Creating new life while lives are lost: birth in the face of war in Israel after the October 7 attacks

On 7 October 2023, Israel underwent a sudden, brutal attack. More than 1,100 individuals, most of them civilians, were slaughtered, many in their homes. Immediately thereafter, a war began. Over the past six months, Israel has been fighting on several fronts with hundreds of thousands of soldiers deployed. Additionally, over 100.000 Israelis are displaced, evacuated from their homes near the frontline. Taken together, these events have created the most severe mental health crisis Israel has ever known (Levi-Belz et al., 2024). In this paper, we wish to explore the implication of these dire circumstances on childbirth in post-October 7 Israel. We take a bottom-up approach, basing our text on real-time reports of OBGYN physicians (i.e. four co-authors of this paper – I.A., M.O., G.Y.S.) working in different general hospitals in Israel.

While birth outcomes and perinatal mental health may be negatively affected during war, research on this topic has been relatively scarce (Davis, 2014; Torche & Shwed, 2015). Most studies have not followed the unfolding of events and their impact on obstetric psychosomatics from the acute to the more chronic posttraumatic phases. Furthermore, most studies have been limited to birthing individuals directly affected by the events and were conducted in low- and middle-income countries, with outcomes compounded by healthcare quality and availability (e.g. Bouchghoul et al., 2015; Simetka et al., 2002).

The case of post-October 7 Israel is unusual. Israel is a high-income country, with high-quality, accessible healthcare. However, exposure to war and its repercussions is extremely high. In addition, Israel is very small, and its society is tightly knit, leading to multiple secondary exposures. Finally, Israeli culture is family-focused, with high birth rates as compared to other OECD countries.

Below, we discuss several aspects of birth and war in Israel over the past six months. We examine how the current war has affected those giving birth, the staff treating them, the work environment in the hospital, and more. We will begin each sub-section with a short description of the war’s implication, followed by an example provided by one of the authors working in a maternity ward at this time.

Initial response and the acute phase

The unfolding of events on October 7 slowly permeated delivery rooms throughout the day. Staff and patients underwent highly stressful experiences within the acute phase, strongly sensing a state of emergency, fear, and a threat to personal safety. For example: ‘many of us noticed high arousal among birthing women – in their body language, and in the nature of their questions. Some had partners in military reserves, and more women were forced to come with their children for follow-ups’.

The chronic phase

Within a month or so, a transition to a state of chronic stress, and specifically into the posttraumatic phase, was evident. Staff began reporting psychological difficulties, including PTSD symptoms, guilt and moral injury, burnout and compassion fatigue. General energy levels in delivery rooms were not the same as before, and signs of joy decreased.

Some displayed outright posttraumatic distress: ‘a midwife described to me that mainly she experienced flashbacks from the horrific events on 7.10. Every time she saw large amounts of blood on the floor or on the bed, she recalled the events from “there”’.

Despite such difficulties, some staff members described attempts at meaning making, or what could be regarded as initial signs of posttraumatic growth (Beck et al., 2017). For example, a midwife who shared that she felt different than usual regarding the birth of a baby, with broad social context for a new life in the face of collective loss and tragedy.

The presence of war in the delivery room

Due to the mandatory draft in Israel, most civilians are ex-military personnel, with the months following October 7 seeing approximately 30% of men between the ages of 20–40 drafted, alongside civilians of other genders. In addition, there are many more men and women in the midst of their mandatory service. This naturally led to the presence of soldiers – fathers, mothers, and family members – in maternity wards. This presence was felt not only during routine births, but also during complicated, traumatic births, and even stillbirths, occurring with the looming possibility of continued separation from the drafted partner following birth.

Changes in birth plans and procedures

Due to drastic changes in one’s sense of safety, in the ability to travel, and to make long term plans, birthing also changed. This was evident in many ways, for example in women’s choice to give birth closer to home (and not in remote hospitals). Other women felt the need to postpone labour, in hope that significant others, either drafted or taken hostage, would join them. Other noteworthy changes also occurred. As one physician stated: ‘Some staff members felt an increase in the number of women who arrived beyond week 40–41, with a feeling … as if they “didn’t want to give birth”, as often occurs in nature during unsafe situations’.

Conclusions and final comments

For the sake of brevity, we will merely note that other changes in maternity wards were also apparent. These include a sense of increased stress and worry among medical staff, a significant reduction in the workforce (due to military recruitment), and unexpected clinical decision making (e.g. providing anti-anxiety medications to both birthing women and their drafted partners).

Birth is often a joyous, emotional experience. However, it is also a stressful event, that may entail a sense of threat and anxiety (Heyne et al., 2022). When accompanied by war and a compromised sense of security, birth becomes even more powerful for all involved, both by augmenting stress and by enhancing the symbolic aspects of birth, as an event in which new life is met with celebration. Following October 7, this mixture of life and death, hope and despair, was highly confusing and potent. We hope that the case of Israel would help shed light on the sensitive issue of birth during war. Unfortunately, such circumstances characterise many places across the world, in the middle east, and beyond (Bogdanova, 2022).

Disclosure statement

No potential conflict of interest was reported by the author(s).