Is it Better to Buy or Lease a Car After Bankruptcy?

If you want to get approved at the best possible terms when buying a car, it’s important you know a car lender’s credit guidelines before you apply for credit…especially if you’re bankrupt.

It will save you time and frustration–but more importantly, it will help you avoid credit inquiries that may lower your FICO credit scores up to 12 points per inquiry.

Step 1 in making a lease or buy decision is to determine a lender’s credit guidelines.

You start by asking if they lend to people with a bankruptcy. If so, on what terms?

That’s right. You have to be upfront that you’ve filed bankruptcy. Don’t hide it. We have to face the fact that some dealers just won’t work with people who’ve filed bankruptcy. So our job is to find the ones that do.

Some lenders will only lease to people with a bankruptcy. Others will only offer purchase financing. Yet still others will only lend using a hybrid of the two–this is especially common in Texas.

Ask the finance director at the dealership to direct you as to what structure the manufacturer prefers.

And here’s a quick tip for you: if your bankruptcy doesn’t appear on the credit report your lender pulls–then, in the eyes of the lender, you’re not bankrupt.

The only lenders I would consider using are:

– First choice: Captive lenders (car manufacturers)

– Second choice: Banks (not finance companies)

– Third choice: Credit unions

Ninety-nine percent of the cars I’ve leased over the years have been with captive lenders. Just one was leased by a bank.

That particular deal came from a conversation I had with Amy, the finance manager at the local Land Rover dealership here in Indianapolis. I told her I was open to her financing recommendations, but I preferred financing through the car manufacturer.

I told her my current FICO scores. She immediately said that with my scores she could do better through a local bank. I signed a credit application and told her to go for it.

Article Source: http://EzineArticles.com/361234

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How to Attract, Hire and Retain Millennials in the 21st Century

For years, there has been talk among employers regarding the influx of millennials into the workforce. I recall a conversation that I had several years ago with a friend that managed the local branch of a bank. He was very frustrated with the turn-over rate in his branch and he began to tell me how difficult it was to get this “new generation” to play by traditional corporate rules. Moreover, he was wrestling with some of the “suggestions” that had been given to him by some of his employees, which were millennials. They included changing the dress code from business to casual and changing their work hours from 8:30am – 5:30pm to 10:00 am to 4:00p, because they simply could not get to work by 8:30am. I have to admit that I was appalled. I could not believe that these young people were making such demands and I vividly remember that after finished my rant regarding their suggestions, my friend quietly said, “This is what they want and we may have to appease them.”

Research has shown that in 2014, millennials accounted for 40 million people in the workforce, and they are set to become the nation’s first hundred-million-member generation. Moreover, they are influencing not only the way they will work but also the way everyone else in the workforce will work. The problem is that many employers still don’t understand this new generation and the value that they bring to the workforce. Therefore, many either consciously or sub-consciously fail to attract millennials or Gen Zers to their companies. However, for companies that want to be the best in their industry, failing to attract, hire and retain A-players, many of which are millennials, will be detrimental to the success of the companies.

Based on the way millennials have grown up, they adapt well to change, are technologically savvy, and are very creative. Millennials are also highly-skilled and highly-educated. Research has shown that millennials are continuous learners, optimistic about the future and one of the most diverse generations ever. They are team players, results-oriented, and socially conscious. Moreover, they want to be challenged in their work, understand the relationship between their work and the overall mission of the company for which they work, and receive constant feedback and appreciation. Finally, they want flexibility in how and when they work; rapid career progression and they expect their managers to be engaged with in the process.

Article Source: http://EzineArticles.com/9236519

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The Sports and Hobbies of Mozambique

Mozambicans are quite passionate about their sports; with a firm focus on soccer and to a lesser extent other sports. There are lots of opportunities for hobbies and recreational activities, but as these can be quite costly at times you will find most Mozambican’s aren’t able to partake. As with most other facets of this beautiful country, the lack infrastructure combined with the poverty levels have had a profound effect on the development of sports and hobbies through the entire land.

As a result of this, many of the most popular sports are those that don’t require much money to play.
Soccer

Soccer, sometimes known as football due to the Portuguese influence, is hugely popular in Mozambique as in other African nations. You will often come across both children and adults having an informal game whenever possible, especially on weekends. The structure for proper club soccer is not as good as in other countries due to infrastructure challenges, but there are still some professional clubs about. There is a lot of exchange between Portugal and Mozambique in soccer terms, with players and teams from each country regularly playing with and against each other.

Athletics

Athletics is a sport that is not a widely practiced as it should be, given the relative ease of getting involved. Mozambican does at times punch above its weight in this field of sport, having won a gold medal in the 2000 Sydney Olympics proving that they can compete at the highest level.

Basketball

Unlike most other southern African nations, Basketball is a very popular sport in Mozambique. While being internationally recognized since 1978, the Mozambican national team has yet to win any notable championships. This of course hasn’t dampened the enthusiasm for the sport and it is still quite widespread.

Capoeira

The martial art sport of Capoeira is starting to take off in Mozambique, with the popularity growing at a rapid pace.

Article Source: http://EzineArticles.com/9014222

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Three Good Hospitals in Baku

The Republic of Azerbaijan is one of the previous constituent republics that made up the United Soviet Socialist Republic or the USSR. The country is located in Transcaucasia, on the shores of the Caspian Sea. It has Russia, Georgia, Armenia and Iran, as its neighbors. Azerbaijan underwent a lot of political assaults and disputes. However, as of late, it has come out of its past and is gradually developing an independent economy, by banking on its oil and gas resources. The healthcare industry is not very well developed, but it has come a long way from the past.

The country has Baku as its capital city. Baku is a top tourist spot and draws huge numbers of visitors, from all corners of the world. The medical facilities are among the best available in all of Azerbaijan. There are both public hospitals as well as privately run clinics in Baku. The public hospitals house ample beds but suffer from lack of adequate practitioners or related staff. However, for basic treatment tourists can seek the aid of these public hospitals.

The private clinics are a better option for more specialized treatment and complications. These clinics along with few international hospitals offer up to date, quality treatment to their visitors. There are separate wards for accidents and emergencies as well. The doctors are well qualified. The hospitals have labs attached that give accurate test results. The nurses are well trained and extremely caring as well. The hospitals have a sufficient number of beds. However, patients are recommended to bring their own basic toiletries as Baku clinics often fall short in that area.

Language seems to be the main concern of foreign patients of Baku hospitals. As of late it has been observed that many Baku doctor are comfortable conversing with their patients in English. It is, however, always safe to get in touch with your respective embassies, in order to obtain a list of doctors who speak your language.

The most popular hospitals and clinics among tourists visiting Baku are Western Medical, Turkish-American Medical Centre, Oil Workers Hospital, Mediclub Centre, Mediclub Paedriatic, German Medical Hospital, and Central Clinical Hospital.

MediClub Centre:

More than a traditional Hospital, the MediClub Centre can be branded as a complete medical assistance organization. Tourists can receive excellent treatment at MediClub Centre. The doctors and staff are very conversant in English, the wards are clean and there are specialized departments to treat various types of illnesses. The food served at this center is of great quality and the help lines to the clinics are open round the clock. The ambulance service is very active and will be able to provide emergency transportation easily. The doctors and nurses take proper care to ensure the satisfaction of all of their patients. All that expats need to receive care from this center is a card that allows them to access the quality services on offer by the MediClub group.

German Medical Hospital:

Set up under German authority, the German Medical hospital is one of the leading medical service providers in Baku. The staff members are well qualified and trained in the western methods of medicine. The facilities are up to date as is the equipment which is state of art. Tourists may also come across staff who possess a working knowledge of English.

Turkish-American Medical Centre:

Dating back to 1998, the Turkish-American Medical Centre is one of the most modernized medical centers that caters to tourists and residents alike. The treatment methods, labs and facilities are all at the latest standards. The staff and doctors are committed and well qualified. The hospital has departments for almost all aspects of medicine and diseases.

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Jerusalem’s Best Hospitals

Jerusalem, the capital of Israel, lies in the Judean Mountains nestled between the Mediterranean Sea and the Dead Sea. Together with East Jerusalem it forms the largest city of the country. It is a great tourist attraction for religious and cultural reasons.

Bikur Cholim Hospital is situated in the heart of the city at the junction of Strauss and Hanevi’im, Jerusalem, 492. It was set up in 1826 and over the years it has emerged as one of the largest and most important hospitals of Israel. The branches of medicine for which the hospital offers treatment are surgery, pediatrics, ENT, internal medicine, obstetrics and gynecology, nephrology, neurology and urology. The hospital also has an Alternative Medicine Clinic, Neonatal Intensive Care Unit, Baby Welfare Clinic and a Women’s Clinic. The emergency department at the hospital offers quality services to its patients and is also the largest emergency department in Israel.

The Shaare Zedek Medical Center located at Jaffa Road is a century old hospital that provides high quality medical care. The hospital started as a modest healthcare center with 20 beds and is now a modern hospital with state of art infrastructure. It is a multidisciplinary hospital of international repute which specializes in the following fields: cardiology, cardiothoracic surgery, women’s health, medical genetics, neonatology, pediatric neurology, oncology and palliative medicine, laparoscopic surgery and Gaucher’s Disease. The Emergency Department at the hospital is well equipped and this department includes the Kennedy Leigh Trauma & Resuscitation.

The ALYN Pediatric and Adolescent Rehabilitation Center was set up as a voluntary organization by Dr. Henry Keller, an American orthopedist in 1932.  The multidisciplinary hospital is dedicated to providing modern and advanced care to children. The hospital provides an array of medical and paramedical services that include physiotherapy, speech therapy, rehabilitation, cerebral palsy, acquired brain damage, respiratory disorders, and psychosocial problems. It is also is the leading pediatric orthopedic clinic in the country treating both simple and highly complex cases. 

The St John of Jerusalem Eye Hospital Group is part of the Foundation of The Order of St John which is the oldest charity in the world. This hospital is known for its high level of services and specialization in eye related ailments throughout the West Bank, Gaza and East Jerusalem. The hospital has an ISO accreditation and is staffed by well trained doctors and paramedical staff from within the country and from offshore countries as well. This modern hospital runs a 24 hours emergency room and also runs an outpatient department and treats patients regardless of their ability to pay. The hospital specializes in Retinal, Corneal and Pediatric services. The address and telephone number for the hospital are; Nashashibi Street, Sheikh Jarrah, Jerusalem 97200; Tel: 00 972 (0)2 5828325    

Hadassah’s Medical Organization has two medical centers at Jerusalem; one is at Ein-Karen and the other is at Mount Scopus. Both the hospitals have a large team of doctors and support staff which makes them ready to deal with all kinds of medical emergencies and routine procedures and care. The Hadassah is known for its proficient services and contemporary infrastructure. Both the centers are multidisciplinary and the medical branches for which they provide services are orthopedic surgery, neurosurgery, oncology, rehabilitation, dermatology, E.N.T, endocrinology, hematology, genetics and metabolic disease, bone marrow transplant and psychiatry. The hospitals are also outfitted with Emergency Rooms, Trauma Units, Pain Clinics and Blood Banks. The Emergency Department at Ein-Karen provides comprehensive and quick care to patients for a large range of medical problems and is supported by modern technology. The Mount Scopus Emergency Department receives a large number of patients each year owing to its highly specialized care especially in the neurological and cardiac surgery field.

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Survey Shows US Families Who Can’t Pay Hospital Bills Still High

A study by the The Commonwealth Fund, a private institution in the United States which seeks to promote a better health system, showed that a third of American adults forgo a visit to the hospital because they either have no insurance or a plan that is inadequate for their true needs. Those who seek medical care and pay their hospital bills did not end up any better anyway because they have no money to purchase medicines. Contrast that with some areas in Europe such as United Kingdom and the Netherlands, for example, which boast of just 5-6 percent slippage in the number of patients in population who failed to seek medical care due to insurance concerns.

The same survey showed that one in five adults or about 20% in the US could not pay hospital bills. You know what’s the second developed country in the list? France, with a measly nine percent. The issues don’t stop there because the U.S. also has one of the highest out-of-pocket expenses-meaning the amount patients pay before insurance kicks in-for medical bills in the world, right up there (or to be more specific, right down there) with other third world countries with poor government allocation for health service.

The study compared the health care systems in 11 countries like Canada, Australia, U.K., Switzerland, Sweden, Norway, the Netherlands, Australia, France, U.S. and Germany. The gap between the rich and the poor has more impact on the capacity of the patient to pay hospital bills compared to other countries where the “haves” usually foot the bill for the “have-nots.”

The report result is nothing new, of course, because it only confirms what most of us already knows: there’s a need to reform the U.S. health system.

The study analyzes findings from the Commonwealth Fund 2010 International Health Policy Survey in Eleven Countries, focusing on insurance and access to health care experiences reported by 19,700 adults from Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States. The study reveals widespread disparities by income within the United States. Lower income U.S. adults were far more likely than those with above average incomes to report difficulty with medical bills and timely access to health care.

“We spend far more on health care than any of these countries, but this study highlights pervasive gaps in U.S. health insurance that put families’ health and budgets at risk,” said Commonwealth Fund Senior Vice President Cathy Schoen, lead author of the article. “In fact, the U.S. is the only country in the study where having health insurance doesn’t guarantee you access to health care or financial protection when you’re sick. This is avoidable – other countries have designed their insurance systems to value access and limit out-of-pocket costs.”

A new 11-country survey from The Commonwealth Fund finds that adults in the United States are far more likely than those in 10 other industrialized nations to go without health care because of costs, have trouble paying medical bills, encounter high medical bills even when insured, and have disputes with their insurers or discover insurance wouldn’t pay as they expected. According to the report, the findings highlight the need for Affordable Care Act reforms that will ensure access to health care, protect people from medical debt, and simplify health insurance.

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Automobile Business Plan – Four Steps to Success

Like other business plans, the contents of an automobile dealership business plan cover four primary steps towards success. These steps are “opportunity”, “capacity”, “activities”, and “results”.

Opportunity

The industry, customer, and competitive analysis in your business plan proves the opportunity. This should identify that customers in your local market are in need of a dealer of the type you’ve chosen to be because competitors are not fully serving their needs, or because their demographics are changing (more population, richer, poorer, more families, etc.) The opportunity could also be that a certain combination of services by your dealership could improve on what competitors are currently doing. The overall industry situation should look ahead to how the car sales market will be doing six months, one year, or more in the future, when the dealership will actually be open.

Capacity

The experience of the management team, your license as a car dealer, and the financial resources the partners can bring to the table cover the capacity of the entrepreneur to jump on this opportunity. Funders reading the business plan expect that there will also be an element of cash missing from the entrepreneur’s capacity at the moment. Otherwise, they would not be reading the plan in the first place.

Activities

Marketing and operations plans cover the activities the company will engage in to bring in car buyers (and car sellers if you are a used car dealer as well), and run the business as efficiently as possible. As a small car dealer, consider how you can make up for this lack of scale, and the cost savings that come with it for dealer chains, through creativity and hard work.

Results

Finally, the projections of business success and financial section of the plan show the results that you and investors should expect. If results take into account the full costs of the methods you’ve described, and include adequate compensation for staff and key team players, readers will be less likely to question elements on the cost side. If your revenue projections are based on reasonable, researched assumptions about the car buying behavior of your local market, then readers will be more likely to accept this side of the projections as well.

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Automobile Dealerships – Valuing Blue Sky

Blue Sky is the intrinsic value of an automobile dealership, over and above the value of its tangible assets. It is sometimes equated to the goodwill of a car dealership.

Most articles regarding the blue sky value of new car dealerships cite a multiple of earnings formula, such as three times earnings, four times earnings, and so forth. The idea that “blue-sky” can be determined by anything times anything is just plain wrong.

Even NADA the National Automobile Dealers Association in its publication entitled “A Dealer Guide to Valuing an Automobile Dealership, NADA June 1995, Revised July 2000 bemuses, in part, with respect to valuing a dealership by using a multiple of earnings: A Rule of Thumb valuation is more properly referred to as a “greater fool theory.” “It is not valuation theory, however.”

In its Update 2004, NADA omitted its reference to “fool”, but referred to the multiple formula as rarely based upon sound economic or valuation theory, and went on to state: “If you are a seller and the rule of thumb produces a high value, then this is not a matter of great concern. Go for it, and maybe someone will be stupid enough to pay you a very high value.”

A dealership’s blue sky is based upon what a buyer thinks it can produce in net profit. If potential buyers think it cannot produce a profit, the store will not sell. If it can produce a profit, then variables such as desirability of location, the balance the brand will bring to other existing franchises owned, whether or not the factory will require facility upgrades, and so on and so forth, determine whether or not a buyer will buy that particular brand, in that particular location, at that particular time.

I have been consulting with dealers for nearly four decades and have participated in over 1,000 automotive transactions ranging from $100,000 to over $100,000,000 and have never seen the price of a dealership sale determined by any multiple of earnings unless and until all of the above factors have been considered and the buyer then decided he, she or it was willing to spend “x” times what the buyer thought the dealership would earn, in order to purchase the business opportunity.

To think otherwise would be to subscribe to the theories that (1) even though you think a dealership could make a million dollars, the store is worth zero blue sky because it made no money last year; and (2) if a store has been making $5 million per year you should pay say 3 times $5 million as blue sky even though you think you will not produce that kind of profit. Both propositions are absurd. If a buyer does not think a dealership is worth blue sky, then what he is really saying is that he sees no business opportunity in the purchase and therefore, in my opinion, he should not buy the store.

Each dealership is unique with respect to its potential, location, balance that its brand brings a dealer group, and condition of facility. The sale is also unique with respect to whether it is a forced liquidation, orderly liquidation, arms length, insider, or a case where an anxious buyer is trying to induce an unwilling seller. There are management factors to consider, length and term of leases, possibilities or non-possibilities of purchasing the facilities and whether or not the factory wants to relocate the store or to open a new store up the street.

In the car business it is impossible to pick a dealership or a franchise out of a hat, multiply its earnings by some mystical number and predict either what the dealership is worth, or what price it would sell for – and it doesn’t matter if you are talking about a Toyota, Honda, Ford, Chevrolet, Chrysler, Dodge, or any other dealership. At any given time one franchise might be considered more or less desirable than another, but they are all valued in the same manner.

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Synopsis of Automobile Industry

It was way back in 1769 when a steam-powered automobile was created for transport purposes. The next important year was 1806, when cars were running on fuel gas and was powered by internal combustion engines. Later electric cars came into the industry during the 20th century; However it became popular only in 21st century when consumers and government were more concerned about low-emission vehicles.

Phases in automobile industry:

• Steam automobiles (Cugnot Steam Trolley)
• Electric automobiles (The Henney Kilowatt)
• Internal combustion engines (Benz Patent Motorwagen)
• Veteran era (Renault Voiturette)
• Brass / Edwardian era (Ford Model T, Mercer Raceabout, Bugatti Type 13)
• Vintage era (Austin 7, Bugatti Type 35, Lancia Lambda, Cadillac V-16)
• Pre-World War era (Alvis Speed ​​20, Ford V-8, Bugatti Type 57, Volkswagen Beetle)
• Post-War era (Morris Minor, Jaguar E-type, Ford Mustang, Datsun 240Z)
• Modern era (Toyota Corolla, Range Rover, Mercedes-Benz S-Class, BMW 3 Series, Ford Taurus)

The largest automakers in US are General Motors Corp., Ford Motor Co. and Chrysler. US ranks third after Japan and China under the list of world's top 20 motor vehicle producing countries.

The future of cars is overloaded with high end technologies which are eco-friendly and cost effective for customers. The auto manufacturers are spending a lot of money in R & D (Research and Development) to create a product that is safer, sustainable, energy efficient and less polluting. Alternatives to fuels like hydrogen cars, electric cars, compressed-air cars, etc are entering the market to give high mileage at low cost which is beneficial for owner of the car and environment too.

Latest technologies like BMW's Turbosteamer, Regenerative braking, Installation of Vortex is used which helps in saving energy and thus cost. To improve the quality and strength of automobiles, the auto manufacturers are replacing steel with materials like fiber glass, carbon nanotubes, duralumin and carbon fiber. Few other technologies like platoons, automated highway systems and vehicle infrastructure integration enhances road safety and traffic flow.

Automobile industry was deeply affected by the recession which recently occurred. However, it is reviving and it will soon come back to normal in the near future.

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Giving Birth in Shaarei Zedek Hospital of Jerusalem, Israel

More pregnant women choose to give birth in Shaarei Zedek hospital, Jerusalem, than any other hospital in Israel. They must be doing something mothers like.

In 2012, there were more than 15,000 births in Shaarei Zedek. This figure does not include any births related to their taking over the management of Bikur Cholim hospital in late December 2012.

In 2013, the combined total of the two locations under their management was over 20,000 births! On average, there were 41 births a day in Shaarei Zedek alone, not including Bikur Cholim.

Shaarei Zedek’s magazine reports that the cesarean rate in 2013 was 11%. Professor Samuelov, the director of the department of obstetrics and gynecology, emphasized that “This is one of the lowest cesarean rates in the country, and the reason for it is that Jerusalem is a very supportive environment for normal birth. We provide assistance and ideal treatment for women who desire to give birth normally, and ensure ways to do it safely. We have a lot of experience, and we have the knowledge and ability to prevent cesareans in certain cases. We make it possible to have a normal birth even after two cesareans, for breech presentations and for twins, something that isn’t accepted in most places.”

As Professor Samuelov notes, “Jerusalem is a very supportive environment for normal birth” because many pregnant women in Jerusalem “desire to give birth normally”. Why is this desire stronger and more common in Jerusalem than it is in other parts of the country? Apparently, the reason is that more women in this locality belong to ethnic groups with a high birth rate. Simply, avoiding an unnecessary cesarean is much more important to mothers who intend to have many children than it is to women who don’t, because of the increased rate of complications in subsequent pregnancies for women with a previous cesarean.

Professor Samuelov explains that his department tries hard to keep the cesarean rate down in order to give pregnant women what they want most. In order to do this safely, Shaarei Zedek provides top-quality medical care, including a carefully supervised trial of labor after two cesareans, and breech births in selected cases.

Supplying what women want means that more pregnant women choose to give birth in Shaarei Zedek hospital, which increases its income, since Israel’s National Insurance Institute pays hospitals very well for births. The fact that Shaarei Zedek officially observes the Sabbath also helps the hospital to attract religious women who have a high birth rate. Two out of three pregnant women in Jerusalem choose one of the hospitals under their management, and only one in three choose one of the Hadassah hospitals. Attracting a greater market share of births is what keeps Shaarei Zedek’s finances in good condition, while the two Hadassah hospitals are having great financial difficulties. As a childbearing woman, you are likely to benefit from choosing a hospital that doesn’t have to cut back on services to patients.

The high birth rate itself provides an incentive to the hospital to keep the cesarean rate down, because the more cesareans a women had, the greater the risk of complications in subsequent pregnancies and deliveries, even if they are delivered by repeat cesarean. Obstetricians in Jerusalem have seen more of these complications than doctors in other places because they serve a population with a high birth rate. Providing the option of regular birth after one or two cesareans for women who want large families prevents a lot of risky high-order repeat cesareans, the kind of surgery that doctors in Jerusalem would rather avoid having to perform.

Presumably, the director of obstetrics in Shaarei Zedek terms Jerusalem “a very supportive atmosphere for normal birth” due to the combination of its high birth rate and competition between the local hospitals.

If it is important to you to participate in decision-making, Shaarei Zedek is very amenable to this. On a recent tour of the delivery suite, without being asked, the midwife leading the tour mentioned the importance of involving the mother in decision-making.

Dr. Abulafia, a retired obstetrician who worked in Shaarei Zedek, in an interview for Shaarei Zedek’s magazine, described the differences between the mother’s participation nowadays and in the past: “The involvement of the childbearing woman has changed noticeably. The accessibility of information, the calculators in the internet, the great variety of medical tests and the modern equipment for imaging and surveillance, have all made the mother into a real partner. In the past it was the doctor who knew and understood, and the patient put herself in his hands. Today, pregnant women come to us with a great deal of knowledge, and this obligates the doctor to keep updated in order to be able to answer any question.”

Shaarei Zedek’s magazine also interviewed the head midwife, Chava Chacham. She too addressed the topic of the mother’s participation: “In the course of the pregnancy, the couple is exposed to a lot of information. In many cases, they ask to be participants in planning the course of the birth and make special requests. We advise mothers to share her desires with us when she arrives at the delivery suite so we can coordinate expectations together. Some women are interested in delayed cutting of the umbilical cord, others request not to bathe the baby immediately. We respect every request. Our staff believes in the autonomy of the childbearing woman’s decisions, and we will do whatever is possible to answer her requests openly and in cooperation. As long as the birth proceeds safely and there is no medical problem, the decision is in the hands of the woman giving birth. There are some women interested in an epidural, others prefer that we decide for them. Many women choose to give birth naturally, and in order to help them to carry out their wishes, some of our midwives took continuing education courses in yoga and relaxation – techniques that help reduce both tension and pain.”

What this means for you as a childbearing woman is that on any given shift, there are likely to be some midwives who enjoy supporting natural birth, and you can probably get one if you request this. If you don’t say anything about your preferences, your midwife may presume that you would like her to recommend when she thinks you would benefit from an epidural. The head midwife of Shaarei Tzedek advises you to tell the staff in the examining room what approach you prefer, natural birth or epidural. If you follow her advice, they will be able to assign a midwife who is most appropriate for you. This will enable both you and the midwife will find the experience as rewarding as it can be.

Only 55% of all women giving birth in Shaarei Zedek request an epidural, but 80% of all first-time mothers get an epidural. In comparison, in hospitals in the center of the country, 80 to 90% receive epidural. One of the reasons for the low rate of epidural usage is that Shaarei Zedek serves a population with a high birth rate, meaning a high percentage of the births there are not first births.

Shaarei Zedek has its own nursing school. Of all departments in a hospital, the quality of the nursing staff is most important in the delivery suite, because medical care during normal uncomplicated childbirth is provided by midwives, not doctors. Having a staff of top midwives means a higher likelihood that childbirth will remain normal and uncomplicated.

You can choose to give birth on their birth stool, which makes the birth more modest and faster and may also be more comfortable for you.

Until recently, Sharei Zedek had three maternity wards with 134 beds. In early 2014, they opened a fourth maternity ward in their new building, with an additional 40 beds. The new ward offers full rooming-in, in which the baby is next to his/her mother almost all hours of the day, including at night. Babies in full rooming-in are taken to the newborn nursery for examinations four times a day. Every mother receives instructions how to care for her baby on her own, but if she wants a short break, she can bring him to the nursery. All three pre-existing maternity wards have partial rooming-in.

Shaarei Zedek also moved its neonatal special care unit to the new building in early 2014. The new unit has 70 beds, enough to handle expected growth in the next few years, as well as the most advanced equipment available today, including things that no other hospital in the country has. Although the old unit had only about 35 beds, almost immediately, the new unit began to care for an average of 50 babies at a time! Two reasons could be contributing to this sudden increase: more mothers whose babies were likely to need special care decided to give birth in Shaare Zedek and/or more babies born elsewhere were transferred here to get the best neonatal special care available in Israel, and among the best in the world.

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