Friday, March 19, 2010

Defects Contained

Back when I first started asking mums and mums to be questions about their experiences of Irish pregnancy and motherhood for "The Mammy Diaries," I received the following reply from a woman who had chosen to give birth at home;

"I benefited from the combined experience of my mum and my two older sisters; all three went through the hospital system themselves but encouraged me to explore natural or low intervention birth options. I started reading up before I even became pregnant and the more I read, in books and on-line, the more I understood that the odds of having a natural birth are stacked against you in a hospital, especially first time out. I recall reading the annual report from my local maternity hospital and discovering that only five percent of first time mothers give birth spontaneously without any form of intervention or instrumental delivery. Meanwhile, I was also reading birth accounts from homebirthers and I was completely won over by their enthusiasm for delivering at home. Shortly after getting a positive pregnancy test, I attended a home birth meeting and I was hooked on the idea. "

Having had both the experience of a hospital birth and a home birth myself, I knew there was a lot of truth to what she was saying, but SURELY the figures she quoted couldn't be right! Surely she'd meant 50 or even 15 percent of first time mothers (which would still be criminally low in my opinion.) Could it really be possible that 95% of first time mothers in Ireland are thought to be deficient in some way and unable to get through what is without a doubt one of the most natural experiences in life, without intervention from the medical community?

I put it to the back of my mind and continued on with the work of writing and compiling and writing some more. Then it came time to put a bit more polish on the Birth Stories section, a section which I am still having trouble with for reasons I'll get to later...

With the figure of 5% still floating around in the back of my mind, I started re-reading through the birth stories with fresh eyes and was shocked with what I found. Time and again, the same words and phrases kept popping up. "Induced," "help labour along," "gel," "sweep," "Speed up labour," "episiotomy," "epidural," "section," "forceps," "vacuum," and then at the end of each story a general variation on the theme of "Oh well, my baby was born healthy and well and that's all that matters."

But is it?

I'm not so sure.

Of the almost two hundred birth stories I received, only a handful gave birth spontaneously and vaginally with no intervention, the vast majority of those being home births, second time mothers or babies born in the MLU's. Two of them were planned hospital births, one of which ended up being an unplanned homebirth and the other in a hospital car park! I talked to my friends, surely at least one of them must have had a spontaneous vaginal birth with no intervention whatsoever?

Well actually, one of them did. The midwives didn't believe she was in labour until she headed off to the labour ward herself, hopped up on the table and popped out the baby herself.

Am I crazy in wondering if we've taken a wrong turn somewhere along the way?

I understand that there are times when interventions are called for, that things can and do go wrong in labour. I would think though, and call me naive if you will, that this number should be far lower then that of women who experience healthy, problem free pregnancies and deliveries.

Low risk births should be the norm, not the exception. The vast majority Irish of women cannot be defective.

That though, is the message that our hospitals are sending out, and that is the issue I am having a hard time dealing with.

In writing the " Mammy Diaries," I am trying to give a balanced view of what the average Irish woman's experience of pregnancy, birth and the first year of motherhood is really like.

However, by including all of these tales of interventions and things going wrong, what exactly is the image of birth that I am portraying to new mothers to be? What sort of conclusions about birth and their own body's capabilities will they draw if they start to see things like induction, c-section, membrane rupturing and instrumental birth as the norm and not the exception? What effect would this lack of confidence have on their own labour and births and would it merely become some sort of self fulfilling prophecy?

I would love to hear your thoughts on the matter...


  1. I went to antenatal classes for my second one as I didn't get a chance to finish them on the first one. I was the only 2nd time mother there and I have to say that I was shocked. 95% of the ladies present wanted an epidural. I really was shocked at their attitude towards pain and birth. I didn't have anything on my first one (well an episiotomy but I don't count that as something really) and was fine. I didn't want any kind of drugs etc on the second onee but unfortunately she was breeched and I didn't have much of a choice. Actually I did have a choice but the likelihood of ending up with an emergency C-section didn't appeal to me. I suppose people's pain thresholds differ a lot but so many people wanting an epidural without having felt any pain yet, surely that's not 'right' is it?

  2. Wow I'm shocked at that stat 5%? I think there is a definite correlation between length of labour and pain relief, I think sheer exhaustion when there is a lack of progress/slow labour causes women to seek pain relief even though they might be managing the pain quite well. Are you writing a book on this? I'd be very interested in reading it x

  3. I know I mostly gave birth back in the dark ages of the last century, but I felt that labours were managed to suit the needs of the hospital - including cost minimisation - not the woman in labour. None of mine went to plan, and my requests were often ignored, but neither would I have been confident about giving birth at home. One of my friends did give birth at home on her third, and was very happy about it: however, unlike many of my other friends, her previous labours had all gone well, and she hadn't really needed pain relief.

  4. Even if a woman chooses to give birth in the hospital though, shouldn't she be able to expect that minimal to no intervention be the norm and not the exception? I loved my home birth, but like blue sky said, it's not for everyone.

    There was an interesting study done in Cork in 2002 checking the safety, cost, etc... of home births in the area compared to hospital births. The differences when it came to interventions, esp in first time mums, was incredible. All of the women in both groups were considered to be low risk so as to keep the comparisons realistic.

    For example, in the first time mums, 77.2% of women in the Home Birth group gave birth spontaneously and vaginally (not induced) compared to only 45.2% of the first time mums in Hospital. The numbers for episiotomy also showed a huge difference with only 6.1% of Home Birth women receiving one compared to 38.5% of hospital women.

    Pain relief again showed huge differences with 18.4% of women in the HB group recieving Gas and Air versus 67% in the Hosp. Group. 6.1% of women in the HB group ended up with an epidural (trans to hosp) versus 65% of Hospital births.

    8.8% of the HB moms required instrumental deliveries (forceps/vacuum) compared with 35.6% of hospital women. Only 16.3% of the first time moms involved in the hb scheme ended up being induced compared to 33% of the first time hospital moms.

    Why is there such a huge difference in the numbers?

    One of the most dramatic differences though was in the breastfeeding rates which as most people know are extremely low in Ireland where less then 50% of women even initiate breastfeeding in the hospital and where by the end of the first month the numbers are down around 24% and negligible by 6 months.

    In the homebirth scheme, there was a 96% initiation rate at birth. All of these women were still feeding at three months and 80% at six months. That's a massive difference! Why can't we achieve the same rates in hospitals?

    Good lord, this reply is turning into a post in itself! Whoops :) And there are babies looking for me! Must run and continue later...

  5. I am shocked at the 5% figure. I had gas and air on my first two and as my third was in distress I was prepped for c-section (she arrived on her own though) and I honestly didn't realise the intervention stats were so high. I am speechless! Jen.

  6. I delivered completely natural and was told that being a first time mom, I didn't really understand the pain of labour but if I 'really' wanted to try it they would allow it. I was asked about 4 times throughout the 5 hours I was in labour if I needed an epidural and each time I replied that I wanted to continue naturally and was doing just fine. I felt as though the hospital definitely pushed the issue but I was insistent and they eventually backed off.

    I find it shocking the numbers for the breastfeeding that you've found! I have opinions on that but for another time I suppose lol!

  7. I am not suprised by this at all. One of my best friends is a doula and she tells me over and over that even with clients of hers who have intentions on having a natural birth, hospital staff are SHOCKED when they see a woman attempt this. And they still want to intervene and break the client's water, put her on a pitocin drip, give an epidural etc. etc. etc. They cannot imagine WHY a woman would even want to attempt this. There have been many nurses who have said, "I have never seen a woman attempt to birth naturally in all my years of nursing." Can you imagine? I love that you are writing a book about this!! I think it is important for women to know that birth IS natural, and while it is nice to have the benefits of modern medicine, birth does not need to be seen or viewed as a medical procedure. Wonderful post!!! I adore you. XOXOXXOX

  8. God, it's so hard. Every time I talk to a first time mother, I ask them where they're having the baby, and my heart drops. Sometimes you can just feel the interventions coming.

    You know they're turning women away from Holles st (our National maternity hospital) this year? Due to over crowding? Wards that used to hold ten women now house thirty?

    I understand why women don't want home birth, and are afraid. But they don't read the home birth info, only the hospital info.

    GIVE US DOMINO SYSTEMS, GIVE US BIRTH CENTRES. Give us continuity of care and space and time to let the process work. Give us comfortable safe spaces where we don't feel scared or pressured. Let the emergency service wait in the background.

    If I were to have another baby, I'm not sure I'd do it in this country. And if I did, it would cost a lot. My first independent midwife is charging five grand now...

    It's so sad.

  9. That statistic is scary! I had my first via emergency c- section in Copenhagen (baby's heart rate dropped and I had pre-eclampsia and was very ill with hypertension) it was horrific. But I have to say up to that they were very hands off and even sent me home and instructed me to walk for a couple of hours (which I did but still nothing was happening). The 2nd baby was born via c-section, 11 days overdue (pushing the hospital policy of 10 days maximum) and I was not in any sign of labour. The c-section was arranged and I had no choice, I wanted to wait and see if it came naturally, the doctor warned about mortality issues. Did I want to risk the health of my baby? when it is put to you like that there is little choice left.

  10. I just could not only pass by without a comment. Homebirth for healthy women is safer. A few years ago a large large study was published in the british medical journal. Any doctor that reads research should know about it.
    I did four homebirths and one hospital birth and there is no doubt in my mind what was the better choice. Well that, I admit is very anecdotal evidence from a stranger.
    Women should discuss this more without the I feel reasoning and look at research.