An alternative method for performing a C-section, developed by French doctors, is gathering momentum in Israel. Recovery is said to be faster and less painful. A few local hospitals have already adopted the method, but the medical mainstream continues to have reservations
The first time I gave birth was by C-section, and I ended up in the recovery room bleeding, hooked up to a catheter and an IV, with the lower part of my body numb – and without my baby.
I went through the three pictures my husband managed to take via cellphone and from them tried to burn the image of my firstborn into my memory. I hadn’t been able to see him in real time, because I wasn’t allowed to wear my glasses. I now lay there alone among the masses of other women who were recovering from various operations, thirsty and hungry. I was afraid that maybe my baby was hungry, because I wasn’t offered the chance to breastfeed him before he was taken away.
I didn’t remember then that my hands had been tied for most of the operation; that no one had warned me about the foggy feeling I would be left with from the anesthetic; that I would feel so lonely until my husband was allowed into the room; and that meaningless conversations were held above my head. Those moments started to come back to me only later, descending on me at the least expected times. It was the first operation I had ever undergone, but for the medical team it was just another C-section, a routine procedure lasting half an hour at most.
“Most of those departments are run by men, but no man has ever undergone a C-section,” says Michal Silberman, 37, a mother of two, from Tel Aviv. “A man can’t understand that experience, what it’s like to be tied to the bed, what it feels like when they take your baby away without letting you see it – the fact that you’re not in the least part of the process. The doctor has already performed a million operations like that. Open a womb, take out a baby – for him that’s the job and he doesn’t understand that there’s another way, too.”
About five years ago, Silberman gave birth to her first child, a son, in an emergency C-section that left her scarred physically and mentally. A year ago, she chose to have her second son by an advanced method, originating in France and known as French Ambulatory Cesarean Section, or FAUCS. In Israel the method is known as the “French cesarean,” but only a few physicians have learned how to perform it, and few will suggest it to their patients – some because they are strongly opposed to it, others due to a lack of knowledge.
Silberman underwent the costly procedure at the Nazareth Hospital EMMS, also known as the English Hospital, in Nazareth, which was the first medical institution in Israel to adopt the method. Even before she became pregnant with her second child, she relates, she knew that the next time around she would give birth via French cesarean, though she says she didn’t find even one physician who agreed with her decision.
“Throughout the pregnancy, all the doctors I met were dismissive or scornful when I mentioned the French approach. Both of my pregnancies were the result of fertility treatments, and in both I was under the care of a well-known professor in the field, who from my point of view was no less than God. When I told him I was planning to give birth via French cesarean, he was immediately against the idea. He said that it was just a gimmick and that I was endangering the baby. In retrospect, it was the most justified amount of money I’ve ever paid for something. I would have spent four times as much, too.”
Since the 1990s, regular C-sections in Israel have been performed using the “Misgav Ladach” method, after the Jerusalem hospital where it was first introduced, in which the prospective mother is given a spinal block, followed by a lateral incision on the line between the lower abdomen and the groin and the bladder being moved aside; the uterus is then lifted out and cut open and the newborn is extracted. With this method, the mother does not participate in the birth – a screen is placed between her and the physicians, which prevents her from seeing the procedure, and in most cases her hands are tied to the bed to ensure that she will not “interfere” with the delivery.
The French operation is based on the extraperitoneal method, in which access to the womb does not entail an incision in the peritoneum (the membrane that covers and protects the organs in the abdomen). The method was developed about a century ago, but its use waned in the 1970s.
In the 1990s, a French surgeon named Dr. Denis Fauck improved the method and developed a cesarean procedure in which the smooth, longitudinal muscles of the stomach are not separated, no catheter has to be inserted into the mother’s bladder and the incision in the womb is made on the left side of the body only. In addition, dissolvable stitches and surgical glue are used.
In 2014, the extraperitoneal technique was enhanced by French physician Bénédicte Simon with a substantial innovation: the use of a Guillarme blower (a kind of mouthpiece, like a whistle, that is used for stomach and pelvic-floor muscle exercises), which helps the laboring woman simulate the “pushing” that is required at the end of a regular birth and facilitates delivery. Many of the Israeli women who have chosen to give birth according to the updated French cesarean method learned about it from stories posted to a designated Facebook group titled “French Cesarean Section – Information and Advice.” There, women share their birthing experiences, make recommendations and counsel others about the method. According to the International College of Obstetrics Surgeons organization, a total of some 10,000 women around the world have undergone the French procedure in recent years, some 10 percent of them in Israel.
The upgraded French method has only been in use in Israel since 2017, and until a year ago the operation was regularly performed, on a private basis only, in the Nazareth hospital and in Mayanei Hayeshua Medical Center in the ultra-Orthodox city of Bnei Brak, for a fee of 15,000-20,000 shekels (about $4,500-$6,000); these are two of only a handful of hospitals that perform private C-sections in the country. In the past year, the procedure has begun to be accepted in the public health system and it is now also performed at Shamir Medical Center (formerly Assaf Harofeh), subject to certain conditions. Within a year, the operation is expected to be available at Beilinson Hospital, and the Clalit HMO is examining the possibility of offering it to those of its members who have extra insurance policies, albeit only in the Nazareth hospital, with a certain deductible.
“There is no question: The French cesarean is preferable to a regular C-section. On the fifth day after the French operation I was already able to sit cross-legged. I’d even forgotten that I had an operation. My family was stunned,” relates Gaya (not her real name), 34, from the central part of the country, who gave birth about six months ago. “I have no doubt,” she adds, “that within a year or two, the French operation will be available in almost every hospital – and in another few years it will replace the regular C-section and be available to every woman and for free.”
“The first time I saw the French operation, I didn’t understand a thing. After 6,000 regular C-sections that I had performed, it was like going back to first grade,” relates Dr. Israel Hendler, a senior physician in the obstetrics department in Sheba Medical Center, Ramat Gan, and at the Hospital. “Today I am no longer capable of performing regular C-section deliveries – I find them terribly crude.”
Hendler learned about the French technique thanks to his partner, Sivan Navot, a physiotherapist who specializes in pelvic-floor rehabilitation. She had heard about the procedure at a professional conference abroad in 2014, when she also learned about the use of the Guillarme blower during C-section deliveries. She subsequently tried to interest various physicians in the method, but in vain.
About 20 years ago, when married to someone else, Navot learned the hard way about the trauma that can be caused by a C-section. “I was given supposedly deluxe conditions, because they knew me at the hospital,” she recalls. “I was allowed to keep my glasses on, and my hands weren’t tied – but at the time they didn’t allow my husband to be with me in the operating room, and when they delivered my daughter they didn’t even tell me it was happening. It took me a few minutes for me to grasp that the crying in the next room was coming from her. Then they ‘did me a favor’ by bringing her in for a moment so I could give her a kiss, and then they took her away again. Why did she have to start her life like that? The day of the surgery is a birthday, it’s not supposed to be bound up with trauma.
“In 2016,” she continues, “when I started dating Israel [Hendler], I gave him a ‘test’ by showing him a video of a French cesarean. He said, ‘Cool, the woman looks like she’s genuinely giving birth.’ And I told him, ‘Wait till you see how she functions after the surgery.’”
Navot and Hendler are members of the International College of Obstetric Surgeons, which is today the organization that’s officially promoting and training physicians in the use the French technique. Hendler is the only person in Israel who is authorized to teach the method to other physicians; so far he has trained about half a dozen.
While Hendler was learning the new method in France with Dr. Simon, Navot came up with the idea of the role of an aide who accompanies women who choose to undergo what she calls an ABC – abdominal birth cesarean. The aim of such a companion, similar to that of a doula, is to create a positive birth experience for the mother and family, to encourage the mother to be an active participant in the process and to enable early bonding with the infant and a speedy recovery.
To that end, during the pregnancy, the companion meets with and advises the mother several times. During the surgery itself, the companion explains each stage of the operation in real time, helps document the birth, takes part in delivering the newborn and assists with recovery and the initial breastfeeding.
Hendler and Navot now work as a team – he performs the surgery, she accompanies the mothers – at the hospitals in Nazareth and Bnei Brak, and they split the fee they are paid. Hendler emphasizes that even though it’s an expensive, private operation, “we won’t get rich from it. I was already on the track I had been aiming toward my whole life – to be head of a hospital department – but I stepped aside. Sivan was also very well known in her field and doing well financially. Today we travel at our own expense to places abroad where they want to learn how to perform the surgery, and sometimes we do the operation pro bono. It would seem easy to say we are making millions from it, but that’s not the case.”
A comparative study carried out between August 2018 and March 2019 at the Mongi Slim Hospital in Tunis, compared the cases of 100 women who gave birth via two types of C-section: the regular, Misgav Ladach one or the French cesarean. The parameters the researchers looked at were: duration of surgery, frequency of complications, blood loss, level of pain felt by the mother in the six hours after the operation, length of time needed for the mother to resume regular activity, and fetal health.
The results of the study, published in January 2021 in the scientific journal PLOS One, showed that the women who underwent surgery according to the French method reported 33 percent less pain as compared to women who had a regular C-section. It was also found that the former resumed activity in a shorter time (94 percent were completely independent in terms of mobility and food intake, etc., within 12 hours, compared to only 4 percent in the Misgav Ladach method). No differences were found between the two groups regarding complications.
During the regular C-section the baby was extracted from me; with the French operation I was part of the process. I ‘blew’ her out in a way that is closest to a vaginal delivery.
In Israel, the Bnei Zion Medical Center in Haifa decided about four years ago to carry out a comparison between the two methods. For half a year, Dr. Hendler trained surgeons there in the French technique. The hospital staff avoided the use of forceps, which is customary as part of that method, choosing instead to deliver the newborn by hand and using something called the intraperitoneal approach, which tears the peritoneum. In fact, the French C-section was not performed in its full configuration. All that remained was the use of a Guillarme blower, no catheter, and getting the mother back up on her feet soon after delivery.
In August 2018, the hospital started to compile data from women who gave birth via a regular C-section and via the modified French method, concerning post-op pain level, speed of recovery and return to independent mobility, blood loss, weight of the newborn and complications in the first 24 hours after the delivery.
However, publication of the research has been delayed, due to differences of opinion between Hendler and the Bnei Zion surgeons. The latter maintained that there were no substantial differences between the two methods, and that what improves the recovery is not the surgical technique per se but rather other features involved in the whole birth experience. For his part, Hendler says that performing a manual delivery instead of using forceps has a less desirable affect on the mother’s recovery, since the latter method is less invasive vis-a-vis the abdominal cavity. In the wake of the trial, the hospital decided not to deliver babies by this method anymore.
Dr. Shlomi Sagi, director of the Obstetrics and Gynecology Department at Bnei Zion, who along with Dr. Rami Sammour has performed the C-sections and compared the two methods, explains: “There were 116 participants in the study. Half underwent regular cesarean surgery and half underwent modified FAUCS. They did not know which method had been chosen for them. All the women were asked to get out of bed after four hours, a catheter was not used in any of the deliveries and all of the women used the blowing device. We believed that the important thing in the whole process is the transverse incision in the stomach wall, as opposed to the [external] lateral one.
“All the women recovered remarkably well,” he continues, “and there was no difference between the two groups in terms of the painkillers they were administered. There’s a term in the surgical world: ERAS (enhanced recovery after surgery). It turns out that if people who undergo surgery are given fewer fluids, get out of bed fast and are without a catheter or other surgical drainage, they recover more quickly. In my opinion – and this is also what my study said – that’s the main thing. In a regular cesarean, most of the women receive 1.5 to 2 liters of fluids during surgery. When that doesn’t happen, there are fewer edemas and you can get out of bed sooner. Our research will be published very soon – I have reached an agreement with Hendler that we will publish it and note that the researchers have some differences of opinion.
“I really don’t see myself going back to the French method,” Sagi adds. “It’s a technique that requires surgical skill and it’s difficult to teach. I would agree [to use that method] if I believed that it’s preferable, but that’s not the case. I learned a great deal from it, and also adopted certain elements of it that are related to the birthing experience. In the end, I want what’s best for the mother.”
Surgically, the French cesarean is more gentle than the regular method vis-à-vis the body, and the fact that the mother is aware of every stage of the process both before and during the delivery, in real time, means it has an advantage among women who previously underwent complicated and difficult deliveries.
“My first C-section was pretty traumatic – I felt like an object from which an infant had to be removed,” says Danielle (not her real name), 38, from the coastal plain area. “I felt like I wasn’t being seen or heard. My needs weren’t important; the approach was purely medical-surgical. I ended up with a C-section a second time after the attempt to have a regular vaginal delivery was not successful. This time the experience was slightly better, but there was a long separation from the baby and I suffered quite a bit of pain.”
For a long time, Danielle recalls, “we didn’t even think about another child, because I knew there was no chance I was going to go through that nightmare again. In my third pregnancy, we started to think about the French method but hesitated mostly because of the cost. Every doctor I consulted had something to say about it. One well-known senior physician who runs the obstetrics ward in a hospital, called the French C-section a ‘gimmick’ and hinted that it was a matter of a placebo effect. Another doctor told me that the French method doesn’t reduce pain. Only when I asked her about the emotional experience involved in it did she admit that, ‘We, as doctors, have much to learn in this field.’ For me, that sums it all up.
“Last April, I gave birth to my daughter in a French cesarean in Nazareth. I saw the baby emerging from me, she was placed on me for half an hour and I also breastfed her. Two weeks later I was already dancing at my brother’s wedding, which I had never believed could happen. Hundreds of women in Israel have undergone this surgery, and they all have one thing in common: They’ve made a successful mental and physical recovery. My feeling is that the system is oblivious to this, and that this makes genuine evaluation and research impossible. If the physicians would listen to the mothers’ personal experiences, maybe they would understand.”
Keren Levy, 35, from Tel Aviv, describes a similar experience. “My first time giving birth was supposed to be a regular delivery, but I was taken in – in large part because of pressure from the [medical] team – for a cesarean. During my second pregnancy I already knew that I would opt for the French method. Today I can definitely say that there is a difference, not only in terms of recovery but also in the kind of mother I am.
“I’m certain that if professionals delve into the matter thoroughly, they will find that a connection exists between C-sections and postpartum depression,” she adds. “After the first operation, I felt like I had been run over by a truck; it took me around two months to get back to my old self. I couldn’t connect with the baby, because I was in pain. After the French procedure, I took painkillers for four days, and on the fifth I was already like new. Before the surgery I was skeptical, but now I can say that all the promises were kept. During the regular C-section the baby was extracted from me; with the French operation I was part of the process. I ‘blew’ her out in a way that is closest to a vaginal delivery. The recovery, including separation from the baby, lasted only 40 minutes, in contrast to the regular C-section, after which I could not see her for three or four hours.”
Levy notes that “from the moment I chose the French method, I felt that the whole ‘chain of command’ was against me. The pregnancy-monitoring nurse, the gynecologist at the HMO and also the doctor I took privately for prenatal care – all of them said it was nonsense and that the difference between the two types of surgery was a matter of marketing. At some point it became so unpleasant that I simply stopped saying how I planned to give birth. I preferred to lie. In my profession I do tech scouting for major corporations, so I know that whenever someone new shows up, they generate opposition from the old generation. But in this case, there is surgery that respects a woman’s body and also spares her many risks that are liable to accompany a regular C-section. It’s worthwhile in terms of the system, too.”
“There are two different models of hierarchy when it comes to giving birth,” says Paula Aji, a doula and childbirth preparation counselor who uses what’s called the HypnoBirthing (Simply Birthing) method, to help women during labor and birth. “The classic model really does resemble a military model to a certain degree. The hospital is above, flanked by the insurance companies, below them the senior physicians, the midwives and the rest of the team, and at the very bottom is the family.
“In the second model, the mother and baby are at the center, and around them are the partner, a doula and family members. In this model, the midwives, the physicians and the medical system are in the outer circles,” Aji explains, adding, “Women who have undergone trauma need to feel they are in control. The choice of the type of birth experience and [if necessary] surgery can provide them with that experience.”
In the case of Hilla Moshkovich, 34, from Givatayim, the choice of the French cesarean came following a difficult vaginal delivery. “I came out of it with stitches almost up to my ears, because the baby’s head was very large,” she relates, adding that a year ago she delivered another child by French C-section at Shamir Medical Center.
Moshkovich: “This time, in week 36, I told one senior physician that I wanted to have the French surgery. He immediately cut me off and said, ‘It’s the biggest fake news I’ve ever heard of.’ I asked him what he meant, but he would not elaborate and was totally dismissive. But I decided to go for it and today I know I made the right decision. After I gave birth the first time, I couldn’t walk or sit; I had terrible pain for six months. After the second birth, via the French method, I was able to walk around freely after an hour. On the day I got home from the hospital, I cleaned and organized the house. It was a 180-degree difference.”
Maya (not her real name), 34, who lives near Haifa and recently gave birth via a French cesarean in Nazareth, says she chose that procedure in the wake of serious damage sustained in a vaginal delivery, from which she emerged with fourth-degree perineal lacerations.
“They used a technique known as ‘Fundal pressure’ [applying external physical pressure on the mother’s uterus], parallel to a vacuum extraction. No one asked me what I wanted, no one explained anything – they just did it to me and tore me as far as the rectum. Since then I have had pain while relieving myself, and also gas and excrement and urine leakages. It’s been a few years and I still need to wear absorbent underwear like I did after giving birth, when I leave the house. I keep an extra pair of underpants in the car and I only wear black. I emerged from my first childbirth experience with lifelong damage. The only reason I decided to become pregnant again is that I am an only child, and I didn’t want my daughter to grow up like that, too.”
Maya adds that her most recent pregnancy was high-risk, “and my decision to give birth by the French method provoked negative responses from all the professionals I saw. My attending physician simply refused to treat me and released me from her clinic. She claimed that there is nothing in the professional literature about the procedure and that made me anxious. But I need to be in control, and the French C-section allowed that to happen.”
If I thought that surgery like that is preferable medically, I would do it. I think it’s a gimmick, a marketing thing, and I don’t feel comfortable with it as a physician. There is no great difference.
She describes her recovery from it as a dream: “I gave birth on Sunday evening and on Thursday morning I was already cleaning the whole house and preparing lunch. Already that week I slept on my side. Those are things that are far from self-evident after a regular C-section. From hour to hour there is a huge improvement – people didn’t believe I had surgery.”
In addition to women who have experienced a trauma in a previous childbirth, there are some who opt for the French procedure in their first pregnancy.
“I knew I didn’t want to give birth in the regular [natural] way. In the hospital you have no control over anything, labor is induced, there are emergency C-sections. That’s not for me,” says Dana Hadad, 41, from Modi’in, who gave birth to her first child, a son, two months ago via a French cesarean for which she paid out of pocket.
Hadad: “From the very beginning of the pregnancy, I said that I want to remain healthy in body and mind. I didn’t care what they said in other hospitals, certainly when it came to male doctors who don’t go through this themselves and don’t know the consequences. I didn’t want to get to a traumatic state – after all, there’s also a child here whom I need to raise. It was the best decision I’ve made. The recovery was rapid, perfect.”
Of course the French method is not problem-free. To begin with, claims about a faster recovery have not been substantiated yet by comprehensive research, although separate studies on that subject are underway at both the Nazareth Hospital EMMS and at the Shamir Medical Center. Second, a mother undergoing this operation must for reasons spend some time, albeit brief, separate from her newborn, whereas now a “friendly” C-section is being offered that does not require any separation during the immediate recovery period.
Another big issue is often the high cost of the procedure, compared to a regular vaginal birth or cesarean delivery at a public hospital, which do not entail payment. For now the HMOs are not on board; there is partial reimbursement of expenses only for people with supplementary, private insurance policies. For its part, Shamir Medical Center offers the French surgery free only to women undergoing their first cesarean – others have to pay for it. According to Dr. Rony Chen, director of the maternity wards and obstetrics department at Beilinson Hospital, when the French method is introduced there, it will be offered also to women who have already undergone a C-section.
“In the future the French cesarean will be adopted at additional public hospitals,” says Chen, who is creating the program to integrate it at Beilinson, and performs the surgery privately at present at Mayanei Hayeshua. “It’s taking a long time because we are conservative. Physicians reject the procedure without ever having seen it, only on the basis of rumors or reading about it. I have no doubt that the recovery from the French surgery is better and accompanied by less pain compared to a regular cesarean. For me as a surgeon it’s also a challenge. Every surgeon likes to improve and learn new things.”
When he first heard about the French method, he continues, “I raised an eyebrow, but from the moment I actually saw the surgery, I fell in love with it. I’ve been performing operations for 28 years, and I was as excited as a child by the French procedure. My mother told me that the only time she saw me so excited was after the first operation I ever performed. I discovered a new world here.”
Nonetheless, the most substantial obstacle to the widespread adoption of the method was and remains powerful opposition by professionals in the obstetrics field. “If I thought that surgery like that is preferable medically, I would do it. I think it’s a gimmick, a marketing thing, and I don’t feel comfortable with it as a physician,” says Dr. Roni Levy, manager of the delivery rooms and maternity emergency room at Kaplan Medical Center in Rehovot. “There is no great difference – the incision is made in the same place in the abdomen [i.e, along the bikini line], and only after that is an incision made slightly to the side; it’s no big deal.”
“If the surgery is really so good, why are physicians against it?” he asks. “And why is there no study showing that it’s preferable? Maybe if I paid 20,000 shekels for an operation, I would also think it’s better. Most physicians agree that it’s not. They have tried it out in Haifa, too [at Bnei Zion], and didn’t get the impression that there’s a difference. There is no special risk involved in the French method, but also no advantage. Much ado about nothing. A cesarean delivery hurts in any case. I don’t think it’s possible to avoid pain completely.”
Levy agrees that women giving birth need a better experience. “Even in a regular C-section we allow the partner to be present, and after delivery the woman is allowed to breastfeed while we close the abdomen and to be with the baby during the recovery. It’s always better to let the mothers be with their baby. It has an impact. When there is a good surgical experience and the woman is pleased, she will have less pain afterward.”
“At a certain stage, I felt I had run the gamut with the regular C-section,” says Dr. Miki Moskovich, deputy director of maternity rooms and obstetrics at the Shamir Medical Center. “I looked for something innovative surgically, which would also have added value. That’s how I got to the French method. I was all set to go to France, but then the coronavirus crisis erupted. I heard that Hendler, with whom I was on good terms, had become the representative of the method in Israel, so I got in touch and he invited me to study with him in Nazareth.”
Moskovich started using the French method in July 2021. Since then, he has delivered more than 150 babies at Shamir that way, and his waiting list fills up rapidly. He also performs private surgery at Mayanei Hayeshua.
At the moment, Shamir is offering the French method only to women for whom this is their first cesarean delivery, and there are only four operations a week. Will the service be extended?
Moskovich: “At the moment, this is the maximum I can allow. The method was presented up front as a private niche in the public health system. I would be happy to offer it as a ‘return’ operation, too, but that’s not possible. I am constantly trying to persuade the hospital’s management, but at the moment I am mainly saying thank you for being permitted to perform these operations altogether. At this stage I can’t train additional surgeons myself, but that will also happen at some point.”
Under which conditions do you authorize the use of the French cesarean?
“[Shamir Medical Canter] is opposed to a scheduled C-section without medical necessity. If there is no medical risk or any complication, a woman is supposed to have a vaginal delivery, so the French surgery will be authorized only in cases where it is indicated medically. We give priority for such surgery to women with PTSD of various sorts. In cases of women who have a trauma associated with a previous C-section, we perform a ‘friendly cesarean,’ which is similar to the French method in terms of the exterior envelope” – that is, without the mother’s hands being tied, in the presence of the partner, a transparent screen and with no separation between mother and newborn during recovery.
From the point of view of the mother’s recovery from the surgery, it’s not similar at all [to a regular procedure].
After my first time performing it, I was very excited at the professional level, but the big boom came three hours later, when the mother got off her bed, stretched and moved about freely. It’s unbelievable.
“The recovery from the French operation is amazing, it’s really not the same thing. After my first time performing it, I was very excited at the professional level, but the big boom came three hours later, when the mother got off her bed, stretched and moved about freely. It’s unbelievable. From my viewpoint, to give the mother a remedial experience, or a positive experience of surgery altogether, is the peak. That’s why I became a doctor.”
You are continuing to perform regular C-sections daily. How do you feel about them now?
“I still use the C-section as a good tool, when needed. If circumstances permit, I will prefer to use the French method, but I and everyone else here have to know how to perform the regular procedure, because it can save lives. It’s true that the French method does not take significantly longer than the regular surgery, only a few minutes, but those minutes are focused on the actual delivery, and that is the critical part.”
Moskovich dismisses criticism raised by opponents of the French method: “It’s hard for people to accept new things and to leave their comfort zone. In addition, people look at things through their own prism. When a gynecologist enters the delivery room, he doesn’t necessarily think it’s part of his role to please the woman, but must use the tools at his disposal in order to deliver physically healthy infants.
“The incision in the French method is slower and more complicated, via smaller cuts, so it is not suitable as an emergency operation and it also can’t be performed by residents, only by specialists. That involves a very large investment. Still, I don’t understand physicians who don’t even want to come to see the operation. Hey, doesn’t it interest them? Why not try another method? It’s hard for me to understand that stubbornness,” Moskovich says.
To which Dr. Hendler adds, “There are skeptical physicians who come to see an operation and get excited about it. To learn, you need to forgo the ego.”
Prof. Tal Biron-Shental, chairwoman of the Israel Society for Maternal-Fetal Medicine and director of the Gynecology and Obstetrics Division at Meir Medical Center in Kfar Sava, provided these comments: “There is no good and reliable scientific proof that the different [French] surgical method hastens recovery. The French procedure is not new, but it has made the headlines recently in Israel thanks to the marketing approach to this cesarean surgery as being a childbirth experience from the mother’s perspective.
“First, the general attitude toward the woman in labor reflects a good and correct experiential approach, which is seen in many hospitals, in C-section deliveries that take place every day. Of course, the public health system has no possibility to allocate to every women in childbirth a physician and a midwife who will accompany them personally, as is done in the private system.
“Second, suturing the skin using dissolvable stitches or surgical adhesives, and not pins, provision of sufficient painkillers and allowing mobility soon after surgery improve the substance and pace of recovery, and are used today in all forms of surgery – not only in the French cesarean.
“In addition, the surgical technique used in the French method differs from that of conventional C-sections, and it has not been proved to be advantageous in the professional medical literature. Objectively, given the existing medical information, the French surgery has no advantage and is in dispute, regarding some issues. For example, its need for the use of forceps to extract most of the babies. There are at present no scientific publications that compare the [two sorts of cesarean] operations and sweepingly prove the advantages or disadvantages of the French surgery, so the subject needs to be examined cautiously.
“The desire to attract women who are about to give birth to hospitals leads us all to take an active role when it comes to every possible marketing means, including stipulating a range of benefits for the women. This includes their autonomy to take part in the decisions about conducting their birth and its course. As part of the hospitals’ marketing efforts, the French surgery has also entered the public health system.”
The Israel Midwives Association: “As a trade union that represents 1,300 midwives in the country’s public hospitals, as well as home and community midwives, we believe that the childbirth experience needs to change according to the spirit of the time and to progress, for the benefit of the women.
“We are in favor of the possibility of offering a choice, as this can give childbearing women a better feeling of being in control during the delivery. At the same time, in light of the fact that this is a new method that needs to be grounded in scientific evidence, and whose advantages and shortcomings must be carefully considered, caution is required in applying it in practice.
“We will be happy to hold a professional discussion on the subject in the Midwives Association together with the Israeli Society of Obstetrics and Gynecology and the Ministry of Health, in which the emphasis will be on the professional medical aspect and the emotional-experiential aspect, for the benefit of the childbearing women in Israel.”
The Clalit HMO stated: “The subject is being considered as part of the supplementary ‘Clalit mushlam’ insurance plan.”
Automatic approval of subscriber comments. From $1 for the first month