B’Shaah Tovah! Knowing what to do when you’re pregnant (especially for the first time) can be a daunting task. When you compound this with being an Olah in a new country where the language may be a barrier, figuring out how to obtain the necessary care can be especially challenging. The following article has been prepared to help you understand the system and know what to expect when you are expecting – in Israel.
If you’ve confirmed your pregnancy with an at-home pregnancy kit (urine test), you can make your first appointment with an OBGYN (רופא נשים). A full medical history will be taken including medications you take regularly, surgeries, allergies, family illnesses, smoking and other important information.
You will receive a referral for a first trimester ultrasound to date the fetus’ age. You will also receive a referral for blood tests and additional tests may be requested.
It is important to note that many highly recommended doctors may not have appointments readily available. In addition, they may not have much time to dedicate to their patients outside of the regular visit. It is possible to follow-up a low risk pregnancy with a family doctor. You may also find it helpful to consult with a nurse at your health clinic regarding any pregnancy-related questions.
To find an OBGYN, we recommend asking friends and family to obtain recommendations in your area, and/or you can post to the Nefesh B’Nefesh group and other local Yahoo groups.
You should expect to see your doctor about once every month to two months throughout your pregnancy.
Pregnancy Details Booklet and Nurse Visits
Around week 12 of your pregnancy, you should go to the nurse at your health clinic and begin your pregnancy follow-up (מעקב הריון). You will receive a booklet which will contain cumulative personal data about the pregnancy. This should be brought with you to every appointment and to the hospital when you deliver.
For the first seven months, you will go to the nurse on a monthly basis to have your weight, blood pressure, and urine checked. From week 32 until the end of your pregnancy, your visits will increase to twice a month.
Women who are past their due date enter a specialized follow-up called מעקב להריון עודף. Depending on your health plan and location, you will either follow up with your regular doctor or at a high-risk clinic. In this follow-up, which will occur every 2-3 days, a nurse will weigh you, test your urine and blood pressure and monitor the baby; you will also see the doctor and possibly have an ultrasound. Physicians in Israel do not allow women to deliver more than 2 weeks overdue due to the risks involved.
Dating of a pregnancy is done from the first day of your last menstrual period. The abbreviation in English is LMP. In Hebrew, this is called היום הראשון של הוסת האחרון.
The table below is a chart of the tests routinely done during your pregnancy.
|Week of Pregnancy||Test||Covered by Kupah|
|Depending on the sensitivity of the test||Home Pregnancy Test – Tests HCG levels in urine.||No|
|Up to week 12||Blood test for HCG and progesterone levels.||Yes|
|Up to week 12||Fasting blood test for the following: Blood type, RH+, general blood count, CMV, toxoplasma, sugar level, rubella immunity. Urine test. Some may be referred for additional tests for hepatitis and viruses.||Yes|
|7-12||Ultrasound trimester I to determine fetus age, usually done at a Kupah clinic or at your doctor. Also determines number of fetuses.||Yes, with co-payment|
|Up to week 16||Genetic testing. You may opt to check if you are a carrier for various genetic disorders. The exact disorders to be tested for are decided using a genometer that measures the risk levels between you and your partner based on family origin. This testing is optional and may be done through the Kupah or privately.||No. Most supplemental plans offer partial coverage. Testing for Tay-sachs is offered by the Ministry of Health, free of charge.|
|Weeks 10-12||Chronic Villus Sampling (CVS). בדיקת סיסי שלייה. Identifies genetic diseases and down’s syndrome. This test is a substitute for amniocentesis and allows for pregnancy termination without birth. The test is offered in the genetic facilities of hospitals.||No. The test is free of charge to women at high risk.|
|Weeks 10-14||Nuchal translucency ultrasound. שקיפות עורפית. An optional ultrasound exam that examines the back of the neck of the fetus. The width of the back of the neck in this time period can be an indicator of Down’s Syndrome. The nuchal translucency ultrasound has a 70% accuracy rate to indicate Down’s syndrome. This ultrasound may be accompanied by a do PAPP-A and Beta3 blood test, which increases increase the accuracy of the ultrasound to 85%. This is called בדיקת סקר ביוכימית(Bedikat seker biokemit). The test may be performed at the Kupah offices, privately or in a hospital.||No. Supplemental plans may offer partial coverage. In the case of multiple fetuses, the test is offered free of charge.|
|Weeks 14 – 16||Early detailed Ultrasound. Called סקירת מערכות מוקדמת. This is an optional exam that scans the various systems of the fetus to rule out defects. The test should take about 30 – 40 minutes and is offered in the Kupah and in private clinics.||No. Supplemental plans may offer partial coverage.|
|Weeks 16 – 18||Triple test (blood test) – תבחין משולש. This is an optional test that estimates the risk for Down’s syndrome as well as defects in the central nervous system. If results show a high risk, then amniocentesis is recommended.||No. Supplemental plans may offer partial coverage.|
|Weeks 16-20||Amniocentesis. מי שפיר. Given after medical directive of high risk of Down’s syndrome, usually as a result of mother’s age or high statistical risk based on previous testing.||Yes, if medically indicated.|
|Weeks 20-24||Late detailed ultrasound. סקירת מערכות מורחבת. Scans the various systems of the fetus to rule out defects.||Yes|
|Weeks 24-28||Glucose challenge test. העמסת סוכר. Drink 50 grams of sugar mixed with water and lemon juice. One hour after drinking, do the blood tests. The purpose of this test is to identify women with a high risk of gestational diabetes. When there is a suspicion of diabetes, an additional test will be given with 100 grams of sugar with a 3 hour wait before blood test.||Yes|
|28+||RH Injection- for women who are RH negative||Yes|
|Weeks 30-33||Ultrasound – weight estimate and growth rate – גדילת עובר||Yes|
|Weeks 30-33||Blood tests – general blood count||Yes|
|40+||See section above – Overdue|
|Additional Tests||Given under specific medical indications include: fetal echocardiogram, specified ultrasound, fetal monitor.|
Many women choose to take a pre-natal class before their first birth, and sometimes prior to subsequent births as well. Courses are often offered through hospitals, through Tipat Chalav and privately. Classes are generally designed to address questions surrounding the birth.
Among the subjects covered may be: pregnancy follow-up; high-risk pregnancy; the birth process; techniques for reducing pain during childbirth including conventional means such as laughing gas, epidural anesthesia, as well as natural childbirth techniques like massage, breathing and relaxation. Postnatal subjects such as breast feeding, baby care, and early-stage baby care at home may also be covered.
Dual-Citizen in Utero
Your baby will be an Israeli citizen, but depending on his/her parents’ citizenship, may also be a citizen of the U.S. or another country.
In order to register a baby as a U.S. citizen and obtain a passport, you will need to produce original records showing a parent’s U.S. residency – such as high school and college transcripts, and other documents. For links to the Consular websites, see Registering a New Baby. It makes sense to read the listing of the Consular requirements well in advance of the baby’s arrival, so you can have all the necessary documents ready after birth.
It is recommended to take a tour of the hospital delivery rooms and facilities that you are considering. Most hospitals offer tours on a weekly basis and you can contact them directly for the days and times. Going on a tour offers a good opportunity to ask various questions about the hospital and its policies. Some examples: Are husbands are allowed in the delivery rooms? (Yes, they are – in all hospitals in Israel.) Can I refuse an IV? (It depends on the hospital.)
For hospitals in Jerusalem, you must register in advance. Some hospitals allow you to register by fax while others require you to appear in person. In other parts of the country, there is no need to register in advance.
It is uncommon in Israel to have a planned home birth, though there are some midwives who specialize in this area. It is important to note that Bituach Leumi may refuse to pay a delivery stipend should you choose to have a home birth.Due to possible risks involved, as well as financial disincentives, you are strongly encouraged to speak to women and midwives who have experienced a home birth before making this important decision.
Doulas, Birthing Coaches and Private Midwives
Some women choose to take on a private doula, or birthing coach. Birthing coaches are labor support persons who attend to the emotional and physical comfort needs of laboring women to smooth the labor process. They do not perform clinical tasks such as heart rate checks or vaginal exams but rather use massage, positioning suggestions, etc. to help labor progress as easily as possible. A labor/birth support doula joins a laboring woman either at her home, birth center or the hospital and remains with her until a few hours after the birth. Some doulas also offer several prenatal visits, phone support, and one postpartum meeting to ensure the mother is well informed and supported. The terms of a labor/birth doula’s responsibilities are decided between the doula and the family. In addition to emotional, physical and informational support, doulas work as advocates of their client’s wishes and may assist in communicating with medical staff to obtain information for the client and to help women make informed decisions regarding medical procedures.
Private midwives may also be hired in some hospitals. Check directly with your hospital to verify that this is allowed.
Birthing in Israeli hospitals is mostly midwife-run, as opposed to physician-run. Since this may be different than what many Olim are used to, some women choose to hire a private doctor for the delivery. If you choose to hire a private doctor, you may begin to see him/her at any stage of your pregnancy. Most health plan doctors are not available for private hire. If you do not hire a doctor, there will be delivery room physicians who will examine you and who are available for emergencies during the birth. The supplemental plans of the health insurance may pay for some of your private physician visits in part, but generally will not cover the birth.
If you have not filed this request prior to the birth, you may need to submit a deposit (a check) at the hospital to cover the cost of the birth. This deposit will be returned to you once you bring to the hospital the necessary paperwork from Bituach Leumi.
Hospitalization Following the Birth
Hospitalization for birth is covered by Bituach Leumi for Israeli citizens and you will not have to pay anything out of pocket to the hospital. The routine hospitalization after a birth is two days for a vaginal delivery and five days for a caesarean delivery. When a newborn requires additional hospitalization, the mother is usually allowed to stay for one additional day in the hospital and then is generally discharged.
Instead of going straight home with their new baby, some women choose to stay in a milonit (“baby hotel”) for several days. These hotels are either affiliated with hospitals or private and provide full medical and nursing care for you and your baby. There is a nursery for the baby to stay in, while you rest. The hotels are covered partially by supplemental insurance if this is your fourth child or more.
I had my baby. Now what?
Mazal tov on the birth of your child!
Now that you have your new baby, what do you need to do with the little bundle of joy? See the following articles for more information:
A special thank you to Jody Parente for her contributions to this article. Jody made Aliyah with Nefesh B’Nefesh in 2005.