Delivering
some
home truths about home births
BBA. Born before arrival. That's what is jotted on the charts
of
women who deliver before they make it to a maternity hospital.
According to reports, recommendations by the Medical
Manpower
Forum could result in the closure of 12 of the country's
22 maternity
units, writes Breda O'Brien There are plans to annex
Holles Street,
the Rotunda and the Coombe to the city's acute hospitals, while
maternity units in Ballinasloe, Mullingar,
Portlaoise, Castlebar,
Tralee, Kilkenny, Clonmel and Wexford are
to close.
If these recommendations are implemented by Micheál Martin,
those seemingly innocuous initials, BBA, will become more and
more common.
Let's look at the implications. Bronagh Livingstone was born in
an
ambulance 20 minutes after her mother, Denise, was turned
away
from Monaghan Hospital,
even though a no-longer-used
maternity unit lay empty, and midwives
were present who had
been redeployed to nursing duties. Bronagh
died.
Her chances of survival were not high because she was so
premature,
but to her parents' and family's grief were added the
indignity
of the circumstances of her delivery, without a midwife in
attendance,
on the side of a road. If the closures of maternity
units go ahead,
it will mean longer journeys for women in labour.
Inevitably,
it will mean births in cars, in GPs' surgeries, in Garda
and
fire stations, as desperate mothers look for help wherever
they
can get it.
What we are talking about is the high probability that babies
will
die who would otherwise have survived, as the statistics
show that deaths in those circumstances are 68 in 1,000, which
is
eight times as high as birth in
hospital.
Furthermore, it will result in any woman who has a history of
a
short labour being encouraged to come into hospital to be
induced,
in order to prevent a roadside birth. It will be an
intervention
made for pragmatic and not medical reasons, as the
vast majority
of those women would go into labour on their own if
they did not
have the misfortune to live miles from the maternity
unit.
Having experienced an induction of labour, I can testify that
the
intensity of the contractions is far greater than when you
start
labour normally. As a result, women are much more likely
to
request an epidural.
This in turn can lead to a phenomenon which is well documented
in the medical literature, of a cascade of interventions such
as
forceps or ventouse delivery or Caesarean section. Birth moves
closer and closer to a medical procedure and farther and farther
from the way which nature intended it.
Every intervention in those circumstances increases the degree
of risk for the baby and indeed the mother. Tabloid stories about
mothers who are "too posh to push" might paint Caesarean
section as some kind of lifestyle choice with no medical
implications.
However, as the Master of Holles Street, Declan
Keane, has pointed
out: "People forget that it's still a surgical
intervention
and has immediate and long-term effects on the
mother."
We are frustratingly far from a holistic vision of birth in this
country. The suspension of the domiciliary midwife and home
birth
service provided by the Western Health Board (WHB) is a
good example
of that. Introduced as a pilot scheme in 1999, the
system allowed
women to be cared for by a midwife right through
pregnancy, to
stay at home to give birth or go to hospital for a
few hours and
come home soon after. The latter was termed the
Domino system.
If complications arose, an obstetrician was always available.
Most women chose the Domino option, but a number chose
home birth.
Every year the numbers were increasing due to
parental demand.
The reason given for suspending the service
was that the funding
was needed to appoint a consultant
neonatalogist and an obstetrician.
What does it say about our health service that one of these
things
is presented as an alternative to the other? This move
must surely
embarrass Mr Martin, who recently praised highly
the similar Holles
Street domiciliary scheme. Even from a
financial point of view
the domiciliary midwifery scheme made
sense, as it cost only €372,000
to administer it.
The good news is that parents are no longer willing to be the
passive recipients of bureaucratic decisions which affect them
so
profoundly. There will be a march today, beginning at 2 pm
at the Garden of Remembrance in Parnell Square, Dublin, which
is supported by the Green Party, one of the few political parties
with a progressive policy on birth.
The marchers will include Parents for Choice In Birthing, who
are a lobby group set up to contest the WHB decision to suspend
the domiciliary scheme.
There will be lots of parents from other places who do not want
to see their local maternity unit closed.
No doubt there will be many veterans marching from the long-established
Home Birth Association who have had a frustrating existence trying
to gain support for home birth.
The medical establishment seems severely threatened by the idea
that healthy women can give birth at home with the assistance
of a midwife, and that many studies show that, not only is it
safe, but preferable in many ways for both mother and baby.
Could it be that if it were accepted that home birth is a good
option, consultants will lose business? Surely not. Yet it does
seem odd that not only has the WHB scheme which was backed up
by hospital expertise been suspended, but there seems to be a
concerted effort to make life impossible for independent midwives
who work outside the hospital system.
One certain way to make home birth less safe is to marginalise
it and treat the expertise of these vastly experienced women with
contempt. This has
knock-on effects even for midwives who work
only in hospitals,
who see their profession downgraded and made
subservient to consultants.
We are very far in this country from the situation which pertains
in say, the Netherlands, where midwives are the recognised
experts
in normal delivery and home birth is a mainstream option.
That's
good for mothers, good for babies and good for the
profession
of midwifery. What's bad for all of them is the
possibility of
more unnecessary, and potentially lethal, unattended BBAs.
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