VICTORIA WHITE: Male-dominated labour practices are disempowering women

TWO BABIES born late last year in Portiuncula Hospital in Ballinasloe have died. Seven families in all have had their babies referred for “brain cooling” because of suspected “apoxia” — lack of oxygen to the brain — during their births at the hospital.

 And the inappropriate use of artificial oxytocin to induce or speed up labour is among the possible contributing factors which an independent enquiry will study.

Eight years ago another suspicious spike in baby deaths began, this time at the Midlands Regional Hospital in Portlaoise, when four babies died.

The HIQUA report into the deaths is still pending but an initial report found that in the cases of baby Mark Molloy and baby Joshua Keyes-Cornally, inappropriate use of artificial oxytocin was a factor.

The inappropriate use of artificial oxytocin was also a factor in the case of baby Paul Fitzpatrick, who was left severely mentally and physical disabled in 2001 when the National Maternity Hospital kept pumping his mother with artificial hormone following a foetal heart trace which showed distress.

He was awarded €4million in 2008 but the hospital did not admit negligence.

But the 60,000 women who are pregnant today in Ireland have nothing to worry about because Health Minister, Leo Varadkar says “Maternity services are safe in Ireland.”

How can he say that, when the practice which led to the difficulties of some of the infants — acceleration of labour with artificial oxytocin — is a cornerstone of maternity practice in this country?

Do Irish women not have any natural hormones of their own?

No, they do have hormones, but they are not as good as the hospital hormones. The hospital hormones can be turned on and turned off.

They can be turned up and turned down. This means that the hospital controls the birth, not the woman, and that has to be a good thing, hasn’t it?

Hardly. Concern about the use of artificial oxytocin is growing internationally. The WHO says induction of labour should be performed only when there is “a clear medical indication” and should be performed with caution “since the procedure carries the risk of uterine hyperstimulation and rupture and foetal distress”.

In the UK, baby Jack Clayton was left seriously disabled at birth in 2005 after the flow of oxytocin to his mother was doubled even though he was showing signs of distress.

She had six contractions every 10 minutes; Patrick O’Brien of the Royal College of Obstetricians and Gynecologists says there should be no more than four every 10 minutes. If contractions are unnaturally fast the baby may not recover between them and may be starved of oxygen. That “apoxia” word again.

Philip Steer, a consultant at London’s Chelsea and Westminster Hospital believes the use of artificial oxytocin should be banned excepted in rare cases: “It’s like somebody saying the screw is stuck, let’s hit it with a hammer.” But the use of this hammer is routine in Irish hospitals.

I had a drip of what the nurses called “jungle juice” inserted into my arm at the National Maternity Hospital in 2002 although I was on my fourth child, had always had normal labours and the baby showed no distress. My only crime was that I was not giving birth according to the NMH’s timetable.

Birth to a timetable or “active management” was perfected in the NMH, in the 1960s and exported to every other maternity hospital in the country and all over the world.

According to this practice, a woman labours and delivers her baby to a precise time-table which has got tighter and tighter with the passing years. In 1963 women were given 36 hours to deliver before they were speeded up. In 1968, 24 hours. And from 1972 to the present day, women are given 12 hours.

Obviously “active management” was a response to a baby boom which made the NMH the busiest maternity hospital in these islands. But there was surely more to it than that. Social historians like Patricia Kennedy and Jo Murphy-Lawless have described compellingly how our birth practices disempower women.

“Active management” is obviously a practice evolved by a male-dominated medical establishment which was frightened of labouring women.

The first edition of Kieran O’Driscoll’s Active Management of Labour, which was published in 1963, described a woman’s first labour as “the most disturbing emotional event in the lifetime of one half of mankind.” Which half, I wonder? Male or female?

A process evolved by which labouring women in Ireland are routinely pumped with artificial oxytocin. They are also routinely anaesthetised from the waist down because the pain of unnatural delivery is too great to bear, and I can certainly testify to that, having refused the nurses’ urgent calls for an epidural.

If women are anaesthetised from the waist down and pinned to a bed they cannot labour naturally. This poses many risks including an increased risk that their babies will be delivered instrumentally.

AIMS Ireland have shown instrumental delivery to be a routine procedure in Ireland, with 35 percent of first babies being delivered by forceps or vacuum in Cork University Maternity Hospital, Galway University Hospital and Waterford Regional Hospital.

But instrumental delivery carries its own risks and the its application is one of the factors which will be investigated in the enquiry into the deaths at Portiuncula.

The fight for the control of birth between women and their midwives and men and their medicine has gone on at least since the foundation of the first maternity hospital in the world, Dublin’s Rotunda, in 1745.

As early as the mid-1700s English midwife Elizabeth Nihell was fuming about “keen instrumentarians” who rarely failed “of destroying the child or at least cruelly wounding it, and never but injure the mother.”

The threat of death is always the response to changing childbirth in this country. Babies died in the past, says the current system. Mothers died in the past.

Yes they did.

They were poor and dirty and hungry and didn’t understand infection. Ireland today can afford a maternity service which respects women and their bodies.

In 2008 a KPMG report advocated offering the choice of midwife-led care for all normal pregnancies finding it cheaper than consultant-led care and just as safe.

They also found that the current system could not work without the practice of “active management” although, they said, “that does not mean that it represents best practice.”

I think “best practice” is the least that labouring women and their babies deserve in this country. After the tragic deaths and distress to babies born at Portiuncula we must ask the question if procedures which are routine in our maternity hospitals are themselves damaging babies?

The independent enquiry into these deaths is necessary but will not be enough to reassure us.

Minister Varadkar can only do that by ordering an indepth review of our maternity services which breaks “institutional lock-down” and lets women in.

‘Best practice’ is the least that labouring women and their babies deserve in this country


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