From hospital
hurt to home birth
This week's ruling
on home births highlights an ongoing row between obstetricians
and independent midwives, writes Kitty Holland Some months after
Jo Kavanagh gave birth to her first baby, Lia, she found herself
in a Dublin bookshop. In tears. "I picked up a copy of this
book, Misconceptions, by Naomi Wolf, all about how birth has become
dominated by medicine and what that does to a woman. I began reading
it and found tears
streaming down my face." She was, she says, suffering varying
degrees of depression for more than a year, caused by the manner
of her daughter's birth.
The birth of Lia three years ago at a Dublin maternity hospital
left her feeling "betrayed and cheated". She had given
a birth plan to her consultant, but "almost everything I
asked \ not to be done was done".
She was given the drug oxytocin to speed up the birth (which she
says made the pain worse), her waters were broken, she was given
an epidural and her daughter was taken from her for several minutes
straight after being born and given back wrapped in a towel. "I
had no skin-to-skin contact with Lia when she was born. I had
no encouragement from the staff."
She felt she had
given birth in an atmosphere of threats and fear. "In the
end I felt violated, hurt and taken advantage of at the most vulnerable
time of my life." She left the hospital with "an overwhelming
feeling of sadness, that never really left until after the birth
of my second child".
When she found out she was pregnant again two years ago, she "couldn't
bear the idea of going into hospital". She contacted midwife
Philomena Canning who agreed to meet her and her husband at home
and told her she could have her baby at home.
Jo describes a "magical" experience of having her baby
son at home. She had a birthing pool in her living room; Canning
came to her home at about 4 a.m. the morning of the birth and,
at about noon Charlie swam into the world - "the midwife
plopped him on my tummy and because I'd had no epidural he wasn't
sleepy. He was wide awake and he stared up into my eyes. I felt
bathed in the most amazing feeling of bliss I ever had. And I
couldn't take my eyes off him."
There's no doubt it went wonderfully for Jo and her family. For
others, however, it doesn't go so well, as some concerned about
the lack of regulation of the home birth sector have been telling
the Department of
Health for years.
In the heated stand-off between advocates of home birth and those
concerned about its absolute safety, this lack of regulation,
like the women and their babies in the middle, seems to have been
lost. This week's Supreme Court judgment, that health boards were
not statutorily
obliged to provide home birth services, has refired the determination
and vitriol on both sides.
Determined to refute any assertion that home births are less safe
than hospital deliveries, Marie O'Connor of the National Birth
Alliance strongly criticised a study by former Master of the Rotunda
Hospital, Dr Peter
McKenna. His findings, published in the Irish Medical Journal
in August, that the death rate among babies delivered at home
in the Dublin region was as high
as one in 70 over a three-year period, she says will be "rubbished"
in an article she has co-written to be published later this month
in a "leading international midwifery journal". She,
and others such as Krysia Rybaczuk of the Home Birth Association
and Canning, dispute Dr McKenna's figures, saying he is using
"statistics for his own political ends, i.e., to eliminate
self-employed midwives, his sole competitors, in the community".
His figures, she said were "at variance" with other
studies on home births in Ireland.
Dr McKenna has consistently said that his figures are factually
correct and he "absolutely and utterly" rejects assertions
he is anti-midwife.
Other studies show the death rate among babies born at home to
be about one in 400, compared with one in 1,600 born in hospital.
Since 2000, the Rotunda has drawn its concerns about the safety
of the home birth services to the attention of the Department
on three occasions. It said the deaths of four babies delivered
at home "could have been averted"
if delivered in hospital. At least two of the mothers, says Dr
McKenna, should not have been given the go-ahead to attempt home
delivery. The hospital wrote: "We believe that home birth
can work but only if the
professionals undertaking them adhere to agreed guidelines and
have their practice regulated by an appropriate authority. We
do not believe this to be
the case at present and we do not accept the supposition that
if the parents of the deceased babies find no cause for complaint
that there is no case to
answer for the home delivery service."
The hospital's concerns have not been addressed by the Department.
Currently the 15 private independent midwives in the State are
not supervised by any
authority.
Obstetricians such as Dr McKenna as well as Dr Peter Boylan former
Master of Holles Street and Dr Declan Keane, current Master of
Holles Street, are gravely concerned that independent midwives
are agreeing to deliver babies at home that the doctors believe
should be in hospital - breech deliveries, twins and deliveries
"too far away" from their nearest maternity service.
Independent midwives reject these criteria for refusing to allow
women to give birth at home. Birth is on the brink of "becoming
an operation" when in fact it is one of the most natural
things in the world, says O'Connor.
"Women are being penned into ever-larger units of production
and the quality of care is being compromised."
Dr Keane insists he and his colleagues are not trying to undermine
midwives. He agrees, in an environment where half of first-time
births are now delivered by Caesarean section, forceps or vacuum
delivery, that birth has become over-medicalised. "For the
vast majority of women pregnancy is a normal physiological experience.
I would feel far more should be seen out in
the community by their GPs with minimal contact with obstetricians.
But that's a funding issue. For the Department of Health to put
a midwife in every GP practice, well, that would cost an awful
lot of money."
It's a sentiment Jo agrees with. "I think it's awful that
the only choice for women is either active birth management in
hospital or an expensive home birth. There's no half-way house.
There should be midwife-led birthing units
where obstetricians are on hand only if needed."
Women and their babies have become "victims", she says,
caught in a row between obstetrics and independent midwives. "They
really should sit down
together and sort it out."
© The
Irish Times
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