Benig Mauger B.A

She is a Jungian psychoanalytic psychotherapist in private practice in Ireland, and founder member of IAPA (Irish Analytical Psychology Association).On the editorial board of the International Society of Pre- and Perinatal Psychology and Medicine (ISPPM), and member of the Association of Pre- and Perinatal Psychology and Health (APPPAH), she lectures and writes extensively on modern living from a psychological and spiritual perspective.

Childbearing & Spirituality
In old Ireland, no such reclaiming was necessary. Childbearing was characterised as a spiritual state. A woman with child was said to be in a sacred state. Many sins, it was said, are forgiven the mother who has twins! Another traditional belief concerned salvation: it was said that the mother who gives birth to a child in marriage would never go to hell!

Pregnancy & Sickness
Pregnancy was referred to as 'sickness', and the pregnant woman, I am sorry to say, was referred to in Irish as a 'sick' woman. So much for those of us who would like to believe that childbirth in the old days was 'natural' and pregnancy a time of joy! Not so. Pregnancy was seen as a time of danger both for the mother and for the baby. Fear and anxiety seemed to have been the dominant emotions!

Sex was taboo
Talking about the body was not encouraged, and this was an attitude which persisted into the 1950s. Sex was taboo and birth a mystery. Pregnancy was not a matter for announcement. Women concealed theirs for as along as they could by the way they wore their clothes.

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Superstition
It was a time of special caution. If a pregnant woman were slapped on the face, it was believed that this could leave the baby with a birthmark. Meeting a hare on the road could leave the baby with a harelip, or so it was said. It must have been difficult for women to go outside the door! If a pregnant woman did venture out, she was recommended to stop by a forge and blow the bellows - for a safe birth!

Infant mortality
These were times of high infant mortality. The pregnant woman was discouraged from having anything to do with the otherworld. Pregnancy was a time when you might be overlooked, that is, given the evil eye. A pregnant woman was not supposed to enter a graveyard. If she did, there was a belief that the child ever after would starve and have weak spells. Neither should she remain in a house with a corpse. In Co Tyrone, it was said that a baby might be born prematurely if her mother helped out at a wake, or if she were in the room when the dead person was being put into the coffin.

More Superstition
A pregnant woman, it was believed, should also avoid contact with newborn babies, since they were regarded as recent arrivals from the spirit world! She was not allowed to be a godmother to a child. If she did, people believed that either the child she was carrying, or the child being baptised, would die.

The Midwife
Just as in other cultures, the midwife was feared, as well as respected. Even going to call the midwife was fraught with danger. A man was not to make this journey alone, lest he be carried away by the fairies! To protect himself, he was supposed to say a prayer.

Scandinavia & Ireland
One of the things that surprised me when I was doing research in UCD's Department of Folklore was how much we in Ireland share with Scandinavia. The handy woman appears in stories from Northern Sweden just as she does in accounts from Northern Ireland. In these countries, the country midwife or handy woman was known as a 'light mother'.

'Strawmothers'
Midwives were also called 'strawmothers' or 'earthmothers'. In Ireland, however, the midwife was known as a bean chabhartha or the woman of help. In the north of the country, she was known a bean ghluin, the woman of the generation. And since gluin is the Irish word for 'knee', the term also carries this sense of a child being passed from knee to knee.

The following account is a translation from Irish about birth in Co Mayo.

After she went into labour, the woman was transferred from her usual bed, which was in the kitchen by the fire, to the floor, which was covered with straw. She put on her husband's jacket, an outsize flannel garment with sleeves, made of homespun wool, or bainin.

'As the great event drew near, the husband stood at his wife's back, and placed his hands on her shoulders while she was in a kneeling position on the floor. With words of faith, hope, and encouragement, he supported her morally and physically in her trial, while the midwife got on with the great task of bringing a new human life into the world.'

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The straw bed
This birth account is particularly interesting for several reasons, not least for the straw bed. The straw bed, having the double advantages of hygiene and disposability, was common right across Northern Europe. Wearing a garment of your husband's in labour, such as a tie, was also common. For women today, however, the birth position may be of particular interest. Kneeling seems to have been the position of choice for the second stage. Accounts of the labouring woman describe her kneeling down, her legs spread apart, and the upper part of her body leaning against the seat of a chair.

Father's role
Another point of interest is the father's role. Folklore accounts on this point are contradictory. In the husband's absence, according to one source, his place was taken by another man, a neighbour or friend of the woman's, if at all possible. The very best birthing position, according to this account, was for the woman to lean against her husband or to grasp him firmly, by what part of his anatomy we do not know! Other accounts suggest that it was common to ask men to leave the house altogether! In Co Tyrone, it was said that the midwife would allow nobody near the labouring woman, except a female relative or a neighbour.

Eileen Kane
The American anthropologist Eileen Kane, in her book 'The Last Place God Made' - a book I worked on myself- related how the woman in childbirth would be looked after by her mother-in-law, and by neighbours. Why not her mother, I hear you ask. This was because the woman had married 'into' the farm and was now living with her mother-in-law.

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Perth
Last November, however, I found myself speaking at a national homebirth conference in Perth, Western Australia, with Ina May Gaskin. Aboriginal women give birth traditionally on their own, among women, away from men. Some are accompanied not by their mothers but by their mothers-in-law, and Ina May was of the view that the closeness of the mother-daughter relationship might make mothers-in-law - not mothers - a better bet in the business of labour accompaniment!

Pain
Some of you may be wondering what cures there were in the old days to ease the pains of labour. You wish! The only reference I came across to a cure was the juice of wild raspberries, which had been brewed in water. The juice of blackberries was another remedy, but this was taken to make the labour physically less demanding, and I heard about it when I was interviewing women for my study on home birth.

Interestingly enough, the practice of couvade was also mentioned by folklorists. Couvade was an ancient custom whereby a man took on his wife's labour pains…. But it is fair to say it does not feature heavily in these accounts.

The otherworld was very much part of the birth, and there were many beliefs surrounding labour. There was a belief, for example, that no ashes could be removed from the fire, nor even a piece of coal, after the woman of the house had gone into labour.

For the afterpains, burnt whiskey poured onto a metal spoon which had been heated on the fire was the remedy! As soon as the whiskey hit the hot spoon, it evaporated, leading one woman to remark that it was the first time in her life that she had ever been offered a spoon with nothing on it!

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Fairies
After the birth, both mother and child were in danger of abduction. A nursing mother was said to be at particular risk from the fairies, and special precautions had to be taken. (In her brave and important book on Irish obstetrics, 'Reading Life and Death',

Jo Murphy-Lawless has some very interesting things to say about the risks new mothers in Bolivia are believed to face from spirits. She makes the point, quite rightly, that with high maternal mortality, such traditional beliefs serve an important function in that they underline the mother's need for care and attention at this particular time.)

Getting back to Ireland, the fairies' interest in nursing mothers was seen as a practical one: since they had countless babies in their liosanna, or fairy forts, whom they had previously kidnapped, they needed a constant supply of nursing mothers to feed them!

The theme of abduction goes on to the present day. Last week Marian Finucane seemed staggered by the news that the Coombe Women's Hospital is on the point of introducing electronic tagging to prevent babies from being snatched by latterday abductors!

Tagging Babies
While I sympathise with the authority's concern to make hospital more secure for babies, tagging does smack uncomfortably of animal production. The Coombe is, or used to be, the largest maternity hospital in Europe. Perhaps if we were to demand a smaller, more human scale for birth than those offered at present by Dublin's three massive maternity hospitals, measures originally designed for cattle would not now be needed for babies.

New millenium
As we approach the new millenium, what do we see? What will birth be like for our daughters? Women, some women, will soon have the option of leaving hospital, we were told in The Irish Times this week, within 12 hours of giving birth. They always had that option - even if they didn't know it. Women, some women, we were told, will have a hospital midwife sent out to them after the birth for five days. We were led to believe that this was progress, a step forward, that things, at last, were getting better.

Recent history
But a look back at recent history will put this particular advance into context. Back in 1980, when I was having my first child, a midwife was sent out to visit me at home. That service, and it was a good one, was dismantled, presumably for economic reasons. Now it is to be brought back - for some women.

As a country, we have had, and still have, some of the worst postnatal care in Europe. Turfing women out of hospital 48 hours after giving birth and expecting them to get on with it does not amount to postnatal care. We need to demand more for women from our maternity services.

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Caesarean rates are on the increase in Irish hospitals. 25 per cent has become thinkable in Dublin, and some units, mainly private maternity hospitals, have rates of over 30 per cent, or so it is said. But we really don't know, because there are no statistics. When it comes to maternity care, we are still in a fog of disinformation.

The PR line, in 1999, continues to be an acceptable substitute for hard information, and some journalists don't seem to know the difference. We have far more statistics about livestock production in Ireland than we do about how babies are born.

Freedom of Information Act
We need to demand that the Freedom of Information Act be extended to the voluntary hospitals, such as the NMH, the Coombe and the Rotunda in Dublin, Portiuncula in Galway, Our Lady of Lourdes in Drogheda, the South Infirmary - Victoria in Cork and so on.

We need to look for the publication of statistics on operations such as Caesarean section, and forceps and vacuum deliveries, to see to it that interventions such as breaking the waters, giving oyxtocin to induce or accelerate the birth, EFM or electronic fetal monitoring, are put in the public domain, in the form of percentages, as in, let us say, 60 per cent of all first- time mothers last year got episiotomies. What kind of public pressure this might result in for change we cannot know. One thing is certain - not knowing makes for no change.

Planned home birth in Ireland
When I started to do my research into planned home birth in Ireland, annual reports from Dublin's maternity hospitals were still available in the medical libraries. Such reports contain potentially dynamite information - if you crosstabbed rates of operative delivery, for example, with rates of epidural anaesthesia, you might see that 50 per cent of all epidural births in one hospital for last year ended in a forceps, vacuum or Caesarean section. I am not sure that the demand for epidurals would be as high if women were given this information.

Copyright
By the time I had finished my research, these clinical reports had been taken off the shelves. Now the hospitals have apparently copyrighted them, so that even if you get lucky, and find one on a skip, you might hesitate to use it. I have been assured, however, if you publish and be damned, that no such case taken by a hospital against an individual, would succeed before the courts.

Doris Haire
It is many years since Doris Haire successfully lobbied for the introduction of legislation in New York State obliging maternity hospitals to publish annual rates of intervention. I believe we need such legislation in Ireland, and until we get it, we will make very little progress.

Birth for our daughters
To return briefly to the question of what will birth be like for our daughters. In Asia, in Africa, in Latin America, traditional birth attendants are on their way out. The World Health Organisation refuses to recognise them.

The active management of women in labour has found its way into Chile, Bolivia, and Nigeria, but I will leave it to Maire O'Regan, who knows more about this topic than anyone I know, to tell you more about this after lunch.

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14 independent midwives
In Ireland, just as in Australia, home birth is hanging on by a thread as fine as a spider's web, just like independent midwifery. In countries where birth has been hospitalised, just how many independent home birth midwives are there out there? In Ireland there are currently 14 independent midwives in private practice. It takes a huge amount of courage to work on your own out there in the community, particularly at the present time.

Won't women have more choice, I hear you saying, in the new millenium? Won't they be able to choose whether to have their babies in hospital, or to opt for a half-way house, a Domino scheme where you are supposed to get your antenatal care from community midwives, go into hospital for the birth with one of the midwives delivering your baby, and come home again after 12 hours, again under the care of the team. And those women who want a home birth will be able to have one - won't they?

In Dublin, under the present pilot scheme, the woman on her booking visit will be seen by a consultant obstetrician, who will presumably decide what her level of care should be, whether she can be permitted, for example, to have a home birth if that's what she wants, whether she can be allowed to opt for a domino delivery, or indeed, whether she should have an actively managed labour complete with rupture of the membranes, and a synthetic hormone infusion in the shape of a Syntocinon drip.

Some women will not have the option of a home birth because they live in the wrong area, or because they are deemed to be high-risk. Women who have had a previous Caesarean section, for example, will not be eligible.

Although not all the details of the new scheme are known, it seems clear is that the new service, both in Dublin and in Galway, will be provided by hospital midwives under the direction of consultant obstetricians.

The new home birth service has been presented as a hospital outreach service. The language is one of partnership, but it is clear that obstetrics rules. Only midwives familiar with the practices of the obstetric unit in Galway, the Irish Times reported, would be employed on the new scheme.

One assumes that the same may be true of the Dublin scheme. Is it not strange that the independent midwives, some of whom have been providing a domiciliary service for up to 20 years, were not invited to be part of the new service? That they were not invited to share their expertise with hospital staff? Or are independent midwives just too independent?

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Not without its contradictions
The new scheme is not without its contradictions. How can hospitals which until now have had only one approach to childbirth, only one view as to how to deal with women in labour, and that is by actively managing them, deliver a home birth service directed by obstetricians, and based on what is, to obstetrics, an alien philosophy, namely, natural or physiological childbirth? Or will women be expected to dilate at the rate of 1 centimetre per hour at home? Can we look forward to the aggressive management of women in labour - at home?

There is, it seems to me, an even deeper contradiction here. Does the Department of Health expect obstetricians to take an active role in breaking their own monopoly on normal birth, to champion their leading competitors, namely midwives, by promoting home birth, which is based not on obstetrics but on midwifery?

What about fees?
Will the private patient who is allowed to have a home birth pay a fee to the midwife who delivered her baby, or to the obstetrician with whom she booked initially? Are obstetricians expected to work towards a drop in their own incomes? To collude in the loss of their own private fees?

What's the story
So, you may well ask, what's the story. JUST WHAT IS GOING ON? It's all beginning to look like a chapter from Alice in Wonderland. Obstetrics has been taking the ground from under midwifery since the 18th century. And the reason, part of the reason, has always been economic. Since the beginning of the century, doctors were up in arms against midwives bcause they charged lower fees for doing the same job. Now, it looks as though the demarcation lines have been re-drawn, and that home births are about to be taken over by obstetrics.

Emotional needs
Women have emotional needs in birth. They want to be looked after in labour by people they know. They want privacy and intimacy. They want their partners to be on hand. They want their children, if they have other children around. They want to be looked at, to be talked to when they are having a baby. And above all, they want to be listened to, they want to be free.

If obstetrics is allowed to rule home birth, freedom, for individual women, will be lost. Under the current rules and regulations, hospital midwives, with the best will in the world, can only deliver consultant rules, or obstetric protocols. A hospital birth at home will not satisfy the demand for home birth. Ultimately, in the present scenario, what is at stake is nothing less than freedom in birth. So let's hear it for our independent midwives.

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Myths in childbirth
Now to come to one of the most cherished of all modern myths in childbirth. I am sure you all know that 12 hours is the limit for labour. Once you have been admitted to a labour unit, that's all you have got, 12 hours, 12 hours in which tohave this baby.. Anything longer is regarded as a medical complication. The 12 hour limit is in force in maternity units all over the world. Why not 11 hours, or even 13, I hear you ask. Even speed limits vary from country to country. And it is this universal 12 hour limit that standardises the production of babies in maternity units acrosss the globe.

Emmanuel Friedman
I decided to see where the 12 hour limit came from. And I found that it originated in the US, in the 1950s, and that it was based on the work of an American obstetrician called Emmanuel Friedman.

Friedman studied the length of time women spent in labour, However since all the women he studied were in hospital he was not in a position toknow when their labour began.

Neither did it occur to him to exclude from his study women whose labours had been accelerated by Syntocin, a synthetic form of oxytocin. Nor did he exclude women whose labours had been slowed down by anaesthetic drugs.

Mathematics
Setting aside the problems of the raw data, he focused instead on mathematics, and came up with statistical averages. These showed that the average length of labour was 12 hours. Obstetricians found his graph-based approach to labour useful and the partogram, the graph that controls labour in the labour ward, was born. One centimetre per hour, that's what it says.

And if that sounds unreal, if you imagine that women's bodies were not designed to be average, or that what is normal is not necessarily average, then you would be wrong. We now have graphs, and there are norms. Norms are for fitting into, and no one is allowed to be outside the average.