Time for our patriarchal birth industry to finally put woman and children first

OUR crazy Irish birth industry has reached crisis point. This week we wept with Sarah Williams and Emmet Heneghan, parents of baby Kai whose little black-haired head was visible in his home near Westport at 10.30 on May 23, 2011, but who was pronounced “stillborn” at Mayo General Hospital at 3.29 the next morning.

His parents had planned a home birth and had contracted Christina Engel, a midwife with many years experience in New Zealand. Sarah Williams informed the Director of Nursing in Castlebar of her planned home birth, and was told it was OK if no complications arose during pregnancy.

But what of the complications which arose during labour? Was it OK for baby Kai’s birth to be attended to just one midwife who was not working within a hospital structure, 14 miles away from the nearest hospital and with no suitable transport? Was there any mother who didn’t share some of Sarah Williams’s panic when she read that midwife Christina Engel’s car didn’t start that fateful morning?

This was not a situation which could be described as OK by anyone. Sarah Williams and Emmet Heneghan were not to know that. And your heart has to go out, too, to midwife Christina Engel. But most of all your heart goes out to baby Kai, who might have died if he were born in hospital — but might well not have.

The problem with home birth in Ireland is that, apart from the very limited Domino schemes, it is not integrated properly into mainstream birthing services. The complaints made about home birth practitioners are very often about a failure to get the mother to hospital quickly enough. Just last month, home birth midwife Ann O’ Ceallaigh was struck off the nurses’ register having been found guilty of professional misconduct in the case of a baby who was stillborn eight years ago. The young mother laboured for three full days at home until her baby girl was born dead.

The Nursing and Midwifery Board’s Fitness to Practice Committee censured O’Ceallaigh for failing to recommend transfer to hospital, for failing to give appropriate consideration to the poor position of the baby’s head, for failing to adequately carry out resuscitation on the baby and for failing to communicate accurately with the staff at the hospital to which the mother was eventually transferred. That’s quite some list.

Why would anyone choose a poorly resourced, poorly supported home birth in Ireland when modern, fully-staffed hospitals are now available to everyone? Here’s why: in Irish hospitals labouring women are treated with something close to disdain.

The births of their babies are “scheduled” so that what the National Maternity Hospital’s birthing handbook calls “the bottleneck” of the labour ward can be kept clear. To keep those babies coming nice and regular mothers are subjected to a barrage of often unnecessary interventions, starting with an oxytocin drip to speed up labour.

Our rates of induction are 38%, nearly four times what the WHO recommends. Inductions lead to more interventions such as epidurals to combat the pain, which lead to the use of the forceps, the suction cup, and finally, Caesarean Section. Our C-section rate is 27%, while the WHO recommends 15%.

The HSE itself spells out the reasons some women choose home births: they want to feel more in control; they feel safer at home; they dislike being in hospital; they want to avoid interventions. Does the HSE not consider that list an indictment of hospital maternity services?

Aja Teehan went as far as the High Court in her attempt to have a home birth, having previously had a Caesarean section. She lost. But I doubt she would have tried so hard to stay home if she had felt she would be safe in hospital. If she had felt the hospital staff would not see her merely as “the woman who had the Caesarean” and cut their way through to the baby, no matter how willing the baby was to come by the traditional route.

She has travelled to a location in the UK where, she says, she will have “self-determination” during the birth because to stay “would be to increase the risk to my child.”

It’s no more than the shocking truth. Although Vaginal Birth After Caesarean (VBAC) is now common practice internationally, with rates of around 45% recorded in countries with more woman-friendly birth industries, here the rate is between 10% and 36%.

Are Irish women different in the downstairs department? Or are Irish doctors different in the upstairs department? You choose. A labouring woman cannot trust an Irish hospital to help her deliver according to the best, evidence-based, obstetric practice. And that is no doubt why earlier this year, a pregnant woman suffered the trauma of a court preparing to order her to have a Caesarean section against her will at Waterford Regional Hospital. Her baby was barely overdue and she had a previous Caesarean section. The best evidence-based obstetric practice would not have indicated a Caesarean section on either ground.

But convention, rather than evidence, is what matters in Irish maternity hospitals. The woman’s voice is not heard.

I HAD my own tragi-comic experience of this during the birth of my daughter in a Dublin hospital. She was my fourth child and exhibiting no distress but because, I am sure, the hospital decided labour had begun when it hadn’t, I didn’t perform to their arbitrary time-table and they wanted to induce.

I remember sitting there in the clear morning light saying, “Give me one good reason why I should be induced.” They couldn’t. Then someone said: “In the past, women had endless labours.” They stuck the drip in my arm but my own fast labour had already begun so I exploded like a firecracker.

These court cases about our birthing practices are the tip of the iceberg which is the Irish birth industry. It needs to melt, and fast.

Alternative models of care are already out there. They’ve even been tried in Ireland and succeeded. In Our Lady of Lourdes Hospital and Cavan General Hospital there are units led by midwives (MLUs), in which a labouring woman has a private room with a birthing pool and a pull-out couch and telly for her partner.

When TCD studied the outcomes in these units by comparison with those in traditional, consultant-led units they found them just as safe but with fewer interventions. Although the women had fewer epidurals more of them said they were satisfied with their pain relief than the women in the consultant-led group.

This relatively luxurious, woman-centred service cost a full €330 less per woman than consultant-led care. The Chair of TCD’s Nursing and Midwifery department, Professor Cecily Begley, recently calculated that moving to midwife-led care for suitable women, as was recommended in 2008 by a KPMG report, could save the State €10 million a year.

What’s not to love? Women and babies, that’s what. Sarah Williams, Aja Teehan and any number of unnamed women and babies indict in different ways our patriarchal birth industry.