I’m a doula and childbirth educator based in Ra’anana, Israel

לעברית לחץ כאן

Births happen thousands of times every day all around the world – yet each one is different, miraculous and a rare, brief day a lifetime. My goal is to help the parents fully experience the birth of their child as the truly magical, unique and life changing moment that it really is – to embrace childbirth with joy.

First babies, babies after a traumatic previous experience, home births, epidural births, quick births, long drawn out births and cesareans- all births can be a beautiful event when the mother and father feel safe and supported, and have the knowledge to understand their own specific miracle. Eliminating fear lessens pain.

Find out more on this site about how I can partner with you, and also discover useful birth resources I’ve collected over time.

Sarah

The Due Date Myth

Most mothers carefully count down the weeks, days, even hours (I’ve seen this, it’s true!) to their due date, looking forward to that magical day. What few prospective parents realize is that the due date is just the result of a scientific bell curve – half of women deliver before their due date and half afterwards. Here is a link to an in-depth description by Transition To Parenthood, including a graph which shows what percentages of women give birth in the weeks before and after their due date. As of week 37 your baby is no longer considered premature! And while as of the day you go over your due date you are considered ‘post dates’ or ‘overdue’, really, your baby is simply going to be among the half of babies who are born after their due date. When a baby is mature, he or she gives off hormones to signal to your body to begin labor. Your body and your baby are beautifully and wonderfully made – trust them.

For this reason, when I am hired as a doula, I am on call day and night for the 5 weeks around the due date, my cell phone is always on and within earshot!

New Classes, New Opportunities

Mother Baby Yoga and Group Support Class

This is a new course that began this past week in the Nof Yam Community Centre in Hertzeliya Pituach. The Yoga instructor is (former birth and post-birth client!) Miriam Menkin, who trained in New York before she made aliya last year. She is mom to a beautiful 9 month old, and through her own process of regaining fitness as a new mother developed this Mommy Baby Yoga class. The yoga is for the mommy – the baby is held in diferent ways and ‘played with’ during the yoga sessions, which helps encourage bonding, as well as increasing confidence in carrying your baby in different positions. At the same time you are learning moves and stretches that strengthen and support trouble areas like shoulders, hips, chest and tummy. I am on hand to play with and sooth babies that are fussy and allow mothers to keep practising their fitness, and to translate if needed into Hebrew. The second half of the session is a discussion time led by me;  we sit in a circle and talk about topics that concern us as new mothers, and get to know each other a bit. Depending on the needs of the class the topics range from breastfeeding, healthy nutrition for weaning and for the breastfeeding mother, sex after birth, childcare options, practice with different kinds of slings and baby carriers – depending on what the moms are interested in.

Doula Led Birth Classes

I am collaborating with another doula to offer a Birth Preparation Course in English which will offer techniques and practical tips to pregnant couples. Why is this course different than other courses? We will explore how belly dancing can be useful for pregnancy and birth, the different types of massage a mother might find comforting, ways of assessing dilation without an internal exam, and using positions and motion to encourage optimal foetal positioning. Since the course is led by doulas the atmosphere is slightly less informal, and we can offer practical tips that have grown out of our experience. For new Olim we offer insight into the workings of the Israeli hospital system, and the nuances between the different hospitals and homebirth options in our area. We give English speaking couples a list of birthing vocabulary in Hebrew. My partner, Leanne Kaye, as well as being a doula,  is also a trained midwife, lactation consultant, and maternity nurse.  Classes are small, and the format consists of 4 prenatal/antenatal meetings plus one post-birth reunion.

Contact me if you are interested in more details!

Epidurals

When offering a woman an epidural at childbirth, in my experience, midwives and anesthesiologists  rarely explain all the side effects that accompany this form of pain relief. I feel this is very wrong, if women are purported to have ‘free choice’ for childbirth! That is why I am including this information on epidurals.

The main reason I try to avoid epidurals because of the increase likely hood of other interventions that may follow: epidurals commonly cause blood pressure to go down, so a saline IV is introduced. Another side effect is that contractions may then tail off, so pitocin (a synthetic hormone that stimulates contractions) is added. Contractions suddenly get very strong with pitocin use, which may cause the baby’s heart rate to drop…. etc. I have met midwives who believe that the epidural can help a woman who is fighting contractions relax, and allow the dilation to take place, and in some cases this might be true. In preparation to allow this to happen without resorting to drugs, you can practice pregnancy yoga, and/or look into hypnobirthing techniques to help yourself relax and let go.

Epidurals also stop the release of oxytocin by your brain – oxytocin is the body’s natural pain relief. (I wish it were  stronger too!) As pain increases, oxytocin levels increase too. As soon as pain goes up a notch, you may start to panic that you can’t cope, but if you can mentally get on top of the panic, you may find yourself coping better again in a few minutes as the oxytocin levels increase in response. It is also an important hormone for bonding with the baby, and for breastfeeding. It doesn’t mean you can’t bond or breastfeed after an epidural birth, but the intuitive response, from my experience, sometimes seems lower. I have had both kinds of births, and the cocktail of hormones and joy make one so high for weeks after a natural birth, as opposed to a birth with lots of interventions which leaves you feeling like a train has run over you, and instead of positive hormones your body has drugs to flush out.

It is rare, but things do go wrong with epidurals. The placement of the IV is in the space just before entering the dura, the which protects the center of your spine where spinal fluid flows up to the brain. If the placement is wrong and the dura is punctured, spinal fluid leaks out and the result is an excruciating headache that may last for days or even weeks – severely interrupting the crucial period for bonding and learning breastfeeding techniques. (Dura puncture rate between 1 and 5 cases out of 100. See below for source.)  Another rare occurrence is when the epidural is only partially effective, meaning one half of the body is pain free while the other half feels everything. Sometimes it’s only a small patch of stomach that can still feel pain – but unfortunately, since the oxytocin (natural pain reliever) in the brain has been switched off, the pain in that one spot is even MORE excruciating than before, which can be very distressing for the mother, especially since she has been looking forward to being pain free.  The NHS suggests that 1 of 6 epidurals is unsatisfactory.

Now, if you do decide to have an epidural,  you can rest assured that you know all the side effects and that you are going into this with eyes wide open. Whatever you do, do NOT feel guilty or like a failure. Every woman’s pain is different, and modern medicine does have huge benefits when properly used. You have a free choice, you do not need anyone’s permission or approval here. If an epidural is what you need to give birth without fear, and welcome your child with joy, then take it. It is important not to bear guilt afterwards.

The ultimate goal is to be able to give birth in full knowledge of the miracle, the holy moment when the breath of life enters your child’s body and you gaze at each other, eye to eye. Embrace the experience!

Management of Accidental Dural Puncture and Subsequent Headache
By Stephanie Goodman, M .D. , Associate Clinical Professor of Anesthesiology, Department of
Anesthesia, Colum bia Presbyterian Medical Center, New York, New York

Epidural analgesia in labour St Mary’s NHS Trust

Back-to-Back/Occiput Posterior (OP) Lobor

So, you’ve been doing everything you can to help this baby turn over and get into their optimal position: you’ve been on all fours and in the knee-to-chest position for so long you’ve picked all the lint off the carpet. You’ve been sitting on a birthing ball at the dinner table, computer, and while watching late-night TV. And STILL your baby is stubbornly posterior.  How are you going to face this labor?

OP labor is what is commonly called ‘back labor’. The baby’s spine is lined up with your spine and in this position it is harder for him to tuck his chin into his chest and come out at the smallest circumference: the crown of the head. Instead, his chin stays up and the larger circumference, the forehead enters the pelvis first – an awkward fit. The back of his head presses against your tailbone, causing that exquisite back pain.  Sometimes, when an OP positioning is diagnosed, the mother is advised at the outsed have an epidural, and if the decent is prolonged she may have an assisted birth.

There is a potential problem with accepting this epidural: your pelvic circumference. When lying on your back, your pelvis compacts into it’s narrowest shape. OP means that a larger shape of the baby’s head is presenting, so if the pelvis shape is also at it’s smallest, you may have more difficulty getting the head to pass through. This could lead to assisted delivery or Cesarean on the pretext that your pelvis is ‘too small’ to have your baby (also known as cephalo-pelvic disproportion, or CPD).

You actually want the exact opposite to happen! Rather than constricting your pelvis, you should aim to help yoru pelvis have its most open shape. More space is created in the pelvis by leaning forward, or being on your hands and knees. This also has the benefit of lessening the pressure of the head on your tailbone (lying down means gravity adds more pressure in that area). If you go into labor and the baby is still posterior, I would advise you to ask for a natural birthing room if there is one in your hospital, or let the staff know your goal is to labor in a way that comes natural to you. Then they are more likely to be generous with allowing you to adopt the position you desire.  You could even request for your initial 20 minutes of monitor time to be done while you are still on your hands and knees. A mother I assisted whose baby was OP did just that instinctively, and simply refused to lie down or even sit. The midwife managed to apply the monitor and get the required inital 20 minute printout while the mother was in this position just fine.

Another way to help the pelvis to widen is to have someone do hip presses – that means they stand behind you, placing one hand on either hip just below your hipbone where you can feel the outer edge of your pelvis sticking out and press together very firmly during contractions. You may find this feels soooo good. Then, at the end of the contraction it may feel better for as much pressure as possible to be applied against your tailbone, providing counter-pressure to the baby’s head on the other side and relieving the strain you feel there. Bring a sock filled with rice, or containing two tennis balls, or even a rolling pin to help apply this pressure. Remember, the kind of pressure you will find helpful does change during the course of labor – what felt good at first may irritate you later. Make sure your birth partner is aware of this and that you agree to feel free to direct them to do something else instead. These presses and lower back massage can be done while you’re leaning against a counter, on all fours, or holding onto your partner’s neck, swaying to music. Gyrating your pelvis in circular movements and figure 8s can help your baby turn into the easier anterior position during labor, so move plenty to help him find freedom to flex and turn.

During contractions, try lunging forward when on hands and knees, bring one foot up beside your chest. Rock during the contraction. This lunge provides a twisting sensation in the pelvis that may help the baby turn. You may also do this while standing, with one foot up on a chair and someone behind you to help you keep your balance. Go to spinningbabies website for more illustrations of positions to adopt during labor to help your baby turn.

For pain relief I would recommend looking into using a TENS machine. It is much better to try to use a small machine over which you have control, before giving yourself over to others to make decisions for you! Some women don’t like the sensation of a TENS, while others have called it their ‘friendly little buzzing bee’ and swear by it. A TENS machine can be rented from Yad Sarah in Israel for a small fee. The electrodes are applied to your back, exactly where your pain is in a back-to-back labor. I recently spoke to a midwife who swore by her TENS machine for her OP labor with her first baby. There are no side effects, either for you or the baby, no drugs to be flushed out of your system.

How about a mobile epidural? This may depend on the anesthesiologist and hospital policy; I would call ahead and ask. If you do feel the need for an epidural don’t, whatever you do, feel guilty – you alone know what you are going through; you don’t need anyone’s permission. If your mobile epidural is successful (not always do they have the same effect on everyone) then you will be able to still move onto your hands and knees, as long as there is someone next to you at all times holding on and making sure you’re stable and supported. Epidurals have quite a few side effects, so read up on epidurals so you can make an informed choice. Most doctors and midwives do not fully explain them at births.

Monitoring is the same as in any other birth. To facillitate the desired mobility in OP deliveryies you can refuse the straps (except in the case of dips in heart rate or an epidural) and the heart rate will be checked every 1-4 hours. If the pushing stage of an OP labor is extended, the baby’s heartbeat will be monitored every five minutes to be sure the baby is coping well;  but even so you can ask that they the hand held monitor be used instead.

Finally, as the baby’s head is being born imagine your vagina relaxing and becoming HUGE, and repeat this to yourself over and over again as the baby crowns. Believing positive words with your head that you can open wide, relax, accept will cause more relaxation in the muscles. As is true during sex, engorgement of blood causes the tissues to expand and become more stretchy, and this is all connected to your frame of mind, the hormones your brain releases. Fear and tension make for painful intercourse. Fear and tension, then, must make for more lacerations in childbirth too. I really wish every mother could read a copy of Ina May Gaskin’s Guide to Childbirth before going into labor! The entire first half of the book is positive birthing story after positive birthing story – women giving birth OP or to big babies (10 lb) with no tearing, even for first babies. The goal of immersing yourself in other women’s positive experiences is to immerse yourself in the idea of the normality of birth, that things can go well. I believe it – I’ve seen it and experienced it myself. You can too!

A wonderful local postnatal food delivery service! Free. Amazing.

This was posted on the local yahoo Ra’analist :

A woman with a newborn can use all the help she can get. That’s where the international volunteer organization Shifra & Pua steps in.

Our Ra’anana branch is seeking volunteers to help prepare a dish for Shabbat meal for a postpartum mother and her family. It works like this: We currently have a list of volunteers who, with several days notice from the coordinator, prepare a dish (salad, fish, chicken, rice, dessert…) that is then delivered by the volunteer on Friday.

The service is available to any postpartum mother – religious or not- in Ra’anana for one month. Hundreds of women and their families have benefited from this service, and the demand is growing. In addition, Shifra and Pua offers babysitting and house cleaning services to women in a lower-income bracket.

To volunteer to cook, or if you know someone who could use our help, please contact Galit at 054-302-5688.

We’ve also just begun a new breakfast service. Often, a postpartum mother is so busy caring for her infant that she forgets to eat and care for herself. Now, for one week, she will enjoy a full, nourishing Israeli breakfast delivered to her door, prepared in the Shifra & Pua kitchen.

Donations are needed to keep this running, as well as other services provided. If you are interested in helping out, contact Julie at 054-789-3970.

Thank you!

Julie Levy

Natural Ways to Induce Labor

-Obviously, keep active. Walk, climb stairs, swim, gently bounce on an exercise ball. In addition, there are a few other activities you can try……

-Nipple Stimulation: Stimulation of the nipples is a very effective way for ripening the cervix and initiating labor. Have your partner suck continuously on the nipple, or rolle the nipple between the thumb and finger. This may need to be continued for many hours to establish regular labor. IT is fine to rest during a contraction and resume stimulation as it fades. (I know, it sounds really funny but it seriously works!)

-Sexual Activity and Intercourse: Sexual activity acts in the same fashion as stimulation of the nipples, if not more intense. If sexual orgasm is acheived, this may actually initaiate labor contreactions through the release of hormones that cause uterine and pelvic contractions found in orgasm. Semen contains a natural prostaglandin that will soften the cervix and help with labor initiation. Some midwives have actually suggested that oral ingestion of seminal fluid also may act just as well (not to mention relaxing a tense father-to-be!) it is wise to keep in mind that the act of loving put the baby there to begin with and it may be the remedy to helping the baby be born as well. Actually, when you are induced the injections and suppositories they give you to stimulate labor are a synthetic type of this exact same hormone!

-Clary Sage Oil shows high indications that it helps strengthen contractions. Mingle 1 TBS carrier oil (like grape seed) with 5 drops of Clary Sage and rub it gently onto your bump in wide, soothing strokes, or use as a hand massage oil if you are attached to a monitor. Then leave the rest of the oil in the room (over a burner if you prefer) so that you will continue to benefit from the fragrance, or dip a washcloth into the remaining oil and keep in a zip locked bag, which you will take out to sniff regularly to keep strengthening contractions. If your hands have been massaged, keep raising them to your face to sniff them. Do not sniff it straight from the bottle, and do not rub it directly onto your skin without a carrier oil, as undiluted it is too strong and can aggrivate your skin. Obviously, as with all oils and essences or even hair colorings, do a patch test on your underarm before applying any oil – if it itches or turns pink do not use the oil.

-Eat a fresh pineapple: Not juiced, cooked, or pre-sliced as the active ingredients perish quickly on contact wtih air. Pineapple has more of that prostaglandin that softens mucus tissue. If you’ve ever over indulged in fresh pineapple then you know what I mean, how your mouth and lips feel burned; that’s the juices affecting your tissues. It’s also a fun midnight run when you’re overdue and need something else to try!

-Hot spicy food: this works by stimulating your digestive system. Have you ever noticed that one might get the runs after very spicy food? The digestive system is very near the uterus, the activity can initiate contractions. The same with Castor Oil, which I do not recommend unless you are under the observation of a midwife who is familiar with using it. There have been some studies performed where it has been suggested that the oil is passed on to the baby, which can cause him to pass his first meconium early, which then leads to the danger of aspiration and breathing problems. It seems to me, that having problems with diarreah while you’re supposed to be pushing a baby out could cause a mother to feel uncomfortable and anxious, just when she ought to be totally present and focused on the beauty and magic of the moment of birth! That said, often just before labor the body does naturally have a clean-out, and during labor itself the change in blood flow causes the digestive system to slow down. And besides, midwives have seen it all before, they are not shocked at what the body does during labor. Don’t worry.

-Ask for an enema: As opposed to spicy food and Castor Oil, and enema cleans your system out in one go, rather than inducing diarrhea over a period of time. If you are going into hospital for an induction, or you arrive with early, light contractions, ask for a self-applied enema. It is a little wax-like capsul shape, and you go into the bathroom and insert it yourself. You can think of it as a moment of privacy, with your own body, before you enter a period where numerous people will be helping you out very intimately. After about 15 minutes your body will empty itself completely. There are two benifits: one, you aren’t afraid of pooing during pushing, which can make some women tense up and not push effectivly. Two, the sudden activity of the bowels massage the uterus and can do strengthen contractions.

-Watch a funny movie and laugh a lot! Laughter also jiggles and stimulates the abdomen, and there are no negative side effects. You’ll raise your feel-good hormones which are only good for you and the baby! I know of someone whose waters broke while laughing over My Big Fat Greek Wedding…

- Take Murphy’s Law into account: Babies are often born at the most inconvinient times. Book up the weeks around your due date with things you look forward to doing: dinners out, walks on the beach, theater, trips to shops, dates with close friends. While there’s no proof that Murphey has ever induced labor directly, enjoying every day of living is much better than moping around and watching the clock. Enjoy!

Red Rasberry Leaf Tea

This is taken to tone the uterus and theoretically will shorten the second stage (pushing) of labor. Drink 1 cut pof red rasberry leaf tea from 34 weeks, increasing to 3 cups from 36 weeks gestation. It needs sweetening, so add honey. It is also very nice as a iced tea in summer – make a big jug of it and keep in the fridge. The tea works by causing small contractions, thus helping practice and tone the muscle of the uterus, making it more effective for the birth. RLT is not safe for earlier in the pregnancy, due to the theoretical possability of inducing early labor. However, it is not a proven labor inducer, do not expect it to induce your labor naturally after one cup of tea if you are overdue! The warning to early labor is just a precaution since it does exercise the uterus.

Make sure that you buy the LEAF tea and not the fruit tea. Buy as fresh as possible from a good health food store.

Evening Primrose Oil

From 38 weeks, take orally up to 3 capsules a day for up to a week before birth in order to systemically soften tissues (including the cervix and perineum.) Also, direct application of the oil on the cervix is beneficial for encouraging the cervix to soften. Insert 1 or 2 gel capsules as far up as you can before bedtime, and they will melt with your body heat. Try to do this at a time when you will be lying down for a few hours, and wear a panty liner. (Note: Always wash your hands before inserting, and don’t insert anything if your membranes have already ruptured.)

Optimal Foetal Positioning

Otherwise known as back-to-front, LOA or ROA. Your baby’s head is shaped in a way that fits the opening of your pelvis only when he or she is facing your back.  Have you ever heard of painful back-to-back labors? They are longer because your uterus has to work to turn the baby around to the correct position before allowing decent through the pelvis, or, because since the baby did not turn the decent is not a good fit and the baby does not slip through as quickly as they ought to.  Most mothers with a back to back labor opt for an epidural to cope. Thankfully, with just some practical tips and working on your own posture during the last couple of months of pregnancy you can actively help your baby get in the proper position, by shaping your body in a way that makes it most comfortable for him/her to face your back.

First, here are the positions to avoid; the ones which encourage your baby to face your tummy. The main culprits are said to be lolling back in armchairs, sitting in the car where your seat is leaning back, or any position where your knees are higher than your pelvis.

The best way to do this is to spend lots of time kneeling upright, or sitting upright, or on your hands and knees. When you sit on a chair, make sure your knees are lower than your pelvis and your trunk should be tilted slightly forwards.

• Watch TV while kneeling on the floor, over a beanbag, cushions, birthing ball, or sit on a dining chair. Try sitting on a dining chair facing backwards, resting your elbows on the backrest as well.

• Sit on a wedge cushion in the car, so that your pelvis is tilted forwards. Keep the seat back upright.

• Don’t cross your legs! This reduces the space at the front of the pelvis, and opens it up at the back. For good positioning, the baby needs to have lots of space at the front.

• Don’t put your feet up! Reclining with your feet up encourages posterior presentation.

• Sleep on your side, not leaning onto your back.

• Avoid deep squatting, which opens up the pelvis and encourages the baby to move down, until you know that he or she is the right way around. If you do want to practice deep squatting as labor preparation, try squatting supported on a low stool, which keeps your spine upright, not leaning forwards.

• Swimming with your belly downwards is said to be very good for positioning babies – not backstroke, but lots of breaststroke and front crawl. Breaststroke in particular is thorught to help with good positioning, because all those leg movements help open your pelvis.

• A birthing ball can encourage good position, both before and during labor. See Your Birthing Balls on the Active Birth and Pregnancy website for more details.

• Various exercises done on all fours can help, eg wiggling your hips from side to side, or arching your back like a cat followed by dropping your spine down. This is described in more detail in an article by Suzanne Yates – Exercise for relieving backache.

Encouraging a Breech Baby to Turn

Babies are often in breech position until 36 weeks, and even later for second or subsequent births, when they suddenly feel the call of the wild and turn head down on their own.  Many mothers have been panicked by ominous warnings from physicians about cesareans and exterior turning, only to discover on the day that the child has turned and the threatened procedures caused angst for naught. However, there are some things you can do to encourage a reticent baby to turn on his/her own!

AT HOME

At 35 weeks you can use the breech tilt position, as follows:

1. Three times a day, when your stomach is not full and baby is awake and active, lie on the floor on your back with knees bent and feet flat. Raise your hips some inches off the floor and slide some cushions beneath to hold your body in a tilted position. You will be lying with your head and shoulders on the floor and hips and knees raised. Remain there 10 minutes. The aim of this position is to help a partially engaged baby to become unengaged from the pelvis and free to move. However, if you feel faint or uncomfortable, stop the exercise at once.
2. As you consciously relax tension in your abdomen, visualize your baby’s head pressing “down” against the top of your uterus, and watch in your imagination the baby trying to get his head “up” again.

MUSIC: If you have high blood pressure or cannot tolerate the breech tilt position, avoid it and concentrate on using music for the same purpose. Place stereo headphones low on your tummy and play rhythmic music moderately loud. Some people believe babies particularly like baroque music. The baby may try to move his head closer so he can hear the music better. The music can also be used in the breech tilt position.

WATER: Go for a gentle swim (no backstroke- it strains the stomach muscles.) If you are uncomfortable going to swim at a public pool, try a bath or shower. Babies seem to like the sound of water and the feeling of weightlessness that they experience when we are taking a bath. Get into the bath or shower when the baby is a wake and especially active, and concentrate on lengthening your torso, imagining more room in your abdomen. Speak soothing, encouraging words and talk to him, encouraging him to turn. I know that he doesn’t really understand speech yet, but the tones of voice are understood and your positive hormones cross the placenta and he feeds on your feelings as well.

Obviously, whenever you feel the baby being active try to adopt an open position that encourages him to have the space to turn over. Check out the Optimal Fetal Positioning post for postures that encourage movement.

EXTERIOR TURNING

When the doctor attempts to turn your baby, he or she will put you in the above breech tilt position for 20 minutes, all the time monitoring your blood pressure, in order to un-engage the baby from your pelvis.  Afterwards, they will do an ultrasound to make absolutely certain that the baby is actually breech, and that they are not making a mistake. Then your tummy is slathered with lubricant, and gently but firmly the doctor will stroke your belly in circular movements until the head is downwards and the bottom up. If you are scheduled for an exterior turning of the baby, don’t be scared by stories of how much it hurts. There are a few good tricks that help the experience to be easier and more successful:

• Don’t eat too much or drink anything acidic (like orange juice) beforehand to avoid uncomfortable heartburn. Do have a light breakfast.

• Bring someone along with you who will make you laugh! Chat and joke the entire time. If you are laughing, you are not tensing your stomach muscles and holding them in, which will work against the doctor’s attempts and cause pain to your sensitive uterus. The massaging movements of your laughing will jiggle the baby and endorphins may help him feel positive and more willing to be manipulated too.

• Take 4 drops of Bach’s Rescue Remedy beforehand, available at all pharmacies in Israel.  I even spotted them on the counter top by the till at Superdrug recently.  This mild distillation of flower extracts is safe to use in pregnancy and does not have any known adverse side effects.  It will help you feel calmer.

*Note: Meir Hospital in Kfar Saba in particular has quite a high record of successes with exterior turning (hipuch) of babies.