Birthing pains

My cover story from today's Irish Independent Weekend mag...

http://www.independent.ie/lifestyle/in-many-countries-expectant-women-have-a-wide-choice-of--how-and-where-to-give-birth-to-their-baby-but-are-irish--mumstobe-getting-a-raw-deal-susan-daly-investigates-1828682.html

BIRTH OF A NATION
In many countries, expectant women have a wide choice of how and where to give birth to their baby. But are Irish mums-to-be getting a raw deal? Susan Daly investigates



By Susan Daly

Saturday July 18 2009

Mention the words 'home birth' to many people and their eyes widen in horror. At least, that was the experience of Lisa Sterrit when she began to tell acquaintances that she was planning to have her second child at home.

The feeling of being pressurised to speed up the long labour with her first daughter had prompted Lisa to seek an alternative for the birth of Thea, now a jolly, seven-month-old girl. Her eldest, Eva (five), was born in a private hospital, where Lisa found the experience "impersonal and rushed".

She had wanted a natural birth but, when her labour slowed, the medical staff wanted to break her waters, and she felt under pressure to follow their advice.

When Lisa, from Greystones, Co Wicklow, became pregnant with Thea, she vowed she would be in charge this time. With an ambulance on call in case of an emergency, and her midwife and husband by her side, she felt relaxed and comfortable. "Even the process of checking into the hospital was stressful the first time round. I had been awake all night with contractions and was worried about when I would go -- I was fretting about rush hour, so we ended up going in at 4am!"

Second time around, Lisa woke at 7am with contractions. Eva was taken by a friend for the day and when her husband came home from work at about 1.30pm, they lay on the bed while she practiced her breathing. Their bedroom overlooks the tranquility of Greystones Harbour and both fell asleep, until stronger contractions woke Lisa at about 4pm. The midwife came and Lisa's husband filled the birthing pool, where she remained until about 9pm, when Thea was born.

"It just happened so naturally," says an obviously delighted Lisa, "The midwife gave me confidence that I could do it. The baby was big -- 10-and-a-half pounds -- so I was pushing for a long time and I do feel that if I had been in hospital, there would have been pressure for a Caesarean." Her husband, too, had a better experience this time round. "The midwife and my husband worked well as a team," says Lisa.

Although Lisa remembers some people being "horrified" when she first announced that she was having a home birth, she says she had done her research. "I also knew my midwife enough to trust that at the first sign of anything making her wary, she would have carted me off to hospital."

Lisa is among a growing number of Irish women reaching out for an alternative to the obstetrician-led hospital delivery wards. With an expanding national birth rate, our large, centralised maternity hospitals are stuffed to the gills. And that is not the only reason women want to get out of the stirrups -- we are becoming aware that other countries do it differently and offer mums-to-be more choice.

"There is no European standard," says Niamh Healy,of Cuidiu, the voluntary Irish childbirth trust. "In Holland, for example, around one-third of all births are home births. In Spain, it's more medicalised, where women have probably even less choice. But certainly we know a lot about the UK system, and women there have much more choice than here."

It's very difficult for a mother to know what choices are available here; unlike in the UK, there is no official register of data about the birthing services in this country. What we do know is that in the UK, the majority of mothers-to-be are attended to by community midwives. They have several options on where to give birth, depending on risk factors: at home, in NHS midwife-led clinics, maternity hospitals or in 70-odd independent birthing centres funded by the NHS.

In Ireland, there are just two midwife-led clinics and no independent birthing centres. Even if you live in west Cork, for example, the only delivery centre near you may be two hours' drive away in the shiny new maternity hospital in Cork city.

Shelley O'Connor, from Cabra in Dublin, speaks with missionary-like zeal about her experience with a midwife-led Domino scheme for the birth of her baby, Adam, in May of this year. Domino means domiciliary care, in and out of the home, where midwives visit mothers before and after the birth in their homes.

Shelley noticed a marked difference to the maternity service she received with her previous child, Ella (three). "With the first baby, I was semi-private and I couldn't fault them, but with the Domino midwives it was much more personal. They came to my house from the word go -- if you have other children, it's very handy not to have to go to the hospital. And you can feel intimidated by a doctor. With the midwives, you're not worried about asking silly questions."

It is a public scheme and sounds like something that would work brilliantly in more geographically isolated areas of Ireland. But there are still only four Domino schemes in Ireland: one operated from Holles Street Hospital, one from the Rotunda Hospital, one in Waterford and one in Wexford. To hear Shelley speak, the majority of the country is severely missing out.

Shelley's son, Adam, had to be induced because he was 10 days overdue, but Shelley found that her Domino midwife kept her fully informed and in control at each stage. "They talked to me about the epidural, they gave me alternatives of gas and air, but they didn't make me feel as if I couldn't have the epidural if I wanted it. They were just giving me confidence the whole time."

Midwife Bernie was with Shelley all night during her labour. "She knew me and my body, and when I was in pain, she was able to calm my husband. She's your pal, you trust her. The doctors were great, but she just made it for me.

"The aftercare was fantastic -- they visited me every day for days after I went home, constantly giving reassurance. It's very important to be looked after, because you are vulnerable."

Shelley's favourite memory of the birth is when Bernie ensured that she was given skin-on-skin contact with the baby straight after his arrival -- and her husband was given the same opportunity. "It was just a beautiful experience," she says.

The philosophy of care in the Domino schemes addresses the fear of being dealt with by a bunch of strangers at a vulnerable time, a fear that drives some women to shell out for the reassurance of their own private consultant obstetrician.

"Going private is very expensive and health insurance only covers your accommodation," says Fiona Hanrahan, assistant director of midwifery at the Rotunda Hospital. She helped set up the Domino scheme there, which is still only available to women in their catchment area. "Semi-private means you are seen by a non-consultant and can be in a shared room, so they are falling between two stools."

Even the stated policy of the Institute of Obstetricians and Gynaecologists is supportive of midwife-led schemes such as Domino for the vast majority of mothers-to-be. The Institute was critical of under-investment in maternity services in a 2007 report. "Obstetricians here are very supportive of it," confirms Fiona, "and if a woman develops a complication, we dovetail services."

The mothers can have their babies in hospital under the Domino schemes, but the time they spend on wards is minimal. Hanrahan says: "Women are far more rested at home. I've never had a woman who is at home say, 'I wish I was in hospital'." Her own sister gave birth recently in a hospital and, says Hanrahan, "It's like a form of torture -- she was awake all night with other babies and mothers".

Mothers might feel that the conventional Irish childbirth is not ideal, but they are wary of alternatives because there hasn't been the opportunity to try them. The Midwife-Led Units (MLUs) in Drogheda and Cavan, for example, have received overwhelmingly positive feedback for their supportive, relaxed ethos. Rooms feature birthing aids such as pools and inflatable balls, en suite bathrooms and facilities for the woman's partner and the new baby to stay together in one room. But these are the only two MLUs in the country.

And Georgina Farren, a midwife on the National Council for the Professional Development of Nursing and Midwifery, explains that there are only between 11 and 13 independent midwives available for home births. While community midwifery is on the increase, "people aren't aware of it, geographically it's not widespread and there is not much money around".

Krysia Lynch is a member of both the Home Birth Association and of AIMS Ireland, which calls for improvement in the provision of maternity services in Ireland. "Home birthing isn't for everyone, just as elective Caesareans or hospital births aren't. Your body will be at its best where you feel safest," she says. "What we are trying to get across is that mothers need to feel that the way they give birth is their choice, that they are not being pushed into anything."

Tracy Donegan, mother of one son, Jack, has an interesting take on childbirth. She is a student midwife but has also worked as a doula (a professional labour companion) and self-hypnosis teacher. She laughs heartily at the stereotype of the doula chanting and blowing incense over the labouring mother.

She was exposed to the concept of a doula when pregnant with Jack, when she and her husband, Philip, lived in California. "She can be an informational support for you, give you the best chance to avoid routine interventions and pharmacological relief by using hydrotherapy, acupressure, positioning and so on," says Tracy. "It's helping the woman have the best birth for her."

And if that best birth turns out to be quite medicalised, then a good doula will be fully supportive. Tracy decided to be induced when Jack was a couple of days overdue and the consultant said he could book her in to have her baby at a specific time. "My doula was happy as long as I was happy. On paper, it was medically managed, but nothing was assumed, I signed on for it. I had the best of both worlds."

Tracey has also taught the GentleBirth method, which shows women how to use self-hypnosis to relax during labour. "The common misunderstanding with self-hypnosis is that you will be walking around like a zombie," she laughs, "but you are never out of control -- it is focused concentration."

While she hopes that maternity services here will become more rounded, we are lagging behind our nearest neighbours. "Ten minutes up the road in the North I can have a water birth -- which we call the midwives' epidural," says Tracy, who lives in Meath. "In the UK, they have set up a midwives' clinic in some branches of Sainsbury's. There are birthing pools in the Rotunda and in Cork, but they are still not being used."

In June 2007, the HSE called for anyone who had expertise in the area of childbirth to join a clinical advisory group on expanding maternity services. There has yet to be a convention or report from such a group. Krysia says that some Polish women of her acquaintance have been shocked at how infrequent antenatal check-ups are here. "They are used to being seen more regularly, and earlier for scans. Here you are not seen until after the first trimester. They just can't believe that."

See www.cuidiu-ict.ie for antenatal classes, free breastfeeding support and networking for parents. AIMS Ireland, at www.aimsireland.com, offers free, confidential support, with many volunteers fluent in several languages.

The HomeBirth Association of Ireland (www.homebirth.ie) provides information and support to those considering a home birth.

Tracy Donegan can be contacted at www.gentlebirthhypnosis.com