Episode 59 - A mobile delivery room, with Reut Sarussi - midwife, Equilibrio therapist, birth preparation and processing

00:00 Speaker 1 You know when you meet a professional who fascinates you and you want to ask her a million questions? Well, that’s what I did. And how could I not, with the amazing Reut Sarusi? She’s a midwife, she does pregnancy checkups, she treats women during pregnancy and helps with all kinds of challenges, and she accompanies women through childbirth. On top of all that, she volunteers with United Hatzalah and has already delivered babies in some pretty unconventional places. Well, you’ll have to listen to the episode for that. Come join me for a fascinating conversation about what goes on behind the scenes in the most womanly field there is. A reminder: if you enjoyed the episode and got something out of it, don’t keep it to yourself. Pass it on to your sister, your mother, your neighbor, a friend—anyone you care about. My shlichus is to record it. Your shlichus is to spread it. To follow me on Instagram, search for Chani Moskowitz. To follow my status or book workshops and talks on life-changing tools from Chassidus, everything is at 050-850-5770. First, the intro, and then we’ll begin. How do we turn our lives into lives of shlichus, full of meaning? I’m Chani Moskowitz, a shlucha in Kharkiv, Ukraine, now continuing my shlichus in Karmei Gat, Israel. On this podcast, we’ll meet different women who bring their shlichus to a range of fields. Through their stories, they’ll help each of us find and clarify our own shlichus in this world. Because living the lives we were created to live—that’s what it’s all about. Shlichus as a Way of Life. We’re starting right now. Okay, here we go with another episode of the Shlichus as a Way of Life podcast, and today we’re with Reut Sarusi. Sarusi? Sarusi.

01:41 Speaker 2 Sa.

01:42 Speaker 1 Sarusi. How are you?

01:43 Speaker 2 Fine, thank you.

01:46 Speaker 1 Spending your maternity leave on podcasts.

01:49 Speaker 2 Yes, coming to see Chani.

01:51 Speaker 1 Yes, yes. We’ve been trying to meet for such a long time, and today we worked out that it’s been two years.

01:56 Speaker 2 Yes.

01:57 Speaker 1 When I met you, I said, “What, you’re a midwife? I have a podcast—you have to come on!” And a midwife, to me, is almost this figure from... I won’t say another world, but something of an angel. So today, bring the angel down—

02:12 Speaker 2 It’s a privilege.

02:12 Speaker 1 Show us the person inside the... But she’s there at what I think is the most incredible moment in life.

02:23 Speaker 2 A miracle.

02:24 Speaker 1 Really. And then I discovered you’re not only a midwife. You wear quite a few other hats—how should we put it?

02:32 Speaker 2 That’s less interesting.

02:33 Speaker 1 Yes, so since we’re talking about birth, we’ll start at the beginning. Take us through the stages before birth—but first, introduce yourself. Who are you? What do you do? The microphone is yours.

02:49 Speaker 2 Okay, so I’m Reut. I’m married to Assaf and the mother of eight sweet children. The youngest was born recently—hence the maternity leave. I’m a midwife, and I also work with everything surrounding birth: monthly pregnancy checkups, Equilibrio treatments for women during pregnancy and after birth, childbirth preparation, and processing the birth experience. They’re different areas, but ultimately they all fall under a broader umbrella of women’s health and experience.

03:25 Speaker 1 What you wanted to say was the womb and everything that comes with it.

03:28 Speaker 2 Yes, because birth is an amazing event. It’s life-changing, but ultimately it lasts a few hours. Pregnancy, support, treatment, processing the birth experience, preparation for birth—that gives it a much broader framework. I feel it’s a privilege to be there at those times, in those places, in those moments. To be part of the miracle of creation—that’s exactly what it is.

03:58 Speaker 1 So how did you get into it in the first place? Where did you start? Did you start as a midwife?

04:03 Speaker 2 I started with nursing studies. But even before that, as far back as I can remember—around twelfth grade—I was very interested in pregnancy and birth, and I really wanted to be a midwife. It was just something that came from within. I remember telling my friends in twelfth grade, and they laughed: “A midwife? Where did that come from? What is that?”

04:22 Speaker 1 But you got there.

04:23 Speaker 2 It just stayed with me. When I took a first-responder course at around eighteen, toward the end of twelfth grade, I was present at a birth as part of the course’s practical training.

04:36 Speaker 1 Wow.

04:37 Speaker 2 And then it was clear to me—completely clear—that this was where I belonged. I started studying nursing, doing a bachelor’s degree. I worked for a while as a nurse on an internal medicine ward, and meanwhile I began studying midwifery. I’ve been doing it for almost fourteen years now.

04:53 Speaker 1 Wow.

04:54 Speaker 2 Yes, and I really try to keep learning, so that I can have a broader perspective myself and more tools to meet women not only in the delivery room, but before and after birth as well. To me, that makes it more complete.

05:13 Speaker 1 Yes.

05:13 Speaker 2 Rather than just that one big event of giving birth.

05:17 Speaker 1 Right. I imagine you’ve come across situations during births where you suddenly thought, “Wait, something could have been done beforehand so she’d come in more prepared.” So the need itself—the gap—shows up especially during birth, but not only then. It’s...

05:33 Speaker 2 During birth and afterward, too. Look, birth is a big event. It’s a very significant event in life, whether you go through it once or several times. Each time is a big event in its own right. It never becomes a small thing.

05:48 Speaker 1 Yes.

05:48 Speaker 2 It always has its place. And I think preparing for it, physically and also... Childbirth preparation is very significant. Because birth really isn’t something you can plan. In the end, it happens when it happens. You usually don’t get to choose when. Some women feel that they’re about to give birth, but generally it isn’t something where I can say, “Okay, I’ve decided I’m giving birth on this date.”

06:13 Speaker 1 Unless you’re having a planned C-section—and then we hope it doesn’t come to that.

06:17 Speaker 2 Right. And even for women who had a planned C-section, sometimes the surgery suddenly had to be moved up. So it really isn’t in our hands.

06:24 Speaker 1 Exactly.

06:26 Speaker 2 And that’s very hard for women, because so often we’re people who need to manage things, make decisions, set plans, get organized—and suddenly, in childbirth, we’re not in that place.

06:36 Speaker 1 Control? What’s that?

06:37 Speaker 2 In childbirth, we’re not in that place. On the contrary, we want to let go of control so we can go through the process by looking inward and turning inward. Because trying to control things actually gets in the way during birth. It works the other way around: the more I try to be in control during labor, the harder the process will be for me.

07:00 Speaker 1 Yes.

07:01 Speaker 2 During birth, we want the primal brain, the oxytocin—not the logical, thinking, planning brain. And naturally, that planning, thinking, logical brain gradually recedes during labor. You can see it. People can tell when a woman is well into active labor. She has no headspace for things—

07:24 Speaker 1 She’s not here.

07:25 Speaker 2 —like logical thinking and planning. She needs to focus inward and be with the process, inside herself. It’s an amazing thing.

07:33 Speaker 1 You really have to learn to do that. I know people who like to be in control. Just recently, a pregnant friend told me she doesn’t want to know whether it’s a boy or a girl. I said, “Wow, there are so many question marks—here’s one you could answer!” So it really is a feeling of... I think it’s one of those events in life where, well, things happen. Hakadosh Boruch Hu gives us all kinds of surprises. But here, you know it’s going to happen, yet you don’t know anything about how it will happen. And I think it’s a very big test of faith, too.

08:02 Speaker 2 Right.

08:02 Speaker 1 And trust. Strengthening your trust and faith before birth really helps a great deal, too—the sense that what needs to happen will happen, and...

08:10 Speaker 2 And on the other hand—not “on the other hand,” but at the same time—it’s important to learn and prepare for it.

08:15 Speaker 1 Yes.

08:16 Speaker 2 To learn breathing, movement. What is this whole process? What’s happening in the pelvis? What’s happening to the baby? And I really believe in working together with the baby. I mean, it’s not that there’s the baby and there’s the mother, and if labor is taking longer, then the baby is being stubborn. Or, “Why are you doing this to me?” or “Why aren’t you coming out?” It’s about really being in that frame of mind: we’re working together. We’re both here together; we both want you to be born. Do you want to be born or not? Actually, they say it’s better for the baby to stay inside the womb than to come into this world, with all its challenges and difficulties. But broadly speaking, the baby is also trying to be born throughout the process. And that feeling, that thought that we’re working together, that I’m giving you strength and I can’t wait to meet you—all of that is very meaningful. More generally, your whole mindset around birth—what do I want to think about during contractions, what do I want to think about between contractions? Where is my mind? What am I focusing on?—is very, very significant. Because contractions hurt, after all. There’s no getting around it. Even if you get an epidural, you have contractions before you get it, and often you can still feel the urge to push, and—

09:37 Speaker 1 So many questions are going through my mind as you talk. Suddenly, the midwife, like—

09:41 Speaker 2 Yes.

09:41 Speaker 1 So let’s go back a second. First of all, wait, I have to ask you something. Do you know how many babies you’ve delivered?

09:46 Speaker 2 No.

09:47 Speaker 1 Wait, actually, is it women you deliver? No. Do you deliver the woman or the baby?

09:51 Speaker 2 I’m not so fond of the term “deliver,” because then it’s as if I’m at the center: I’m delivering her baby. I prefer “attend the birth,” because the way I see it, the midwife is there for the woman. She isn’t at the center of it. I mean, she’s a very significant person in the process and has a lot of influence, but the woman is at the center. The birth and the baby are hers.

10:17 Speaker 1 And really, in a natural birth, the baby will come out in the end.

10:20 Speaker 2 Right.

10:21 Speaker 1 Even on its own.

10:21 Speaker 2 Right.

10:22 Speaker 1 So you’re there to receive the baby, so to speak.

10:24 Speaker 2 To receive the baby and support the woman, but always to remember that it’s her birth. It isn’t mine in any way. I mean, I have the privilege of being there, the privilege of accompanying her, the privilege of caring for her. If, G-d forbid, there’s distress, then of course I provide the professional care that’s needed. But ultimately it’s hers. I think that calls for a bit of humility. Yes, I have knowledge, I’ve studied, I have experience, and so on—you know, your ego can really swell. But ultimately you have to remember that there’s a woman here: it’s her body, her baby, her process, her birth, and I’m here for her. And I think that simply approaching it that way is already healing for women in many ways.

11:06 Speaker 1 Yes, because it gives her strength, puts the—

11:08 Speaker 2 Right.

11:09 Speaker 1 Beautiful. Wait, so how many babies have you received?

11:11 Speaker 2 Wow, what a good question. Honestly, I don’t know.

11:15 Speaker 1 And that’s it.

11:16 Speaker 2 I suppose something like... I’ve been in the field for fourteen years now, and... it’s moving.

11:26 Speaker 1 Do you get used to that moment?

11:28 Speaker 2 Yes and no. I mean, you get used to it because you know what’s going to happen. So you’re familiar with it, but it’s moving every single time, because suddenly a wonder comes into the world. It’s amazing.

11:41 Speaker 1 It really is. Wow.

11:41 Speaker 2 It really is amazing.

11:43 Speaker 1 Okay, let’s go back to pregnancy. After that... What was it I wanted to ask you? Right. First, there’s the whole subject of the midwife, which we’ve discussed and will discuss more. But you told me about an interesting method.

11:56 Speaker 2 Right.

11:57 Speaker 1 Something we should get to know, so to speak. We should hear about it.

12:00 Speaker 2 Yes.

12:01 Speaker 1 And I deliberately told you I didn’t want to know anything beforehand. I want to be curious and hear about it for the first time as we talk. So what is it? Why is it? How does it work? Take us through it... Maybe start with pregnancy itself: what challenges do we face during pregnancy, and what can we do? How can we help? How can we cope better? I won’t even say “cope”—how can we have a genuinely good experience of it from the outset, as much as possible?

12:25 Speaker 2 So with pregnancy, the starting point is that it’s a wonder, something very, very great. Now, as with many great things that happen in the world, the way they come about can sometimes be a little challenging. Chazal also say that the Geulah of the Jewish people comes little by little, and the path can sometimes be difficult. The Geulah is often compared to birth, too.

12:49 Speaker 1 Yes, and now we’re moving on to birth.

12:51 Speaker 2 Yes. So during pregnancy, various challenges can accompany us. First of all, physically, the body changes. There are hormones, the belly grows, your center of gravity shifts, and there’s strain on the pelvis and lower limbs. Suddenly the womb—I like to refer to the womb as “she,” even though that isn’t standard Hebrew—suddenly she meets other organs she wouldn’t normally meet. Because the womb of a woman who isn’t pregnant sits inside the pelvis. It’s small, tucked away inside its palace, between the bones. And then, as the baby grows, the womb grows and develops. She meets the diaphragm and the back muscles; there’s pressure on the lower back. All of that can cause discomfort, back pain, pelvic pain, tingling down the leg, difficulty lying on your back, difficulty breathing deeply. Some women actually describe feeling as if the baby is sitting on their—

13:51 Speaker 1 Ribs.

13:52 Speaker 2 On their ribs. And some women have trouble sleeping through the night without heartburn, because they really suffer from it, even in the later stages of pregnancy. And there’s a treatment. There’s a method called Equilibrio, developed by Rachel Shapiro, who taught me this method. Essentially, the idea is to help the body regain its balance, because pregnancy is, by its very nature, a state of imbalance. Suddenly there’s another baby growing inside me, my belly is growing, my womb is growing, my center of gravity is shifting—everything changes. That alone takes my body out of its usual balance. And that’s okay; it’s healthy, it’s good. But it’s also often challenging. So this is a hands-on treatment that, in a manner of speaking, gives the whole body an overhaul, right there on a treatment table. A woman lies on the table, and we start working on the muscles and ligaments in the back, the pelvis and around the womb. We have ligaments that support the womb, surrounding it and holding it in place, stabilizing it. When we work on all those areas, including the diaphragm—which is a very substantial muscle and one of the muscles that helps us maintain posture—it calms the system a little and allows the body to find more balance. Areas that were tighter, muscles that were more painful, can receive more blood flow, and that simply leads to feeling better overall. Sometimes women get up from the treatment table and say, “Wow, I can breathe better. My belly feels more comfortable.”

15:33 Speaker 1 So you’re basically putting the organs back in place. I’m trying to—

15:37 Speaker 2 It’s a bit presumptuous to make such a big claim—“Wow, I’m putting the organs back in place.” I think it’s more about giving them attention and care, and allowing them to receive better blood flow.

15:49 Speaker 1 Anyone who got overlooked along the way... Yes.

15:53 Speaker 2 And it really is a gift. I mean, this treatment truly is a gift. For some women, one session is enough; it helps them enough, and that’s it. And then there are women who’ve been in pain for a very, very long time. One session helps, but it isn’t enough, so they need to come back for another. And it isn’t a short treatment—it lasts between an hour and a half and two hours. It’s a lot of work. The body gets a lot of attention. There are different kinds of touch, too: some deeper, some gentler. Each part of the treatment is tailored to what’s needed.

16:30 Speaker 3 Personalized to the—

16:31 Speaker 2 Yes.

16:32 Speaker 3 So what kinds of problems can it help with, for example? Symphysiolysis, things like that?

16:35 Speaker 2 Symphysiolysis.

16:37 Speaker 3 Symphysioly... or...

16:38 Speaker 2 Yes, it’s a difficult word.

16:39 Speaker 3 You can tell I don’t have it, because I don’t know how to say it.

16:41 Speaker 2 That’s a hard word. These days, there’s a lot of overdiagnosis of this whole issue of symphysiolysis. Symphysiolysis is actually a very specific condition that occurs in the joint at the front of the pelvis, and nowadays, any pelvic pain is often called symphysiolysis. That’s important to know. But there are also many cases of lower back pain, pain at the back of the pelvis, or pain around the buttocks, where everything feels very tight. Sometimes it also shows up as shooting sensations down the leg. Many women also have varicose veins—prominent veins in the groin or legs. When treatment allows the blood to flow better and helps bring the pelvic ligaments into better balance, it improves venous return. Women sometimes—actually, quite often—report that their varicose veins have improved too.

17:39 Speaker 3 Wow, now you’ve sold me.

17:40 Speaker 2 They sleep better at night.

17:42 Speaker 3 First of all, everyone has their own gifts from Hakadosh Boruch Hu. It’s amazing. It’s amazing.

17:46 Speaker 2 Yes.

17:46 Speaker 3 Beautifully wrapped, with a ribbon.

17:48 Speaker 2 Yes, exactly.

17:49 Speaker 3 Wow, interesting.

17:50 Speaker 2 And it’s very, very interesting. You really have to approach each woman by listening to her. I mean, what does she need? What’s going on for her? Why has she come for treatment? Some women also come to prepare their bodies for birth, so they come later in pregnancy. And it’s very... I feel it’s a privilege to treat pregnant women, and I really want women to hear about this, because it does them good.

18:19 Speaker 3 Tell me, I’m curious how widespread it is. Are there practitioners across the country? Are there...

18:22 Speaker 2 Yes, there are practitioners across the country, and there’s a list of them. It’s very easy—if you Google Equilibrio practitioners, you can find them.

18:31 Speaker 3 You just need to know how to spell it.

18:33 Speaker 2 Right. The word comes from Spanish and basically means “balance,” so it’s a bit of a complicated word.

18:40 Speaker 3 Equilibrio.

18:42 Speaker 2 Equilibrio, yes.

18:44 Speaker 3 Why Spanish? Interesting.

18:45 Speaker 2 Good question. I don’t know.

18:46 Speaker 3 I understand it’s Israeli, though, if she invented it.

18:50 Speaker 2 Rachel Shapiro lives in Israel. She made aliyah from the United States, and she drew on a great many things she’d learned. She’s also a midwife. In the United States, she worked in various birth centers, not necessarily hospitals like we have in Israel. She gathered all her extensive knowledge and built a very structured treatment method from it, one very much geared toward pregnant women. It helps women who aren’t pregnant too, but her main focus was pregnant women. And awareness of it is gradually growing. Women hear about it, see it, hear from friends who’ve had treatment. Just today, a woman near the end of her pregnancy called me because her mother had come to me for treatment about two years ago and recommended that she come too. So word is starting to spread, and good things do spread, you know.

19:51 Speaker 3 To the right ears too, yes.

19:53 Speaker 2 Yes.

19:54 Speaker 3 What was I going to ask you? You’ve been talking about everything around the uterus, but do you work with the baby itself too, or...?

20:02 Speaker 2 Yes, there’s very focused work on the uterus itself. The idea is to help bring the uterine ligaments into balance too. Often, when you work on a woman’s abdomen like this—as you develop a better feel through your hands over time—you suddenly feel areas that are more sensitive. And the woman suddenly says, “Wow, I didn’t know it was sensitive there too. I didn’t know that spot was sensitive.” Then, little by little, she feels it releasing and says, “Yes, that’s better now. It’s less sensitive.” It’s amazing to feel that with your hands and hear her say it.

20:38 Speaker 3 Yes, wow.

20:39 Speaker 2 And then, when we work on the uterus again, through the abdomen, those areas that were very, very sensitive before suddenly feel much more comfortable, and they’re less sensitive to touch.

20:53 Speaker 3 So you’re really putting everything in its place. That’s how I’m imagining it from your description.

20:59 Speaker 2 Yes, in your imagination, that really could...

21:01 Speaker 3 Sometimes during pregnancy you have that feeling... Oh, I remember saying before the birth in my last pregnancy, “There’s a foot inside my ribs. There’s no way there isn’t.” But there’s nothing you can do about it.

21:15 Speaker 2 Well, it turns out there is.

21:16 Speaker 3 Exactly. So I’m wondering whether this helps with that too—just, “Sweetheart, move your leg a little. Let Mommy breathe.”

21:22 Speaker 2 Look, we don’t manipulate the baby. We don’t move the baby. We work on the whole space around the baby, and the baby naturally moves and settles into position.

21:33 Speaker 3 Yes.

21:33 Speaker 2 Working on the diaphragm is very, very important. Once there’s more balance there and everything is softer and more comfortable, the baby can move more freely too. The baby can settle into a position that’s comfortable for them and, ultimately, for the mother too.

21:48 Speaker 3 Yes.

21:49 Speaker 2 A while ago, I had a woman who had pain in one very specific area. It got to the point that she went to the emergency room and underwent so, so many tests. They wanted to rule out gallstones and pneumonia, and they did lots of tests, imaging, X-rays. She went through so much. Everything came back normal, but she was in pain, in pain, in pain.

22:10 Speaker 3 Oh my.

22:10 Speaker 2 She came for treatment...

22:12 Speaker 3 Poor woman.

22:13 Speaker 2 Really. I met her in the emergency room too. She’d heard about the treatment and had spoken to me on the phone, but we hadn’t ended up scheduling anything. Then we ran into each other in the emergency room, and she recognized my name. She really had undergone so many tests, and everything was normal, but she was in pain. She did come for treatment, and there was an area around the diaphragm that was very, very, very hard. It really felt like stones. We worked on it, and I gave her exercises to do at home too. Little by little, it released, and she began to feel relief. It’s just amazing. Before I learned this treatment, I would tell people, “Okay, it’ll pass after you give birth.” As if there were nothing to do.

22:52 Speaker 3 Yes, that’s something people say all the time. Come on, this hurts, that hurts, something else hurts—give birth, and then...

22:59 Speaker 2 Give birth and it’ll all go away.

23:00 Speaker 3 And then we’ll talk. Yes.

23:00 Speaker 2 Well, first of all, not everything goes away after birth. Some women are left with pelvic pain, lower back pain—mainly around the pelvis, but not only there. That’s why we recommend coming for treatment even after six weeks, once the postpartum recovery period is over. For one thing, it feels really good to have someone work on almost your whole body, and for another, it’s very effective. So that’s important too.

23:27 Speaker 3 I’m curious—this just occurred to me—what about those babies who insist on not, not, not turning head-down? Can you help with that too?

23:36 Speaker 2 Well, look...

23:37 Speaker 3 Apart from all those segulos, you know, like checking that none of the books on the shelves are upside down.

23:41 Speaker 2 Right, just kidding. There are all sorts of things.

23:42 Speaker 3 Yes, yes. Oh, just kidding.

23:44 Speaker 2 There are all kinds of segulos.

23:45 Speaker 3 I’ve heard that one works, though I personally never needed it. But whenever I hear about a relative or friend in that situation, I’m like, “Turn around already—what?”

23:53 Speaker 2 Right. So first of all, yes, because, look, I always tell women: if someone promises you that doing A will get you B, be careful.

24:05 Speaker 3 Yes.

24:06 Speaker 2 Be careful of promises like that. So first of all, there are no guarantees, because ultimately there can be other reasons a baby is in breech position that don’t necessarily have to do with the space available. But often, when we bring things into better balance and add Spinning Babies exercises—which are also highly recommended during pregnancy...

24:30 Speaker 4 Babies?

24:31 Speaker 2 Spinning Babies.

24:32 Speaker 4 Isn’t that the exercise-bike workout?

24:34 Speaker 2 No, Spinning Babies isn’t a fitness workout. It’s a set of exercises you can learn. Rachel demonstrates them on her Instagram page, and if you attend a birth-preparation session with a midwife who knows them and has taken the Spinning Babies course, she can show you the exercises too. One is a forward-leaning inversion: you put your knees on a couch or a bed that isn’t very high and lean forward into an inverted position. During labor, that can really help things progress, and it’s also good for babies in breech position. Of course, that’s alongside Equilibrio treatment. The idea is that the more room we make for the baby, the more we allow the baby to turn.

25:30 Speaker 4 And the baby will go where they need to go.

25:31 Speaker 2 Exactly. Unless, again, there are sometimes other factors... Sometimes the umbilical cord is wrapped around the baby, not just the neck but other parts of the body too, and then it really is hard for the baby to turn. In those situations, even if a woman goes to a doctor to try an external version, it won’t necessarily work. But I say it’s worth trying. And even if the baby doesn’t turn in the end and she does need an external version, it’s worth going into that procedure with more balance and more ease in the tissues, and then having the doctor do the external version.

26:06 Speaker 4 Okay, let’s move on to the delivery room. You know what often crosses my mind? I love how I say “often,” as if every time I go to give birth—and, boruch Hashem, it’s been many times.

26:15 Speaker 2 Or when you’re thinking about a baby, too.

26:16 Speaker 4 So yes. I’ve also given birth twice on Shabbos. You arrive, no matter what time it is, and there’s a midwife there.

26:24 Speaker 2 Right.

26:25 Speaker 4 Okay, we’ll talk in a moment about how many midwives there are compared with how many women need to give birth. But I’m saying, how do you do it at all? You have eight children now, bli ayin hara.

26:36 Speaker 2 Yes.

26:37 Speaker 4 Mom goes to deliver a baby. That’s it. Yom Tov, Shabbos, war, no war. It’s demanding.

26:45 Speaker 2 Right.

26:45 Speaker 4 Demanding.

26:47 Speaker 2 Yes, Shabbos and Yom Tov really are more challenging...

26:53 Speaker 4 Just going to give birth on Shabbos meant I had twenty different things to figure out about what to do with the children...

26:59 Speaker 2 Right.

27:00 Speaker 4 And for you, that’s on top of everything else.

27:01 Speaker 2 It really is challenging. First of all, you don’t have to work full-time as a midwife. You can work part-time, which frees up more of the week. And yes, it’s something the whole household pitches in for. Personally, I also volunteer with United Hatzalah as a midwife.

27:20 Speaker 4 Oh.

27:20 Speaker 2 So...

27:21 Speaker 4 On the side.

27:22 Speaker 2 On the side, you know, delivering babies...

27:23 Speaker 4 Wow, just a month ago, on Shabbos, I was visiting my sister in Kiryat Malachi, and her husband is with United Hatzalah. Suddenly there was a birth on that street, and I thought, oh my goodness, someone’s leaving her Shabbos meal right now and running over there.

27:37 Speaker 2 Yes.

27:38 Speaker 4 It’s unbelievable.

27:39 Speaker 2 Yes, yes. In Kiryat Malachi and the surrounding area—I live in Kiryat Malachi—there actually aren’t many unplanned home births where a woman suddenly goes into labor. It happens from time to time. I actually had one like that this week.

27:53 Speaker 4 On the sidewalk, in the street, or...?

27:55 Speaker 2 No, in her home.

27:56 Speaker 4 At home, wow.

27:56 Speaker 2 Yes. There have also been cases where it wasn’t at home. I’ll tell you in a moment about one that was quite a story. I really see it as hashgachah pratis. What happened last week was that a call came in about a woman giving birth, and they immediately tagged me in the operations WhatsApp group. Boruch Hashem, one of my daughters was home, so I could leave the baby with her—I have a two-and-a-half-month-old baby—and I headed over.

28:26 Speaker 4 United Hatzalah while on maternity leave.

28:28 Speaker 2 Yes. I drove over and reached the woman. She was fully dilated, pushing, and had given birth before. It was clear she wasn’t going to make it to the hospital.

28:39 Speaker 4 She just missed it. It happened so fast...

28:41 Speaker 2 You know, she doesn’t think of it as having missed it. In the end, she saw it as a gift.

28:46 Speaker 4 Yes, no.

28:47 Speaker 2 But yes.

28:47 Speaker 4 The way she ended up in that situation.

28:48 Speaker 2 Her labor suddenly progressed very quickly. She’d given birth before. She felt something starting, and very quickly it became serious, to the point that she couldn’t walk anymore. So they called an ambulance, a call went out to United Hatzalah as well, and I got there. There were other volunteers—a United Hatzalah volunteer was there, and MDA arrived—and I delivered her baby at home. It was really moving. For me, it happened in the middle of the day with absolutely no advance warning. I saw the call and told my daughter, “There’s a birth. Watch Tal Chaim, the baby, I’m going out.” And boruch Hashem, I delivered her baby. She’s an amazing woman. She took it so well, too, because you know, it could also be upsetting: “How did this happen to me? I wasn’t prepared.” But she seemed very happy, genuinely happy.

29:40 Speaker 4 Then she went back to her bedroom.

29:42 Speaker 2 Well, that’s the thing.

29:42 Speaker 4 With the hospital admission.

29:43 Speaker 2 She went with MDA to the emergency room afterward. It wasn’t a planned home birth. In the end, none of it had been planned in advance, so it was a very, very happy experience. And speaking of births that aren’t at home, a little over a year ago, on Sukkos—not this past Sukkos, the one before—we went as a family to a United Hatzalah activity during Chol Hamoed, near Jerusalem. We were driving along Highway 1 and saw a mobile intensive care unit and a car at the side of the road. We have a rule: if we see something like that, we stop and check whether they need help. I have equipment with me, and I have some medical knowledge, even if it isn’t a midwifery situation. So we’d check whether help was needed.

30:20 Speaker 4 What an education in shlichus for the children. Someone needs us—or might need us—so we come and check. It’s amazing.

30:26 Speaker 2 Yes, yes, they’re used to it. They have equipment in the car.

30:30 Speaker 4 They grow up with it.

30:30 Speaker 2 Anyway, of course we stopped. I went over and asked, “Do you need help? I’m a nurse.” They told me, “There’s a woman here giving birth.”

30:37 Speaker 4 Really.

30:39 Speaker 2 So I said, “Okay, I’m a midwife. Where is she?” She was in the car that had pulled over. I went over, briefly introduced myself, and saw that the baby’s head was about to come out. She was right in the middle of giving birth. So there too, boruch Hashem, I delivered a sweet baby girl. It was really—

30:55 Speaker 4 You were ready to go over there and...

30:58 Speaker 2 Yes. Afterward I wrote a post about it and said, “What are the statistical odds

31:02 Speaker 4 Yes.

31:02 Speaker 2 that someone having her first baby—which is already

31:06 Speaker 4 Wow.

31:06 Speaker 2 something in itself—would give birth at the side of Highway 1, and at that exact moment a midwife would drive past, stop, and deliver her baby?” It was beyond reason. Statistically, I don’t think there’s any reasonable chance of that happening.

31:22 Speaker 4 Unbelievable.

31:24 Speaker 2 And here’s the thing: my husband, Assaf, was waiting in the car with the children, and he could see me standing beside that other car. We hadn’t thought about a birth at all, and he didn’t know there was a woman giving birth there. But he told me, “I saw you standing by the car, bending down, crouching, while people kept coming and going, and you weren’t coming back. I couldn’t figure out what was happening.” When he came closer, he realized a woman was giving birth. So he went back to the children in our car and said, “Mom’s delivering a baby. We have to wait for her to come back.”

31:52 Speaker 4 Just an everyday thing.

31:53 Speaker 2 It really was. And actually, our two oldest had gone ahead on the shuttle to the activity. They called and asked, “Where are you? Why are you taking so long? We got here ages ago.” And we told them, “Listen, I just delivered a baby at the side of the road, so we were delayed.”

32:06 Speaker 4 But how amazing is that?

32:07 Speaker 2 It really was. It’s the kind of story that stays with you. I say thank you—truly, thank you—for the privilege of being there.

32:17 Speaker 4 Absolutely. I’m curious whether United Hatzalah has a way, using GPS, to know that you’re on Highway 1, say, or that you’re in Kiryat Malachi, and...

32:29 Speaker 2 Maybe they do. I don’t know.

32:32 Speaker 4 Interesting.

32:32 Speaker 2 It would be interesting to look into it. Yes, there’s...

32:35 Speaker 4 For cases where suddenly...

32:38 Speaker 2 It was simply amazing, really.

32:39 Speaker 4 Like Uber, searching the area for a midwife—

32:43 Speaker 2 Who’s nearby.

32:44 Speaker 4 Yes.

32:44 Speaker 2 Actually, that’s an idea. I’ll suggest to Giti[?] that she look into it. What United Hatzalah does, which is really wonderful, is that, first of all, they’ve set up a women’s unit. The aim is that if a call concerns a woman—whether it’s bleeding or a birth—they try to send women to the scene rather than men, because it can be very uncomfortable for her.

33:06 Speaker 4 Yes.

33:07 Speaker 2 If she has a midwifery or gynecological issue and a man suddenly shows up—and sometimes it could be a neighbor of hers who volunteers.

33:13 Speaker 4 Usually whoever’s closest will come.

33:15 Speaker 2 It can be very embarrassing.

33:16 Speaker 4 Yes.

33:17 Speaker 2 So United Hatzalah has done something really significant in that regard. There’s also a midwives’ response team in Israel, with a Telegram group for the team. The goal is that when a call goes out, it appears on Telegram, and whoever is in the area can respond. It’s still being developed, but there’s something really wonderful about it.

33:40 Speaker 4 Yes, wow.

33:41 Speaker 2 United Hatzalah is amazing in this area and in general. We know how many United Hatzalah volunteers there were during the recent war...

33:49 Speaker 4 Wow, listen, there’s a midwife, and then there’s a midwife on the road. That’s a whole other title.

33:53 Speaker 2 “Midwife on the road”—yes, that really is something.

33:57 Speaker 4 You have to improvise a delivery without all the equipment around you, without the whole support system. Just like that.

34:03 Speaker 2 Look, basically, you don’t need anything to deliver a baby.

34:06 Speaker 4 No, really?

34:08 Speaker 2 You need a pair of hands.

34:08 Speaker 4 That’s the proof, really.

34:10 Speaker 2 Yes.

34:10 Speaker 4 Yes.

34:10 Speaker 2 Obviously it’s convenient to have equipment—

34:12 Speaker 4 Gloves, for example.

34:14 Speaker 2 So yes, I have a birth kit in the car with the basics you need: gloves, a clamp and scissors to cut the umbilical cord, a bag for the placenta, and, very importantly, a thermal blanket to wrap the baby in afterward so the baby doesn’t get cold.

34:28 Speaker 4 You know that in Ukraine, when you go to give birth, you have to bring everything for the midwife.

34:33 Speaker 2 Really?

34:34 Speaker 4 There’s a list. You go to the pharmacy—well, you stock up in advance. But the hospital bag isn’t just socks and things—

34:42 Speaker 2 The midwife has to bring it?

34:43 Speaker 4 The woman giving birth has to bring it. The hospital doesn’t provide anything.

34:47 Speaker 2 Really?

34:48 Speaker 4 You even bring a needle and thread for stitches.

34:50 Speaker 2 Wow.

34:50 Speaker 4 Everything, everything, everything. A sheet—everything.

34:54 Speaker 2 So it’s not like that in Israel?

34:56 Speaker 4 Right. So that’s why I know how much equipment you need for—

35:00 Speaker 2 Yes.

35:00 Speaker 4 And again, you don’t actually need it. It helps, it provides support, and so on. But the birth happens, whether you want it to or not.

35:06 Speaker 2 Right, the birth happens, and hopefully it goes well for everyone. But birth really can also trigger feelings of having missed out, of failure, or some kind of trauma. And that brings us to the whole subject of processing the birth experience. Because ideally, I think every woman wants and expects—and it really is very, very possible—for birth to be an empowering experience, one that helps her discover the strengths and abilities she has within her. And for me, I want a woman after giving birth to feel like the queen of the world: she went through it, she did it. It doesn’t matter whether she gave birth with an epidural or without one, by C-section or with a vacuum-assisted delivery. The very fact that she went through this enormous process makes her a queen. Unfortunately, sometimes women come away feeling traumatized, and that’s where processing the birth experience comes in: giving that experience space, and perhaps even making it possible to look at it differently.

36:23 Speaker 4 In hindsight, you mean.

36:25 Speaker 2 Yes, to interpret the process she went through from a slightly different place, with somewhat more compassionate eyes. And you really can see that often, when a woman experiences something as traumatic, it connects to things that were there for her before. Maybe a tendency toward self-blame, or toward giving herself grades that aren’t necessarily good. You can also often see that women experience trauma when they feel they weren’t seen during the birth—that they were just another person moving through the system, or—

37:07 Speaker 4 A combination of the facts and the interpretation.

37:09 Speaker 2 There’s a lot we can interpret.

37:12 Speaker 4 Sometimes it’s the facts, too. I mean, with all due respect, yes. It always depends on our interpretation, but if you’re suddenly taken in for an emergency C-section—

37:23 Speaker 2 Right.

37:24 Speaker 4 That’s a huge thing.

37:25 Speaker 2 But even that depends on interpretation. You could have two women who, broadly speaking, went through the same birth. Say an emergency C-section: a woman comes in, doesn’t expect it, and ends up having an emergency C-section. One woman will say, “Wow, that was so hard and painful for me. But how wonderful that they saved my baby. How lucky I got there in time. The staff listened to me; they recognized what was happening.” And yes, her body went through the trauma of surgery, but in her experience, they saved her and her baby. They saw her, cared for her and treated her with consideration. Another woman might go through the same thing—no two births are alike, but broadly, the same story—and feel, “How did this happen to me? How could my body not give birth? Why did my body need surgery to get the baby out? What’s wrong with me? What isn’t good enough about me? What should I have done differently?” Same situation. The interpretation is different, and that affects the feelings too.

38:20 Speaker 4 Like everything in life, now that I think about it.

38:22 Speaker 2 Right.

38:23 Speaker 4 In the end, everything passes through our interpretation. And if you live with certain distorted thinking patterns, then here, because it’s such an extraordinary, overwhelming event, everything is felt so much more intensely.

38:34 Speaker 2 Right, though I’d be a little careful about calling them distorted thinking patterns, because ultimately it doesn’t come from a bad place. It’s not as though it comes from—

38:44 Speaker 4 An inaccurate perception of what just happened in front of me, or to me, that makes me feel a certain way.

38:51 Speaker 2 It may truly be what she felt and experienced. But the good news is that you can work with that and open up the possibility of looking at what happened a little differently.

39:02 Speaker 4 Tell me about it.

39:04 Speaker 2 I studied birth-experience processing using the Alma approach. Basically, you follow a kind of map: there are general outlines for the process, and the woman brings the content. Based on what she brings, we use various tools. Sometimes what’s needed is more compassion; sometimes it may help to explain the professional side of things—what, based on what she’s telling you, really was the right course of action. It very much depends on what the woman brings and what we see. We try to understand where it’s coming from, and gradually ask her where it connects to something earlier in her life. Sometimes it can lead to places like, “I go through life feeling like a failure,” or “I’m not good enough”—all sorts of things that seem unrelated to birth. But because birth is such a major event, those feelings can surface with tremendous intensity. That doesn’t mean every woman needs to process her birth experience. But if a woman has given birth—and it could have been the most ordinary birth: she came in, had contractions, got an epidural or didn’t, gave birth, and everything was fine from a medical and obstetric standpoint—yet she’s left with an experience she finds difficult, and she feels it’s troubling her, won’t let her rest, affects even her day-to-day functioning, or leaves her afraid to give birth again, or anything like that, it’s worth giving yourself that gift and going to process the birth experience.

40:36 Speaker 5 Yes, it’s amazing that this exists. It’s...

40:38 Speaker 2 Yes, it’s something that’s very—

40:39 Speaker 5 I want to ask you something. You’re part of the medical—

40:43 Speaker 2 Right.

40:43 Speaker 5 —system. You know how everything works, and so on. Has a woman ever come to you to process her birth experience, and you’ve thought, “Wow, how did they handle things there?” I mean, you also see what went on behind the—

40:58 Speaker 2 Yes.

40:59 Speaker 5 —scenes. You can see that something really wasn’t right.

41:02 Speaker 2 So I’ll tell you. First, it’s very tricky, because I try very hard not to approach it in terms of what was right or wrong. Ultimately, I have to remember that I’m hearing the woman’s story—how she experienced it. It’s entirely possible that other things happened in practice that she didn’t see; or that things really were handled improperly; or that it was simply the interaction amid a busy shift, with the particular midwife who was there. A midwife is a person too. The interaction between that particular midwife, the woman giving birth, the people accompanying her, and the situation—it’s very, very complex. So it isn’t always black and white. There are times when it’s clear that things could have been handled differently, but when I’m with a woman processing her birth experience, my mind isn’t there at all. I’m approaching her experience and the story she brings with empathy, even if the facts aren’t precise. I don’t investigate them. Sometimes women tell me things and I think to myself, “I’m not sure that’s exactly what happened.” But it doesn’t matter—

42:14 Speaker 5 That’s how she experienced it.

42:14 Speaker 2 Because that’s what she experienced. That’s her story.

42:17 Speaker 5 Yes.

42:17 Speaker 2 And it’s her story that we work with, because when I help someone process her birth experience, I’m not there to fix the system. The system has many strengths, and it also has many shortcomings. But processing the birth experience is about the woman: her birth, her experience, the story she tells herself. That’s what we work with.

42:34 Speaker 5 Yes. When I think about it, even if there was some kind of failure, in the end, that’s what she went through. By hashgachah pratis, she had to go through it. So what do we do now with the situation as it is? That’s really... I’m also curious whether this connects for you to... In my previous birth, I came in on Friday morning for monitoring because I was past my due date. Two doctors examined me and considered inducing labor, but in the end they didn’t. I came back on Saturday night. At five or six in the morning—almost twenty-four hours later—the same doctors suddenly walked into the room. I rubbed my eyes and said, “What are they doing here? They’re still here?”

43:16 Speaker 2 Right.

43:17 Speaker 5 And I thought to myself, how can anyone function like that? I don’t know how it works for midwives; I think your shifts change more often. On the one hand, you talk about the system and its problems, but on the other hand, the people in it are absolutely giving everything they have under impossible conditions.

43:36 Speaker 2 First of all, when we talk about how the system could improve, we’re obviously not talking about any particular doctor working within it. I’m part of the system, the doctors are part of the system, and I hope and assume—and start from the premise—that everyone wants to do the best they can. Let’s start with the fact that doctors have twenty-six-hour shifts.

43:58 Speaker 5 How is that possible?

43:58 Speaker 2 It’s crazy.

43:59 Speaker 5 How?

43:59 Speaker 2 Right.

44:00 Speaker 5 Even a pilot flying for twenty hours gets to rest along the way, get up—

44:06 Speaker 2 Right.

44:06 Speaker 5 A comfortable bed. It’s, it’s—

44:08 Speaker 2 So they really do try to make sure that... First of all, not all the doctors—

44:11 Speaker 5 A pilot has autopilot.

44:13 Speaker 2 Right, not every doctor who’s there in the morning stays for twenty-six hours. There are on-call shifts, and the number of doctors varies from place to place depending on the size of the delivery ward and the whole department. But doctors who are on call are there for around twenty-six hours. If the night is quieter, they divide things up and try to get a little sleep. But on nights when everything is busy and there are emergencies, they stay awake. They work on adrenaline, you know, but in the end...

44:46 Speaker 5 No, I’m asking whether at some point someone simply doesn’t get to sleep.

44:50 Speaker 2 I very much hope not.

44:51 Speaker 5 It’s crazy.

44:53 Speaker 2 Right, it’s very challenging. The OB-GYN residency in general is very long and grueling. It demands a great deal: lots of on-call shifts, and many years of training. Midwives also have very intensive, serious training, but our shifts are eight hours. So that’s much more humane.

45:13 Speaker 5 Yes.

45:14 Speaker 2 The day is divided into seven in the morning to three in the afternoon, three in the afternoon to eleven at night, and eleven at night to seven in the morning. So the twenty-four hours are divided into three shifts. Yes, and in the end we work together. You know, there’s the medical side and there’s the midwifery side.

45:30 Speaker 5 So three midwives change over during one doctor’s shift.

45:35 Speaker 2 Yes, right.

45:37 Speaker 5 That turnover is something. I remember giving birth at eight in the morning. A midwife had been with me all night, and then at seven she said, “Okay, I’m going home. Sorry, someone else will take over.” And I was thinking, how can you leave? I’m still here.

45:51 Speaker 2 I have to say that it’s sometimes terribly hard for us, too, because sometimes—

45:53 Speaker 5 No, of course.

45:54 Speaker 2 You become attached to the woman giving birth.

45:55 Speaker 5 I’m not blaming her. I’m just saying that, ideally, you’d come from home with your own private midwife, who knows you. But that’s the difference between what could be and what actually is. We really do have to work with the facts on the ground, because, with all due respect, we’re here, and these are the facts.

46:15 Speaker 2 And look, the facts on the ground can change over time, too. We need to...

46:18 Speaker 5 Yes? You think so?

46:20 Speaker 2 Yes. In the end, look, it’s not entirely because of this, but there is demand from the public. We can see changes taking place that help the system become a little more flexible. In the past, it was taken for granted that half an hour after birth, the baby went to the nursery. What was there to discuss? Today, baruch Hashem, we’re in a different place. There’s greater awareness of the bond between mother and baby, between mother, father, and baby—the immediate family that’s now taking shape.

46:53 Speaker 5 There’s really been a change. I...

46:54 Speaker 2 Zero separation. There was a time when the system would have thought a woman was out of her mind if she didn’t want her baby in the nursery. Today, these things are taken for granted.

47:06 Speaker 5 But the question is the other way around: why did that practice develop? It’s strange. There are hardly any countries where it exists.

47:13 Speaker 2 Look, in the end—

47:13 Speaker 5 In most countries, a woman gives birth and goes to a room with her baby. Nobody even thinks of taking the baby away from her. Nurses are there to help and support her, but this whole concept of a nursery is something you grow up taking for granted. Then you stop and think: wait, what actually makes sense here?

47:28 Speaker 2 Right. The only rationale I can think of, if we’re trying to judge it favorably, is to give the woman a little rest.

47:35 Speaker 5 Yes, but that’s a long way from the way the whole thing actually works.

47:39 Speaker 2 So today there really are... I mean, things change over the years. It also comes from demand. Women come to give birth with influence. I don’t know whether to call it purchasing power, but in the end, it is a kind of power.

47:54 Speaker 5 I think the biggest share of awareness campaigns and ads in women’s magazines is for maternity wards.

48:00 Speaker 2 Yes, because it’s a very profitable area. In the end, the amount a hospital or medical center spends on a woman giving birth is very small compared with other departments, where sick people arrive and need care, medication, and treatment. Baruch Hashem, almost all the women who come to give birth are healthy women going through a natural, healthy process. Look, this opens up the whole subject of the medicalization of birth: birth was turned from a natural process into a medical one. That’s what happened over the years as women began giving birth in hospitals and so on. There’s an advantage to that, because as medicine advances, the number of babies who don’t survive birth becomes very, very low. In developed countries, including Israel, the percentage of women who, G-d forbid, die as a result of childbirth is very, very, very low. Medicine really does play a vital role in that. But on the other hand, it’s a slippery slope to treating every birth as a medical procedure. There’s a fine line we need to walk: remembering that birth is a natural, healthy process that sometimes requires intervention, but not all the time and not for everyone. Now, when a system operates as a system, it has procedures. And the bigger a system gets, the more bureaucratic and hierarchical it becomes.

49:38 Speaker 6 Sometimes a doctor’s decision comes from the need to... I don’t want to say protect themselves, but let’s say there are emergency C-sections that save babies and women, and there are C-sections that perhaps could have been avoided, but they didn’t want to take the risk.

49:53 Speaker 2 Look, first of all, I agree with you that there are C-sections that could have been avoided, but we also have to—

50:03 Speaker 6 I don’t necessarily mean the C-section itself. Sometimes it starts much earlier.

50:07 Speaker 2 Right.

50:07 Speaker 6 Take an induction, for example.

50:09 Speaker 2 So I’ll tell you. First of all, if we’re talking about lawsuits, obstetrics is a field that faces a great many lawsuits in court.

50:21 Speaker 6 Wow, [unclear]—

50:21 Speaker 2 There are a lot of lawsuits over births, and in the end, that also leads to defensive medicine.

50:28 Speaker 6 Exactly.

50:29 Speaker 2 Now, you know, it’s a chicken-and-egg situation. I truly believe that every doctor making a decision has the best interests of the woman giving birth in mind. And of course they also want to protect themselves from lawsuits. That’s very human, because no one wants to end up in court or in a situation like that. It’s a very, very unpleasant situation, and this is a field with a lot of lawsuits. On the other hand, it’s also very problematic, because there certainly can be interventions prompted by the thought, “Okay, I don’t want to take a risk right now.”

51:10 Speaker 6 Or considerations that come from the system, right? Just as an example, say there aren’t enough delivery rooms, so they speed things up a little. That isn’t the doctor’s fault. It’s just, again, the system, you know.

51:23 Speaker 2 So sometimes, yes, if they give a woman an hour, an hour and a half, two hours to recover in the delivery room, and it’s busy, she won’t get those two hours. She’ll move to another area in the maternity ward that might be less comfortable for recovering, so they can take in another woman in labor. Look, it’s complicated. Ideally, if I could picture what I’d want, I’d be very happy if, first of all, a woman got to know her midwife beforehand. She’d meet her during pregnancy, prepare for the birth with her and receive guidance from her, and they’d come to the birth together. Arriving at a birth with someone you already know is a different world from meeting your midwife for the first time right then. Now, even when you meet for the first time, you can have a wonderful connection and an amazing experience.

52:11 Speaker 6 But then she can also be replaced just before the birth.

52:13 Speaker 2 Right.

52:14 Speaker 6 Which is—

52:15 Speaker 2 Right.

52:15 Speaker 6 There’s nothing you can do.

52:16 Speaker 2 Right.

52:17 Speaker 6 It’s just—

52:17 Speaker 2 Right. So in my view, what I’d want is that continuity of care: the woman knows the midwife before the birth. The midwife knows her, and they come to the birth together. After the birth, the midwife checks on her, supports her, visits her once at home—or while she’s still in the hospital—and guides her afterward too. Something much more complete, more holistic. That doesn’t happen in Israel yet. There are countries where it does. Unfortunately, there’s also the whole issue of home births, which is controversial—are they safe or not? If a woman wants one, she has to pay for it herself, and it’s a lot of money that she isn’t reimbursed for. Ideally, in my opinion, if a woman chooses to give birth at home and meets the criteria—there are Ministry of Health criteria, an official directive, trained midwives, and so on—there’s no reason National Insurance shouldn’t fund it, just as it pays the delivery room or medical center for a birth. So why is it covered when the payment goes to a medical institution, but not when it’s arranged privately? There are a lot of issues here. I think some of it also has to do with politics, money and power. At the end of the day, you know, that’s the world.

53:52 Speaker 6 Our world isn’t all sweetness; we know that.

53:54 Speaker 2 Yes.

53:54 Speaker 6 Yes, yes. When you encounter that in the delivery room, suddenly you think... I’ve given birth in several hospitals in Israel, so...

54:02 Speaker 2 You know.

54:03 Speaker 6 Absolutely.

54:03 Speaker 2 I’ve seen differences.

54:04 Speaker 6 I’ve been to Kaplan, Laniado, Sheba and Assuta. Yes, I’ve been around. Each time it just worked out that way for different reasons. And my conclusion is that it really depends on which staff member you meet, how much sleep they got the night before, what mood they’re in, and the general vibe. For example, I also gave birth right at the beginning of COVID, and that was a completely different story.

54:30 Speaker 2 There was so much pressure then.

54:31 Speaker 6 I mean, it’s not that... The overall approach of the place does matter, but yes.

54:37 Speaker 2 And in the end, it’s the person you meet, the person you look in the eye. That’s what matters.

54:42 Speaker 6 Yes, yes, very much. And really, most of the memories I carry with me are of amazing people—angels, as I say.

54:50 Speaker 2 Baruch Hashem, I truly hope that every woman giving birth chooses what’s right for her. I mean, births in delivery rooms can also be good, wonderful, empowering and joyful. Because ultimately, the people who go into midwifery and medicine are people who want to do good.

55:17 Speaker 6 Right, nobody goes into it because...

55:19 Speaker 2 Nobody comes in...

55:20 Speaker 6 Because it’s profitable, or...

55:21 Speaker 2 Right. And nobody comes in for a shift—a doctor, a midwife, whoever—and says, “I want to give a woman a bad experience during childbirth today.” Of course nobody wants that. But awareness and interpersonal communication are important, as is some understanding of the world of childbirth—not only its medical and midwifery side, how a baby comes out. I think a midwife’s role goes far beyond delivering the baby. It’s the whole process leading up to it. It’s empowering the woman, being there with her, and giving her back the sense that this is her birth. I’m here for you; I’m not managing your birth.

56:03 Speaker 6 Yes, sometimes there’s a feeling that the baby has been whisked away, and...

56:05 Speaker 2 Yes, so...

56:06 Speaker 6 Wow, but when there really is one midwife for several women in labor, what do you do?

56:12 Speaker 2 It’s challenging.

56:12 Speaker 6 Has there ever been a time when they really needed you at the same moment in two rooms? What do you do?

56:17 Speaker 2 Another midwife comes.

56:19 Speaker 6 But is there always someone in reserve?

56:21 Speaker 2 Look, there’s a team in the maternity ward. We...

56:24 Speaker 6 No, because sometimes you get that feeling of, “Guys, the baby’s coming! Where’s the midwife? What’s going on?”

56:29 Speaker 2 Right. So, generally speaking, there are a certain number of midwives on each shift, and we divide up the rooms. Each midwife has rooms she’s responsible for and takes care of. It can happen that I have two women who are both giving birth right now, and I’m at one birth. I can’t split myself in two—I am human, after all. So another midwife on the shift steps in and takes care of the other woman. And if it’s really, really busy, there’s a midwife on call at home, and they call her to come in...

57:04 Speaker 6 Or they call United Hatzalah.

57:07 Speaker 2 Not usually inside a maternity ward. That’s more if it happens outside. Yes.

57:10 Speaker 6 Wow, wow, wow. That’s wild.

57:13 Speaker 2 There was another birth involving United Hatzalah, about five years ago. It was a birth where... I never imagined I’d find myself in a situation like that: a woman carrying twins whose labor progressed very quickly. She had such a strong urge to push that she couldn’t make it to the hospital anymore. United Hatzalah called me, and I delivered both... both babies at her home. It was, it was very...

57:45 Speaker 6 That’s a complicated birth, isn’t it?

57:48 Speaker 2 Baruch Hashem, everything went very smoothly there, but it’s a birth with more potential for...

57:56 Speaker 6 Two births, really.

57:57 Speaker 2 Yes, for complications, difficulties and complexity.

57:59 Speaker 6 Is it really like two births? I don’t mean for the woman. I mean, when the first baby comes out, is the second already ready to follow? The body has already gone through the whole... the uterus...

58:10 Speaker 2 It varies a lot.

58:11 Speaker 6 Really?

58:12 Speaker 2 Sometimes it’s very quick, immediately afterward, and sometimes it takes a few minutes more or less.

58:17 Speaker 6 To me, twins are... We hardly have any in our family, apart from my sisters-in-law, so it’s more like Yaakov and Esav, and...

58:23 Speaker 2 Something distant.

58:24 Speaker 6 Peretz and Zerach. Those are the twin birth stories I know.

58:28 Speaker 2 That you know. Yes. So there are twin births in Israel. And, you know, as the rate of fertility treatments rises, there are more twins too. So it is connected, though not necessarily. Some women have twins without any fertility treatment at all.

58:47 Speaker 6 Or mutations, or... Have you ever delivered triplets, quadruplets, anything like that?

58:53 Speaker 2 No, actually I haven’t.

58:54 Speaker 6 Not yet.

58:55 Speaker 2 It’s also very, very uncommon...

58:58 Speaker 6 A natural birth.

58:59 Speaker 2 With so many... Triplets certainly wouldn’t be delivered vaginally; it would be a C-section. It’s a complicated birth. Though I once saw a video of triplets born vaginally, I don’t think that would be approved in Israel. And these pregnancies aren’t common either, because they’re very, very challenging. Sometimes a reduction is performed during the pregnancy for medical reasons. There are all sorts of situations.

59:22 Speaker 6 Yes. No, but it does happen.

59:23 Speaker 2 It does happen, yes. Again, as there are more fertility treatments, we’ll see more situations like that. Or women giving birth at a much older age, which wasn’t the case in the past. The oldest woman I’ve cared for during childbirth was sixty.

59:40 Speaker 6 What?

59:40 Speaker 2 Yes.

59:41 Speaker 6 A sixty-year-old giving birth?

59:42 Speaker 2 Yes, her first birth. She gave birth, I think, about a year and a half ago, something like that.

59:48 Speaker 6 Well, that must have made the headlines... Wait, wow.

59:53 Speaker 2 You know, we all knew who she was because she’d been hospitalized and monitored, so the staff knew her.

1:00:00 Speaker 6 Wow.

1:00:01 Speaker 2 Yes, she was the oldest woman giving birth that I’ve encountered.

1:00:03 Speaker 6 There must have been a mistake on her ID card or something.

1:00:07 Speaker 2 Maybe there was a mistake.

1:00:08 Speaker 6 Beyond nature.

1:00:10 Speaker 2 Yes, it’s... let’s just say it’s not something you see every day.

1:00:14 Speaker 6 Yes. Wow. And have you had a youngest woman giving birth?

1:00:18 Speaker 2 I’ve had women who were eighteen, eighteen years old. Sometimes, you know, there are also situations that are less...

1:00:26 Speaker 6 Yes, less desirable.

1:00:28 Speaker 2 Right, less welcome. I once encountered a woman in labor who was around seventeen, something like that. Either she had denied to herself that she was pregnant—of course her parents didn’t know. She came to the general emergency room with stomach pains. Stomach pains, stomach pains, stomach pains. They examined her and suddenly discovered she was far along in her pregnancy, and the pains were actually contractions. So that’s a very extreme case, but I’ve encountered even that.

1:00:58 Speaker 6 How can you not notice you’re pregnant?

1:01:01 Speaker 2 Look, it was probably some kind of repression mechanism. I don’t know what was going through her mind, but yes, that happened.

1:01:11 Speaker 6 You meet people at very...

1:01:14 Speaker 2 Yes.

1:01:15 Speaker 6 It’s so much more than physical.

1:01:16 Speaker 2 Right.

1:01:17 Speaker 6 Really.

1:01:17 Speaker 2 Right.

1:01:18 Speaker 6 I mean, on the one hand it’s very physical—the most physical thing there is, because it’s a body and organs and another body coming out. And on the other hand...

1:01:27 Speaker 2 The body and the soul are connected.

1:01:29 Speaker 6 Yes, right. In the end, emotion fills the room.

1:01:32 Speaker 2 Right. The mind absolutely affects the body. We know there are psychosomatic pains. Meaning, there’s nothing physically wrong. The person is physically healthy, but they’re in pain.

1:01:42 Speaker 6 The thing is, all the women giving birth end up giving birth together. Say you’re at a certain stage, you’re calm and quiet, and suddenly you hear from the room next door what sounds like a whole group of...

1:01:54 Speaker 2 They need to work on the acoustics there at the hospital.

1:01:57 Speaker 6 Soundproof rooms.

1:01:58 Speaker 2 Yes. And it’s sweet, because sometimes, you know, you’re caring for a woman...

1:02:01 Speaker 6 And then you wake up...

1:02:02 Speaker 2 Right. Sometimes I’m caring for a woman, and she hears the woman next door giving birth and says, “Oh, I hope it goes well for her. I hope she’s okay.”

1:02:09 Speaker 6 Yes, yes, right.

1:02:10 Speaker 2 Something like that. Or some get really frightened and say, “Whoa, what are those screams?” And sometimes I tell them, “Imagine she’s on a roller coaster at Superland. She’s on her journey, and you’re on yours.” It’s like—

1:02:22 Speaker 6 On a roller coaster.

1:02:23 Speaker 2 Absolutely.

1:02:24 Speaker 6 Climbing up to the loop.

1:02:26 Speaker 2 The final rush.

1:02:28 Speaker 6 Oh, wow, that’s amazing.

1:02:30 Speaker 2 Right, it really is...

1:02:33 Speaker 6 Well, I also want to ask you about this—so we don’t skip it or forget the whole subject of being a halachic examiner. Wow, you really wear a lot of hats. It’s...

1:02:42 Speaker 2 Yes.

1:02:42 Speaker 6 But in the end, it’s all so—

1:02:43 Speaker 2 How do you divide your time? Though actually, with halachic examinations, people call, and if they come, they come.

1:02:47 Speaker 6 Right.

1:02:48 Speaker 2 But with everything else, you have shifts in the delivery room, and you also see people privately for processing their birth experiences and for pregnancy treatments.

1:02:55 Speaker 6 Yes.

1:02:56 Speaker 2 Look, it’s a matter of—

1:02:56 Speaker 6 No time for boredom.

1:02:57 Speaker 2 It’s challenging. Some weeks are very challenging. Look, right now I’m home, so I don’t have the shifts to deal with. But there are definitely weeks that are more challenging. These aren’t fixed appointments, though. Birth processing depends on demand.

1:03:15 Speaker 6 Yes.

1:03:18 Speaker 2 Being a halachic examiner, or a taharah examiner, is something that happens here and now. A woman calls; if I’m available, she comes in. I think it’s a very, very important role, because we know there are halachos about when a couple may or may not have physical contact. And sometimes there are situations that aren’t very clear: a woman suddenly sees some bleeding, or she’s in the middle of her seven clean days and suddenly there’s bleeding, or she does an examination and sees some bloody discharge, and it isn’t clear where it came from. Now, you could say, “Well, you saw blood, so start counting again from the beginning.” But that’s not the goal. The whole idea is to follow the proper path: not to be stringent when there’s no need, and not to be lenient when there’s no basis for it.

1:04:07 Speaker 6 Yes.

1:04:07 Speaker 2 And that’s where the taharah examiner comes in.

1:04:10 Speaker 6 When did that begin, actually? It wasn’t always around.

1:04:13 Speaker 2 I don’t know when it began, but baruch Hashem, over the years there’s been greater awareness of it, including among rabbis who receive halachic questions on the subject. I can tell you that once, a woman came to me for an examination. She’d been married many years—I think over twenty—and had only discovered in recent years that this service existed. In the past, whenever she had any bleeding, she would simply separate from her husband and start counting seven clean days again. It was very frustrating for both of them. She told me, “Wow, when I found out about this, it was as though I’d discovered a whole new world—”

1:04:47 Speaker 6 A new lease on life.

1:04:49 Speaker 2 “—that not all bleeding makes us prohibited to each other.”

1:04:51 Speaker 6 They teach this in classes for brides now, because it’s really...

1:04:54 Speaker 2 A few years ago I gave a talk to bridal instructors about this, precisely to raise awareness. Because ultimately, if it’s permitted, it’s permitted. We don’t want to say it’s forbidden for no reason.

1:05:04 Speaker 6 In a sense, you’re the rabbi’s eyes. You do what he can’t do, and if he could, he could often rule that it’s permitted.

1:05:16 Speaker 2 If he could tell just by looking at the—

1:05:18 Speaker 6 Exactly.

1:05:19 Speaker 2 —what they bring him. So, yes.

1:05:20 Speaker 6 Because often there’s a missing piece between the rabbi and the question he’s asked, and you fill in that piece.

1:05:28 Speaker 2 Right.

1:05:29 Speaker 6 That’s amazing.

1:05:30 Speaker 2 Yes. So it’s an intimate examination, like at a gynecologist. You look at the cervix and at what’s coming from the uterus, and see whether something else could explain the bleeding she saw. Now, it’s important to know that some women have bleeding or something similar early in pregnancy. It’s very important that when a pregnant woman goes to a taharah examiner, a halachic examiner, she goes to one who is also a midwife. In principle, taharah examiners are supposed to be registered nurses who have undergone training. Machon Puah also offers training; I studied there almost sixteen years ago, before I became a midwife. When a woman comes for an examination and she’s pregnant, no matter what stage of pregnancy she’s at, she needs to see a midwife, not a nurse. That’s a matter of professional authorization. And yes, many women come in and, in the end, we see there’s some natural process occurring in the cervix. The bleeding is from there, not from the uterus, and it isn’t bleeding that makes the couple prohibited to each other at all.

1:06:38 Speaker 6 What a shlichus that is.

1:06:40 Speaker 2 Yes.

1:06:40 Speaker 6 Wow, everything you do—each thing is more amazing than the last. It’s just...

1:06:45 Speaker 2 Yes, it really is. To me, it’s a very, very significant thing. And I have a story that really stayed with me, connected to this role as an examiner and a midwife. It brought everything together. A few years ago—I think maybe four years, perhaps a little more—a woman came to me for an examination. She was on the seventh of her seven clean days, and suddenly she’d had some bleeding. I examined her and saw that the bleeding wasn’t from the uterus; it was from the cervix, which is outside the uterus. It wasn’t bleeding that would make her prohibited to her husband. So she could go to the mikvah that very day, in the evening. It turned out that this couple had been hoping for a pregnancy for quite some time. They really, really wanted to have a baby. And we know that ovulation happens at a particular time during the month. That means there isn’t necessarily an opportunity to conceive every month. So she was able to go to the mikvah, and she did that evening, and she conceived that month. Of course, I didn’t know any of this. A few months later I met her and saw that she had a baby bump. She said to me, “You know, the month I came to you for that examination was also the month I got pregnant. We wanted it so much.” And then Hakadosh Boruch Hu arranged it so that when her contractions began, I was in the delivery room. She came in with contractions, and I delivered her baby. It was such a full-circle moment, from that first little step all the way to a baby.

1:08:21 Speaker 6 Wow.

1:08:21 Speaker 2 It really was one of those stories that made me say, “Wow.” It felt like such a privilege, such an incredible full-circle moment.

1:08:33 Speaker 6 Hakadosh Boruch Hu gave you the gift of seeing the... You know, sometimes we do one small thing and we don’t know what will come of it. But here you saw it from beginning to end.

1:08:42 Speaker 2 Yes.

1:08:43 Speaker 6 Wow, wow, wow. That’s incredible. Did she come back to you afterward for postpartum treatment too?

1:08:49 Speaker 2 No.

1:08:49 Speaker 6 So she had a good birth.

1:08:50 Speaker 2 She had a good birth. At that point I wasn’t doing birth processing yet. But she did come to see me afterward, to thank me. Those moments are always a little embarrassing, but she really felt the need. For me it was very moving, because in the end, you know, these are the stories that stay with you throughout your life.

1:09:06 Speaker 6 Absolutely. Wow.

1:09:06 Speaker 2 They remind you that what you do matters. And really, I pray that I’ll be a good shliach, and that every woman giving birth will meet the midwife who’s right for her, who’s the right fit for her—whether during pregnancy, in labor, or afterward. That people will truly come through the experience feeling empowered.

1:09:27 Speaker 6 For you, being in the right place at the right time isn’t a cliché. It’s what...

1:09:33 Speaker 2 Hakadosh Boruch Hu arranges it. You know, in the end, I didn’t plan any of what I’ve told you. None of it was planned. It just happened.

1:09:39 Speaker 6 I think midwives should write a book. Is there a book of stories like that...?

1:09:42 Speaker 2 Oh, there are all kinds.

1:09:43 Speaker 6 Something behind the scenes, you know.

1:09:45 Speaker 2 You’re giving me an idea, but there are all kinds of books. A doctor wrote one too. There are a few.

1:09:54 Speaker 6 Yes, that genre.

1:09:55 Speaker 2 Yes.

1:09:56 Speaker 6 What’s your dream, to finish up?

1:10:00 Speaker 2 Wow. My personal dream is to manage to combine all these things I want to do, and really find the time to learn the things I still want to learn.

1:10:18 Speaker 6 Oh, you still have a wish list of...

1:10:21 Speaker 2 Yes, yes.

1:10:21 Speaker 6 Courses?

1:10:22 Speaker 2 Yes. There are all kinds of things I’m interested in learning about womanhood, pregnancy, birth, and so on. And I’d like to be someone people can turn to in a more established way. I do have a clinic where I see people, but you know, it’s still in its infancy. I’d like to build something more established. Thinking more broadly, I’d love there to be centers that support a woman from pregnancy onward—or even women who need fertility treatments—with guidance and support through birth and afterward. And I’d really like births to be better and better experiences for women. I mean, they already can be, but I’d like more women to experience birth as something good.

1:11:17 Speaker 6 Yes.

1:11:18 Speaker 2 Now, I can’t influence the whole world, but in...

1:11:20 Speaker 6 But you’re not giving up.

1:11:21 Speaker 2 Within my own circle, yes. And on a personal level, I really want to know how to get the balance right between home, the children, midwifery, the treatments, and everything around them. Because at the end of the day, we only have twenty-four hours in a day, and it’s very easy to let things spill over. The work outside the home is so interesting, and so rewarding too. It’s something where you feel the impact very quickly. I want to give enough space to home as well, because that’s...

1:11:55 Speaker 6 To remember that you give birth too.

1:11:57 Speaker 2 Right, right.

1:11:58 Speaker 6 Sometimes it really is challenging. The outside world calls to you, and it seems more rewarding in a visible, immediate way. And you have to remember that, ultimately, your first, first, first shlichus is right here, under your...

1:12:13 Speaker 2 And really to be emotionally and physically available for home too. Not to forget that—or not just to remember it, but to manage to put it into practice. I’m constantly asking myself how much time to give each thing, and what comes at the expense of what. Obviously, some things do come at the expense of others.

1:12:32 Speaker 6 Yes, the question is how much, and...

1:12:34 Speaker 2 But I try to get the balance right. What does “right” mean? I don’t know, but I try. It’s different for each person.

1:12:39 Speaker 6 Yes, yes, yes. I think one of the things that helps me most personally—even though I’m not a midwife, I do other things—is that I’m often asking the same question: how much? How far?

1:12:52 Speaker 2 Right.

1:12:52 Speaker 6 Do I go out for another evening to give a lecture, or stay with the children?

1:12:56 Speaker 2 Right.

1:12:57 Speaker 6 And whatever you do, you’ll usually still have thoughts about the choice you didn’t make, right? But I always tell myself: Okay, the decision you made is by hashgachah pratis. Now, while you’re doing what you chose to do, be there.

1:13:10 Speaker 2 Yes, try to do it as well as you can.

1:13:11 Speaker 6 When you’re delivering a baby, you’re there. When you’re with the children, there are no delivery rooms; nothing else exists. Part of my shlichus is to be one hundred percent present in it at that moment.

1:13:23 Speaker 2 Right.

1:13:24 Speaker 6 That’s the only thing that exists then, and it really helps you focus.

1:13:27 Speaker 2 Right. On the other hand, when you’re at home, there are phone calls, there are things that can...

1:13:32 Speaker 6 There’s a United Hatzalah pager—I don’t know if that’s how it works.

1:13:34 Speaker 2 No, not just United Hatzalah. But what I mean is, it’s challenging. I think every woman deals with this: finding the balance between home and outside work, and being emotionally available at home.

1:13:45 Speaker 6 It’s “Where a person’s thoughts are, that is where they are.” So you can be with the children, but really be somewhere else entirely.

1:13:49 Speaker 2 Right, right. That’s being emotionally available.

1:13:51 Speaker 6 Oh yes, and I was going to say, thank goodness we have Shabbos—but for you that doesn’t quite... You can be called out on Shabbos too.

1:13:58 Speaker 2 Oh yes, there have been times when United Hatzalah called me out. But that’s an occasional thing; it doesn’t take up the whole Shabbos. Shifts really are a bit more challenging.

1:14:10 Speaker 6 May we truly merit the very best. I think everyone who listened to you took what you said to her own place—to what she’s been through, what she’s going through, and what she dreams of. So thank you, Reut, for all the knowledge and tips. And may we ourselves experience these things with as much good as possible, and with revealed good—that Hakadosh Boruch Hu not give it to us in a hidden way, but...

1:14:37 Speaker 2 Right.

1:14:37 Speaker 6 And I think that when there’s more awareness, each of us has friends, sisters, neighbors...

1:14:44 Speaker 2 Right, who are going through things.

1:14:45 Speaker 6 Yes, to pass it on, to talk about it in a positive way.

1:14:51 Speaker 2 Right. Actually, since you asked about dreams, one thing I really want to do is create a digital childbirth preparation course. I teach couples now, but there’s a limit to that. How many couples can you meet in a month?

1:15:04 Speaker 6 You’ll have to clone yourself. There’s no other way.

1:15:06 Speaker 2 No, there are other good people doing things like this too. But I would really like to create a digital course that’s also very practical. Then couples could sit at home on the couch with a cup of tea, in their slippers, and watch and practice. And if they don’t remember something, they can go back and watch it again. I think that could be very...

1:15:26 Speaker 6 Yes.

1:15:27 Speaker 2 Very useful and good.

1:15:28 Speaker 6 Yes, yes. Wow. May we merit to fulfill all our good dreams. Sometimes I say, Hakadosh Boruch Hu, what are we dreaming of, after all? We... it’s all for You, for the Jewish people, for...

1:15:39 Speaker 2 May there truly be blessing, and may each of us merit to be a vessel—a vessel to receive the blessing and abundance.

1:15:44 Speaker 6 Are you ready for six babies in one womb, like there’ll be in the Geulah? You hadn’t thought of that.

1:15:50 Speaker 2 Right? We’ll see.

1:15:51 Speaker 6 We’ll see.

1:15:51 Speaker 2 As they say, we won’t know what it’ll be like until—

1:15:53 Speaker 6 May it come soon, and then we’ll know the answer, with Hashem’s help. Thank you, Reut. Thank you so much.

1:15:57 Speaker 2 Thank you.