We have got to break their stranglehold and make birth safe in Ireland. For my daughter. For all our daughters, writes Victoria White

I don’t want my daughter to give birth in Ireland unless things change.

I don’t even want her to read this because I don’t want her to fear birth.

But the truth is that our over-medicalised, centralised, consultant-led birth system is plain
dangerous.

Ireland is not “the safest place in the world to give birth”, as used to be the mantra until it was discovered the Central Statistics Office wasn’t filing the cause of death in many maternal deaths, and we sank to average among developed nations.

The chance of a young woman like my daughter dying in childbirth in Ireland if she gave birth today would be still be tiny, at roughly 10.5 in 100,000 maternities.

However, although a significant number of women have died in childbirth in the last decade, full inquests have only been held in eight cases, which all returned verdicts of “medical misadventure”. These eight women — Evelyn Flanagan, Jennifer Crean, Nora Hyland, Sally Rowlette, Dhara Kivlehan, Tania McCabe, Bimbo Onanuga and Savita Halappanavar — have been memorialised in a quilt knitted by women all over the country in
solidarity with these lost mothers and their grieving families. It is an initiative of The Elephant Collective — so-called because female elephants circle a birthing elephant and shield her from harm.

Anne Marie Green’s documentary on the collective is particularly heart-breaking when it features the children left behind.

Sally Rowlette’s daughter gently holds the patch knitted for her mother and explaining that Mammy’s favourite colours were used and there is gold thread used because “Golden” was Mammy’s maiden name.

There just is no sadder death than a mother’s death in childbirth. An event which should have been among the happiest in the woman’s life becomes her death sentence. We know this tragedy will occasionally occur even with the best medical care in the world, and we can only imagine the trauma which the entire medical team which is involved will endure.

But families need answers. And in Ireland, they currently have no right to them.

The Elephant Collective is calling for mandatory inquests for deaths in childbirth. Clare Daly TD produced a Private Members’ Bill to that effect. Around the country from Donegal to Cork, from Dun Laoghaire to Kerry, 24 local councils have passed motions calling for the law on mandatory inquests to be progressed.

The Government’s own bill is, according to Justice Minister Charlie Flanagan, receiving its second drafting and Ms Daly has been promised a meeting this month. The clock is ticking.

The collective has organised a major conference to shine a light on “the maternity crisis” which takes place next Tuesday and Wednesday in the Aula Maxima, UCC.

It coincides with the publication of Untangling the Maternity Crisis, a book of essays addressing the over-medicalisation of normal childbirth in the UK and Ireland edited by Nadine Edwards, Rosemary Mander and Jo Murphy-Lawless, the latter a sociologist at the Department of Midwifery in TCD.

The book focuses on midwives trained for four years to deliver babies yet serving as underlings to consultants in standardised, medicalised, timed deliveries.

These (mostly) young women often begin to doubt their own expertise.

“It is sad but I feel more comfortable when it is all happening (induction, epidural, continuous electronic monitoring) because it’s what I know — normal birth frightens me,” admits one midwife. When it is the bald truth that midwife-led births are safer than consultant-led births for low risk women, as found by a report in 2014 by the UK’s National Institute for Health and Care Excellence.

In 2011, a UK study of 64,538 low-risk pregnant women led by the University of Oxford found no significant differences in what they call “adverse outcomes” for births in midwife-led units and home-births compared with consultant-led births.

What they did find was that the midwife-led births were much less likely to involve interventions such as inductions, episiotomies, instrumental deliveries or Caesarian sections — all of which pose risks to both mothers and babies.

No-one is arguing against interventions in all cases. When they are necessary, they save lives.

What we are arguing against are unnecessary interventions and these are common in consultant-led practice. Irish research in 2013 found private consultant-led deliveries to be associated with particularly high rates of “operative deliveries”. This matters because interventions can cause pain, psychological stress, and in the case of Caesarians, health impacts for both mothers and babies.

Interventions can also be accessory to tragedies such as the death of babies. The misuse of artificial oxytocin to speed up labour was implicated in the deaths of baby Mark Molloy and baby Joshua Keyes-Cornally at the Midlands Regional Hospital, Portlaoise, in 2012 and 2009 respectively.

I have counted four recent deaths of babies in which the use of the forceps was implicated, including that of baby Diarmuid Campbell, who died in Cork University Maternity Hospital in 2009 having suffered forceps injuries to his spinal cord and head.

We have to believe these precious babies are angels in heaven now or we would go crazy. But we must also learn to learn. Learn to change.

The National Maternity Strategy, launched last year to great fanfare from this columnist, promised that change. A majority of women were to have midwife-led births in birth centres “alongside” hospitals, leaving traditional wards free for women requiring the specialist care of a consultant obstetrician.

Even while I was blowing my trumpet, I cautioned that, “the main issue is implementation”.

A year later, there is next to none. Not one single new midwifery-led birthing unit has been established. We have not developed any new community midwifery services. In a climate of stress and poor conditions, it is proving hard to retain what midwives there are in the system.

There are 18 midwife-led units in similar Scotland but we have two. Scotland’s new maternity strategy envisages all women being able to be led through pregnancy by their own midwife who would have a caseload of 35 women.

Meanwhile the Oireachtas review of the National Maternity Strategy last month heard dire warnings from former National Maternity Hospital master, Peter Boylan, that creating midwife-led pathways should not cause “divisions between doctors and midwives”. Boylan has been a vocal proponent of the campaign to repeal the Eighth Amendment, a campaign which has convulsed the legislature and dominated the airwaves. It is ironic that the campaign for women to be able to give birth in Ireland with safety and with respect has so far been met with relative disinterest.

That is because it presents a much greater challenge to power.

We have got to break their stranglehold and make birth safe in Ireland. For my daughter. For all our daughters.

For information on “Picking up the Threads: remembering maternal deaths”, a conference at UCC, contact jlawless@tcd.ie or The Elephant Collective on Facebook.


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