Institutionalisation and professional dynamics in home births: insights from a STSM comparing Israel and Portugal

Abstract

The aim of this paper is to explore some of the professional dynamics around home births in Israel and Portugal, in a comparative analysis. Institutionalisation of home births is recognised for its advantages, including making home births safer. In Israel, home births are more institutionalised than in Portugal: there is a dedicated guideline issued by the government; and licensed home birth midwives are affiliated with an association that can work as a community of practice, at the same time as it mediates the communication between these midwives and other health professionals, and between these midwives and the state. However, Israel also serves as an example of how institutionalisation may also lead to intra and inter-professional conflict and further limitation of the autonomous practice of midwives. The involvement of key stakeholders in the process of institutionalisation, including users, on the definition and review of regulations and guidelines seems vital for an adequate integration of home births in the wider health system.