THIS is an important day for the women of Ireland, writes Victoria White. We have said we can have babies. Our bodies know how it’s done. We just need a little help and encouragement. And now they’re listening.
Today, with the publication of the National Maternity Strategy 2016-2026, the women of Ireland have custody, again, of their own bodies in labour — in theory.
This is not the end of the battle, but perhaps it is the beginning of the end. It has been a battle fought by brave, outspoken people, mostly women, such as the leaders of the advocacy group, AIMS Ireland, by writers, such as Jo Murphy-Lawless and Patricia Kennedy, and by survivors and victims of horrific malpractice in Irish maternity hospitals.
You could fill a book with their names, but the following are some of them: Savita Halapanavar, whose sepsis was not diagnosed, whose voice was not heard and whose tragedy prompted this strategy to be commissioned; Valerie Neary, a qualified midwife, whose healthy womb was cut out of her body by Dr Michael Neary, in Our Lady of Lourdes Hospital, Drogheda, in 1996, while she begged “Don’t do a hysterectomy on me!”; Catherine Dunne, whose voice of alarm went unheard in the National Maternity Hospital, in 1982, prior to her son William’s birth with cerebral palsy; Joshua Keyes Cornally, who was born in the Midlands Regional Hospital, Portlaoise, in 2009, but lived less than an hour due to a mishandled labour, following the use of the artificial birth hormone, Syntocinon, and the incorrect reading of the foetal heart monitor.
You could fill books with outpourings of gratitude to doctors and midwives in Irish hospitals. But a fact remains: there is no respect for the mother in the Irish maternity system. Her voice is not heard. It is a system developed to silence the labouring woman.
This is made plain by the National Maternity Hospital’s handbook, Active Management of Labour, which shackles a labouring woman to a schedule called a ‘partogram’: “In the National Maternity Hospital”, announces the handbook, “prolonged labour was defined as thirty-six hours in 1963, reduced to 24 hours in 1968 and, finally, to 12 hours in 1972. A formal decision was taken on January 1, 1972, to restrict the duration of labour to 12 hours.” This magicians’ trick is performed thanks to Syntocinon, an artificial copy of the woman’s natural birth hormone. In Irish maternity hospitals, women are routinely hooked up to this stuff — referred to by my midwives as “the jungle juice” — as if they had no hormones of their own and their bodies did not know how to start labour. This is despite the WHO’s recommendation that it should be used only when there is a “clear medical indication and the expected benefits outweigh the possible harms”, and despite mounting international evidence of its misuse.
At London’s Chelsea and Westminster Hospital, Dr Philip Steer says the routine use of Syntocinon is “like somebody saying the screw is stuck, let’s hit it with a hammer”. He has banned its use, except when a baby is overdue or a mother has pre-eclampsia, reckoning that 70% of malpractice cases worldwide result from Syntocinon use.
I am outraged by an approach to labour which turns a woman and her baby into products on a production line controlled by the hospital. But ‘active management’, controlled by Syntocinon, is used in every maternity hospital in Ireland and the ‘Dublin method’ of childbirth has been exported all over the world.
This is to add to our already high reputation for intervention, established in the Rotunda Hospital in the 19th century, when Fielding Ould invented the ‘episiotomy’, an incision in the vagina to allow the baby out, which can affect a woman’s sexual response and whose effectiveness is debated.
When it comes to controlling women in childbirth, we are world leaders. This is very worrying, because it reveals in the culture an underlying fear of women’s bodies, of their sexuality, of their ‘otherness’ and of the babies they bear. It isn’t any wonder we have the lowest breast-feeding rate in the developed world.
I think younger Irish women know they deserve better. Ceaseless advocacy from a small number of women, easily dismissed as loolas by the medical establishment, finally grew into a movement headed up by AIMS Ireland. An independent review of maternity practice in the Greater Dublin Area, carried out by KPMG and published in 2008, deemed midwife-led care as safe, and cheaper for low-risk women than consultant-led care. It advocated almost exactly the changes finally suggested yesterday by the new 10-year strategy. The plan aims to “normalise pregnancy and birth as far as possible.” The majority of births are to be led by midwives and, whether at home or in ‘alongside birth centres’, without routine access to epidurals, oxytocin, or electronic foetal monitoring. Currently, only 5% of births are midwife-led.
The kind of wards in which most women labour will be redesignated ‘specialised birth centres’ and they will serve women at greater risk or who have more complications. There is a plan for community midwives to work in tandem with local health centres. Critics will point to the lack of provision in the plan for ‘free-standing birthing centres’, as opposed to birth centres attached to hospitals. It wouldn’t matter so much if the hospital birthing centres were genuinely led by empowered midwives, but this will be hard to achieve in Ireland’s authoritarian hospitals. The new UK National Institute for Care and Excellence recommendations say the option of a free-standing birth centre should be open to women, along with hospital birthing centres, home birth, and consultant-led hospital care.
But the holes in the strategy are not the main issue. The main issue is implementation. More than 20 years ago, the NHS published a maternity strategy called Changing Childbirth. This has still not been fully implemented. We are decades late in even expressing our intention to move away from maternity services that are founded on a horror of women’s bodies to maternity services in which pregnancy and birth are normal events in the lives of a large part of the population.
The National Women’s and Infants’ Health Programme must finalise its plan to implement this strategy within six months and will be required to report annually thereafter. But there are no firm costings in this report, and even with health budgets repeatedly running over, it is anyone’s guess whether the extra funds will ever materialise.
Irish women now have a manifesto for change. The campaign starts to make it a reality.
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