Page 208 - ירושלים: גיליון רפואי

Medical File No. 009

Early Labor (Stage 1) in Normal Delivery

Midwifery in In the 19th and early 20th centuries, in the Jewish and Arab communities in the Old
Jerusalem City within the walls, as in many other places in the Middle East, births took place in
the home of the birthing woman with the assistance of women who were skilled but
lacked formal education as midwives. Birth was considered a natural event in which
medical intervention was not necessary.
The “midwife” would arrive at the home of the birthing woman equipped mainly
with her experience in the field. She lacked the knowledge or tools to intervene
obstetrically, deal with emergencies or administer medications. The mortality rate
for women in childbirth in Jerusalem was similar to that in other countries in the
region. The infant mortality rate in the early 20th century was approximately 40 per
thousand live births in the Jewish population and more than 100 per live births in the
Muslim population. In comparison, the infant mortality rate today in Israel is 6.5 per
thousand live births in the Muslim population and 2.6 per thousand live births in the
Jewish population.

Symptoms It is impossible to predict precisely when a birth process begins. At the beginning
and risks of the 20th century, a birthing woman who felt her labor pains grow more intense
or whose water broke would summon to her home the woman the community
recognized as experienced in childbirth. Today, these are the signs that bring a
pregnant woman to the hospital. In earlier times , maternal mortality was mainly due
to hemorrhage (25%), infection (40%), pregnancy toxemia (11%) and other factors
(embolisms, complications during birth).

Childbirth at There were hospitals in the Old City and some were built outside the walls after
home or the settlement began there, but people were in no hurry to seek treatment at these
hospital facilities. In 1912, Hadassah Hospital nurses Hannah (Rose) Kaplan and Henrietta
Szold opened the first well-baby clinic (“Tipat Halav”) in Jerusalem, whose purpose
was to provide medical oversight and guidance to pregnant women. Szold and
Kaplan encouraged women to give birth in the hospital. Over the years, more and
more women in Israel and around the world have given birth in the hospital. Among
the reasons for the trend in this country were greater education among women and
the initiative to distribute pasteurized milk in hospitals only. The decision of Israel’s
first prime minister, David Ben-Gurion, to offer a monetary grant only to women who
gave birth in the hospital increased motivation to do so.
Nowadays, when a woman comes to the hospital to give birth, the following actions
are taken: intake (midwife and physician) ( anamnesis, questioning the woman about
her medical and family history, pregnancy and previous pregnancies); checking of
vital signs – pulse, blood pressure and respiration; general physical examination;
obstetrical examination to determine gestational age, number of fetuses,
presentation of the fetus and extent of cervical opening that determines whether the
mother is in labor; monitoring fetal pulse; blood and urine tests. Ultrasound, used to
determine the precise presentation of the fetus, location of the placenta and number
of fetuses, is an important technological tool in reducing mortality of mothers and
newborns. The strength of contractions is also frequently monitored.

Name of Prof. Joseph Shenkar, Signature
physician gynecologist and obstetrician

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