Ilana Shemesh: Israeli homebirth pioneer founds birthing center for Ugandan Jews

This is the story of a timid child who grew up to brazenly fight the Israeli medical establishment and then trot off to Uganda to set up a birthing center under dauntingly primitive conditions.

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Ilana Shemesh, 70, has been a trail blazer. She was on the first plane-load of volunteers to Israel at the start of the Yom Kippur War in 1973, leaving her college studies at Rutgers to do so. “And that was it!” she laughs. “I stayed here ever since.”

After having married and established a family in Israel, she became a torch bearer for home births in this country and then, after retirement, she set up the Shifra and Puah Maternity Center for the Abayudaya, the Ugandan Jewish community near Mbale, named for the first Hebrew midwives. There are mezuzot on all the doors and each room is named after one of the matriarchs.

Nobody could ever have foreseen that the cry-baby asthmatic kid who needed her mother beside her for months in kindergarten and, afraid to go on the school bus alone, would again need her mother to accompany her for months on the bus in first grade “would end up living far from the family and become a nurse” and, not only that, would end up traveling alone in a bus six hours from Kampala into the Ugandan interior to meet the remote Abayudaya community and establish a birthing center.

At the end of our conversation, Shemesh told me a story, a by-the-way-type of story that made me laugh because it actually does foreshadow the adult woman she grew up to be. But I’m going to make you wait for that story like Ilana, inadvertently and unintentionally made me wait for something to which she had not attached any particular personal predictive value.

I first wanted to know how Shemesh got the idea for home births because it was unheard of in Israel when she began.

In my midwifery course, in 1981-82, there was a girl from California who was a labor and delivery nurse. After every lecture, she said, “You know, that’s really not true. You should read this book and that book and this magazine, and all these radical childbirth books.” So I read everything and I was shocked. I became a big troublemaker in my midwifery course.

I was shocked at the conditions women were delivering in. It was the first time I heard that there are ways to give birth with more dignity, that women can be in control of their birthing experience, that you shouldn’t cut every woman or take away the baby. Women should be mobile and not fasting. 

[With furrowing brows, Ilana continues,] Women were giving birth in a large room with curtains between the beds and they weren’t allowed to bring in anything or anyone. They were being given valium and demeral – epidurals were just beginning then – and they were ‘out of it’ and och, it was terrible. And everyone was in stirrups. Babies were taken away and there was no bonding.

Did any of your peers agree with you?

No. No. From the day my eyes were opened until I retired, I can honestly say I was fighting the whole way. Then, when I started doing home births, I was totally in the closet for the first few years. At Assuta, I was the first midwife who was allowed to do births privately. I got a lot of flak from the doctors but I was bringing money into the hospital.

When I moved to Misgav Ladach, which was much more natural birth oriented, I set up the first home-style birthing room. I was also doing home births then. When I moved to the moshav where I currently live, I opened a birthing center in my backyard with two units for those who wanted to give birth not in the home, but not in a hospital. After Misgav Ladach closed, I only did home births and births in my clinic. I did hundreds of births there. I did prenatal care. I had wonderful experiences. It was the passion of my life.

You get addicted to the thrill of the birth. But it was hard. I was on call for 30 years. It was hard on my family. It was also hard on me physically and by my mid 60’s it was just getting too hard to get calls in the middle of the night and I would have to wake up my husband to help me load up the car with my equipment. In 2014 or 15, they passed a law prohibiting a midwife from delivering in any facility except for the woman’s home or in the hospital. So I decided to retire.

How did your Africa adventure come about?

All my life I had wanted to volunteer in developing countries but I could never do it because I was on call. After retirement, I looked for places to volunteer and found you have to pay a lot of money for the privilege. Then, on a website for traveling midwives I saw an announcement from a Canadian NGO that had started a birthing center in Uganda saying a midwife was needed for July as all the midwives were going on maternity leave; the volunteer fee was waived.

I said I’m going. So I went. I worked there for a month. That was in 2017.

I went alone. My husband agreed. He’s great.

Well, after 30 years of being on call with you, I think the quiet may have been appreciated …

[Ilana laughs heartily.]

So I went, and let me tell you, it was the experience of my life. It’s a whole different midwifery. It’s about 2 hours from Kampala, very primitive, with no running water or electricity. But when I visited the local hospital I saw that the birthing center was way better than the hospital.

Describe what you saw the first time you came to the birthing center.

The building is nice, stucco, in a big grassy area. The first thing I saw was a bicycle with a bed attached to it. I was thinking “what’s this?” It’s to get a woman from her mud hut to the birth center in emergency situations. There’s a waiting room, an office, two delivery rooms, and another room with about six narrow cots where the women stay with the baby after delivery.

Next to the delivery room, there’s a room with a toilet and shower but they were broken. There were pit toilets outside and that was very hard for me. There was another big pit, called the placenta pit, where you have to throw the placentas after delivery.

The midwives do everything. The women never see a doctor. The midwives do prenatal care, the delivery and postpartum care and they take care of the babies up to a year, giving immunizations, something like Tipat Halav [Well Baby Clinics]in Israel.

The mothers have to bring their own sheet and a government issued momma kit that she has to buy. It includes two pairs of sterile gloves for the midwives, ties and a disinfectant for the umbilical cord, a razor blade, a big roll of cotton wool as there are no sanitary pads, and a piece of plastic to lie on.

In Israel, you lie on an absorbent pad that you throw away after and the instruments are sterilized in the hospital. There, the all the fluids from the birth are on this nylon and a big job for the midwife is the art of scooping and dumping: you hold a kidney-shaped basin to catch the fluids as they are coming out and you have a pail and you dump. Catch and dump.

In the beginning, I was missing everything and making a mess. The midwives were annoyed with me until I learned.

Then you have to boil the instruments. You have to gather wood and you make a fire. Collected wrappings of the vaccination syringes are used as kindling. You put the instruments in a soapy solution, then bleach, and then boil them. You have to take them out of the boiled water using a folded banana leaf as a pot holder.

There are no monitors or Dopplers but I had brought my own Doppler.

Midwives and volunteers lived in the midwife house – rooms with tiny beds, pit toilets outside and one sink outside for everyone. All the others were in their 20’s. I said to myself, this is going to be a problem! And I asked if there was a guesthouse. For $10 a night, I had a nice bed, a western toilet and a hot shower.

It was a half-hour walk from the guesthouse to the birth center. I passed by cattle with huge horns and had to cross a stream of murky water. It was scary to cross. I was always afraid of falling in there. I was a big attraction – I’m white, blond and old. Kids would wait for me every day and sing and bang on bottles and call out ‘mzungu’ [white person].

How did you come to establish a birth center in the Jewish villages?

I was always interested in Jews in remote places. When I knew I was going to Uganda I made contact with the rabbi and when I finished in the volunteer position, I took a six-hour bus to the city of Mbale, the third-largest city in Uganda. The bus stopped half-way for a relief stop – a find-a-tree stop.

About 2000 Jews live in seven villages around Mbale. I stayed at the guesthouse in one of the villages. There are synagogues in the villages and Christians and Moslems also live there.

In the 1970s, the American conservative community sent over rabbis who converted them. About 100 years ago, their chief, who was a well-known leader of a large tribe that, like many Africans, had been converted to Christianity, read the First Testament and said “we have to follow what is written – why are we doing the Sabbath on Sunday? We have to do this on Saturday.” He wanted to follow what was written in the Bible so he circumcised himself and his sons. All his followers were circumcised and they started to follow the Sabbath. They still believed in Jesus but others called them Jews so they agreed that they were Jews. Then there was a Jew from Iraq or India and he came to live with them for a few months and taught them about Judaism. He had them take Jesus out.

They are not like a lost tribe – they converted into Judaism. They wanted to be orthodox and in the 1960s, Israel had an ambassador in Uganda and he heard about them and tried to connect between them and Israel. The orthodox in Israel did not want anything to do with them.

The Americans built the synagogue, the health center, the guesthouse. They are considered Jewish by the conservative and reform. Rabbi Riskin went there and converted two of the villages by Orthodox conversion, but his conversions are not recognized in Israel either.

Some have been to Israel and there is a man on Kibbutz Ketura who has been denied citizenship. He converted a year before the village was officially recognized by the conservative movement.

When you were there, did you feel like you were living among Jews?

Yes. They are extremely Jewish. They are so proud of their Jewish identity. They all wear kippot. The synagogue is beautiful. It is the most spiritual and meaningful service that I have ever been to. I love the services; they sing, they dance. The whole community comes – not just a bunch of old folks like us here – half Anglos – in the conservative shul in Rehovot.

They read from the Torah. They also sent one of their leaders to the USA to get ordained in a rabbinic school in California. And he spent a year in Israel. He’s the only officially ordained native African rabbi on the continent.

Tell us about setting up the birth clinic.

The birthing situation in the Jewish community was a disaster, according to the rabbi. The government wanted them to go the hospital. Home births were illegal and, in any case, giving birth in a mud hut was not advisable. The local hospital is horrible and women and babies were dying. So I asked if he would like me to open a birth center now that I know how to do it under African conditions. “If you can equip the rooms,” he said, “I can give you three empty rooms on the upper floor of the health center that serves the Jewish community and everyone else in Mbale.” The lower floor of the center operates similar to a Kupat Holim clinic.

We anticipated we would need a budget of $6000 to equip the rooms so I returned to Israel and did a fundraising campaign. I returned to Mbale the following year, 2018, and saw that there were problems with the plumbing and the electricity and I realized we needed way more money so while I was there I did an emergency fundraising and raised another $7000 and we opened after a month. We were connected with a charity that supports the Abayudaya and now with the Rehovot conservative synagogue as well, so we can give tax receipts for donations.

The birth center has lovely rooms, with pictures on the walls, bed spreads and curtains, and each room has a toilet and a shower. Nothing like this exists in rural Uganda. We had a big celebration with people from the health ministry and village health workers. There was a birth that very night.

We figured that the birth costs $5 and with the women paying, it would be self-sustaining. I went around speaking in the villages to promote the birth center.  

Shemesh promised to treat the women with respect and in a totally different manner from what they were accustomed.

I told them that we’ll never slap them. In the hospital they slap the woman if she makes too much noise. I hired local midwives and I had to instruct them to treat the women with love and dignity and you never ever slap them. I have signs up: Treat women with love and dignity and honour and respect. They were taught by the doctors that if she is making noise slap her.

Ilana Shemesh doing outreach in Uganda. Image used with permission.

The doctors make the women lie on their backs and they make them push very aggressively, saying if you don’t push harder, your baby’s going to die. Things like that. So I teach them to empower the women, but I’m not sure if they keep it up when I’m not there.

At the beginning women were not coming. Nobody had the $5 to pay for the birth. So I wondered if we should just close or totally subsidize the births and we decided to offer totally subsidized births. Again, I had to go on another fundraising campaign to maintain this. I got a donor who gives a yearly donation but now, with more births, 20-30 a month, this is not enough. The Jews are not giving birth as much as the Christians and Moslems because they are now using contraception.

The administrator is the rabbi’s niece. She’s intelligent and has a college degree. One midwife is Christian and one Moslem.  I had to hire two more midwifes. We got a nice donation and were able to purchase an ultrasound machine. The women have to pay for the ultrasound but they cannot afford it, if it is an emergency, we will pay for it.

While most women still deliver in the hospital, the clinic has really taken off, but I have the constant problem of sustainability. The people are too poor.

I now go once a year for a month.

I have also started a volunteer program where volunteers pay for their travel and accommodations. And we are developing a program for Israelis to volunteer in the Jewish primary and secondary schools. The schools are run by the Jewish community with help from the Americans. They teach Hebrew and love of Judaism. It’s very Jewish. Christian and Moslem pupils also attend and they are excused from the Judaism and Hebrew classes.

How do the Abayudaya respond to the fact that Israel doesn’t recognize their conversion?

They’re not happy about it but they’re very mild people and they are hopeful. The young people would like to make aliyah. I hope they can because there is no future there. Most of them have high school diplomas but they don’t have the money to go to college. There is a lovely girl there, so intelligent. She leads the services and reads from the Torah. She wants to go to medical school but she’ll never be able to afford the tuition.

They suffered terribly during Idi Amin’s time. It was illegal to practise Judaism. The synagogues were burned and some were in jail. The rabbi was in jail. He’s probably in his 50s. His daughter is a pharmacist and his is son-in-law got a scholarship and is now studying in Ziegler to be a rabbi. There is one Jewish doctor.

They are attached to the place. It is a beautiful community. They celebrate the holidays together. In their prayer, a lot of the songs are translated into their local language, and there is a drum accompaniment. There is no Jewish cemetery; they bury their dead in their backyards.

You are so happy when you talk about your experiences with the Abayudaya and the birthing center.

These are the two passions of my life – midwifery and remote Jewish communities. And I like adventure and crazy things and this was good for me.

How long do you see yourself continuing to travel to Uganda?

I don’t know how long I can do this trip. This last trip was very difficult for me. I got there and I saw rats. Up on the second floor. Everybody, apparently, in Uganda has rats. And there is no cat. That freaked me out. You cannot have rats – they can bite the babies and they ruin things. The mentality is also difficult What should we do? We cannot put poison because the midwives bring their babies and you have all these toddlers crawling around. Finally someone brought a young kitten which was there for 4 days and disappeared. And then I go into the guest house and there’s a snake in my room.

Then, when I asked about her childhood, Shemesh claimed there was nothing there that foretold her adult adventurousness. And then stories emerged that hinted otherwise. Firstly, her father, who she credits with having had a positive influence on her with his confidence building attitude:“if you really want something you can do anything.”

About being a troublemaker, she said she did not grow up a troublemaker but “I had this keen sense of justice and injustice and it really bothered me the way women were being treated, with the lack of choice.” When I asked where she got this from, she said, “I guess from my father as well. He was always writing letters to senators protesting this and that. So I guess from him.”

Could her interest in remote Jewish communities have come from her father as well?

My father was active in NACOEJ (North American Conference on Ethiopian Jewry) both in the USA and in Israel. He helped Ethiopians raise teff [a grain staple in their diet] in Israel and he brought over sewing machines and started a sewing center. My father did a lot of business in Africa and when I was a teenager, about 17, I accompanied him on a business trip to Kenya, Tanzania and Zambia. I did not at all think of going back to Africa in the future.

Then she spoke about her grandmother, with whom she had a close relationship. She would listen to her mother and grandmother talking for hours in Yiddish even though the story she then told me she says she was told only after she was already a midwife:

My grandmother was a very strong woman and she had 4 of her kids in Israel with a midwife at home. In America, for her 5^th child, she was told she had to go to the hospital. And they had this high bed and she did not like what was going on at all and she ran away from the hospital and went home and she made the doctor come to her house and deliver her there. My mother, who was 11, assisted at the birth. And it was a breech birth.

My mother remembers everything. She said “you’re like bubby.”

Describing her mother as a nurturer, it seems, all in all, that Ilana Shemesh is an apple who did not fall far from the roots of the couple who brought her into this world.

Feature image used with permission.

This article was originally published in Israel National News.