a month. I hired a private midwife and saw her regularly as well. It took us several years to conceive so we were very excited about everything. It was more or less an easy pregnancy. I have a negative Rh factor, so I got my shots on time. I was doing wheat germ oil perineal massage the last few months, I practiced my kegels, but not consistently and that's about it, in terms of that sort of preparation for birth.

The Sunday afternoon before I gave birth, I thought I felt some liquid seepage so I went to see my midwife, Joyce. She was on shift so I just went to the hospital. "My" hospital is primarily a maternity facility, and they are considered to be somewhat flexible and open-minded about less traditional births. For example, labor and delivery take place in the same room (not the case in other Jerusalem hospitals). Joyce checked and said that there was no leaking of amniotic fluid and not to worry. After the exam I had an attack of diarrhea, which Joyce said meant I might be back in the morning. On the bus ride home (over 45 minutes) I started noticing regular Braxton-Hicks. What a joy on a bus! At least I was sitting. (We didn't and don't have a car.)

By the time we got home, the contractions were stronger. Laying down in bed seemed excruciating (it took my 2nd delivery to discover what excruciating really means, more on that later) so I slept sitting up, in the armchair. The next day my husband and I stayed home from work, timing contractions. They stayed 20-30 minutes apart. Another night in the armchair and another morning of stop watches. Tuesday afternoon Joyce told us to come in for a monitor.

Well, the contractions were there alright, but I was not effaced at all, and barely 1 cm open. Yuck. Joyce told my husband in no uncertain terms to go to work the next day. So I spent Wednesday reading short stories and playing endless variations of Solitaire (with real cards - not on the computer then). That day a man came to install our window screens, and it was a strange interlude, having contractions every 20 minutes but not wanting him to know. Thursday progressed much the same way. I was getting exhausted from (not) sleeping in the armchair and by Thursday night the contractions seemed to be speeding up somewhat to between 5 and 20 minutes, irregularly. Friday morning Joyce asked us to come in again, and this time instead of taking a bus or a cab we took an ambulance. It was 7 am on a Friday morning and I had no desire to be stuck in the usual traffic jams while in labor. Of course, by the time the ambulance pulled up at the hospital my contractions had all but stopped. Then the real fun began.

First Joyce put a monitor on me to see if I was having contractions. Yes. OK. Good - she tried some herbal therapy to see if it would speed things up. It didn't. I sat in the jacuzzi for a while, which felt great, except that I had to brace myself to keep from floating up, so I couldn't entirely relax. By noon she gave me subcutaneous Demarol and sent me to the ward to rest. She herself went home. Labor was most definitely NOT progressing.

So there I was in the hospital ward - it was a three-person room, but there was no one else there. I had a great bed by the window (more privacy - furthest from the door) and my husband and I were waiting. After 6 nights with almost no sleep, the Demarol helped me rest. The bad part was, I'd drowse off, and then wake at the peak of the contraction, unable to make much use of my Lamaze breathing. But I was enjoying all the cool, drug-induced auditory hallucinations. <grin, wink> At one point, a friend of ours came to visit me (he assumed I'd already given birth) and arrived with his two daughters, ages 1.5 and 3.5. I kept telling him "go away, PLEASE." and to this day it remains a big joke between us. My afternoon passed this way, with my laughing at jokes that no one told, answering questions that no one asked, and drowsing between contractions. Eventually the demarol wore off, but I kept falling asleep. Between 10 and 12 the contractions were getting stronger, and one of the midwives on call checked me a couple of times. By midnight, I was up to 4 cm and Joyce returned and moved me back to a delivery room. She put me on the table with the back raised, and my knees up, belt monitor on. She gave me a demarol drip and she broke my waters, which raised me to 7 cm. There was some merconium in the water, but no one seemed unduly concerned and the monitors looked good.

A while later (and time really gets fuzzy here - I think it was about 2 am) she called for an epidural. That was great. Before I got it, I remember telling Joyce (who was trying to sleep on a foam mattress on the floor), "I can't do this" and she kept telling me "yes, you can." This really helped me a lot. But after getting the epidural I really slept - which was great. At some point they started a pitocin drip, which I think they also raised a few times, but memory is fuzzy. They topped off the epidural once, but as I got closer to full dialation I declined a further top-off. I really wanted to be able to push on my own, and all the sleep I'd had was really helping. Some time between 8 and 9 Saturday morning I was hovering at just under 10 cm, and I really wanted to push. So I was "feather" breathing (blowing at the imaginary feather on my nose) to keep from pushing. Finally, I reached that magic 10 at just after 9 am. Hurray!

So I began to push with a big grunt, just as they taught us in childbirth preparation. Joyce shushed me, saying that she wanted me to concentrate on down below, not on the noises I was making. I pushed with each contraction, with Joyce "catching", another midwife pushing up one leg and my husband on the other. I'm told I had two cuts for an episiotomy, but the baby was not coming down and they began to be concerned about her. After 20 minutes of pushing they decided to move me to the operating theater and let me push there. Off with the monitors, in came the gurney, away moved the midwifes. Then I had another contraction and I began to bear down. Joyce said something like, "She's not going anywhere, this baby is coming out!" And so she did. Elisheva Chava was born at about 9:30 am Saturday morning in Jerusalem, weighing 3.065 kilos, with Apgar scores of 9/10. Because of the merconium they whisked her away to clean out her lungs and check her, so it was 45 minutes before I got her back, but it was wonderful (and continues to be today, 5.5 years later).

My second birth was similar, but with some strong differences. This time I did not do the wheat germ massage, did not go to Lamaze review class (but practiced at home a little) and had to take a different midwife as Joyce was away that June. Shelly was recommended to me by Joyce, and she had just delivered my sister's son 7 months before. My sister's labor included a "sunny-side up" baby with a big head and 1.5 hours of pushing - all without any drugs at all. My sister could not say enough good things about Shelly and I found that we had good chemistry. Shelly was not into herbal treatment and homeopathy like Joyce, but that was fine with me.

The second labor started on a Wednesday morning. I had gone in for my weekly checkup with Shelly, and I was already having mild Braxton-Hicks. From seeing Shelly I went to work. Hah. That was an interesting day, to say the least. I didn't get much done. My contractions continued throughout the next few days (I stayed home on Thursday - Friday we don't work in Israel). By Saturday night the contractions were stronger, closer together, but still not difficult. Shelly suggested that I drink some wine, which I did, and that stopped them. Until I got up to go to the bathroom. Pee'ing kept setting off contractions. By Sunday morning they were about 10 minutes (I think - I don't really remember) and we went in.

When I came into delivery, Shelly commented on how much MORE water I had compared with the previous Wednesday when she last saw me. I was certainly huge - felt like an elephant. Contractions were still bearable by either leaning forward against a wall or leaning with my arms around my husband's neck. The baby, who had been well down in my pelvis on Wednesday, was now floating up at the top. Shelly couldn't even really measure my dialation or effacement effectively, so sent me for an ultrasound to check on his position and stuff, and then decided that given the amount of amniotic fluid she was concerned of the potential of a prolapsed cord. So she had me labor on my back. What had been an easy, if long, labor suddenly became painful, difficult, miserable. At least she did not have to catheterize me - I could use the bed pan. At some point Shelly decided that the baby had dropped sufficiently to try something else. While a second midwife pushed on my belly and held the baby down, Shelly broke my waters with a needle. Between contractions she let the waters come out (and come out and come out and come out - we had a real lake on the delivery room floor) and during contractions she kept her finger in the hole. This was excruiciatingly painful and Shelly knew it. She kept apologizing and (between contractions) I kept saying, "No, don't worry, it's OK, you're doing what you have to for me and my baby. It's fine. Keep going." At some point she decided that I could once again walk around a little, and use the bathroom. Hurray! The rest is very fuzzy - I remember transition as being horrible pain, trying to use Lamaze breathing and failing at it, hyperventilating, and in general feeling like I was at the end of my strength. I know that at one point I asked for an epidural and Shelly told me it was too late! After delivery I said to her, "Shelly, next time I want drugs. Is this early enough?"

So, exhausted from not sleeping well and from the pain, I finally reached the magic "10", and found myself without the strength to push. The baby had a big head, too, and I just could not bear down to get him out. I felt like my body was dragging me along with it, and I remember saying, "Shelly, I can't pu-USH" as a contractions grabbed hold of me. I just couldn't put any umph behind what my body was doing on it's own. When the head finally came out, I tore slightly - needed only a few stitches - and then had to ease the rest of the baby out. I remember saying to Shelly, "You're tearing me in half" and in fact I was tearing. There was some question as to whether all the placenta came out, also. But the baby was fine and they gave him to me right away. That was great. He weighed 3.5 kilos, and I shudder to think what would have happened if he hadn't been born two weeks early. I don't remember his apgars.

Both my kids were completely breastfed until they started asking for food - Elisheva at 5 months, and Akiva at 9 months. Elisheva nursed until 19 months (when I weaned her because I was pregnant with Akiva, and it was just too painful) and Akiva until 21 months.

So here I am in my fifth month with my third kid. I just met my newest midwife yesterday (because Joyce will be away in May, when I'm due, and Shelly has taken a year off to go to the US.) Shayne also seems great - more like Joyce than Shelly - but we seem to see eye-to-eye about using drugs, etc. Avoid 'em if you can, take 'em if you must. The fact that I divorced and remarried may mean a completely different kind of labor for me, and I'm (sort of) looking forward to it! I hope this summer I'll be able to post our third birth story.