Home or hospital? The politics of birth
The High Court will rule on Friday in a landmark case against the HSE and its strict criteria for home births
The results show that women can be twice as likely to undergo a Caesarean section depending on the hospital in which they give birth. The highest proportion of Caesarean sections, at 38.7 per cent, were performed at Mount Carmel Hospital in Dublin; the rate at St Luke’s General Hospital in Kilkenny was 35.6 per cent of all births. At Sligo General Hospital, 18.9 per cent of all babies were delivered by Caesarean. At Kilkenny hospital, 43.2 per cent of first-time mothers underwent Caesarean sections, compared with 22.1 per cent at the National Maternity Hospital in Dublin.
On rates of spontaneous vaginal birth, with no requirement for ventouse, forceps or Caesarean section, excluding maternity-led units at Our Lady of Lourdes Hospital in Drogheda and Cavan General Hospital, mothers at Sligo General Hospital required the least intervention with 68.7 per cent of all births being spontaneous, while mothers at South Tipperary Hospital received the most intervention, with 52.3 per cent of all births being assisted in those ways.
The spokeswoman for the Homebirth Association of Ireland, Eva Goussot, says many women choose home birth because they have had a bad experience of hospital birth. “I can understand someone who had come out of hospital having had a Caesarean wanting something different. If the hospital you gave birth in has a 43 per cent Caesarean rate for first-time mothers, which is three times the World Health Organisation recommendation, I can understand how you would start to ask questions about the birth you had.”
Goussot, who is soon to give birth to her second child at home, says the main reason more Irish women aren’t giving birth at home is because they aren’t being informed about it. Her experience of Irish GPs is that they are either unaware of home birth or frown upon it.
“In the UK, they provide you with information about your choices but you’re allowed to make your own choice. Informed decision-making is very much respected. I think that’s the problem in Ireland. We don’t have a culture that respects individuals’ decisions.”
Dr Fionnuala Breathnach, a consultant obstetrician at the Rotunda Hospital in Dublin, acknowledges that while studies report excellent outcomes for women who achieve delivery at home, the same cannot be said of those who require transfer to hospital during labour because of foetal or maternal complications.
“As many as 50 per cent of women who intend to deliver their baby at home don’t actually deliver at home,” says Breathnach. Reasons can vary from “the need for stronger pain relief, to a labour that isn’t progressing, concern about foetal heart rate or the requirement for a Caesarean section. “There is a big group that delivers in hospital because of a problem at home and they are somewhat swept under the carpet,” she says.
According to Breathnach, infrastructure that allows for speedy transfer to hospital is key. “I’m not sure that every corner of the country is set up for that in a way that it may be in other countries.”
Devane says for the large number of women precluded by HSE criteria from choosing a home birth, their options are: a hospital birth that they don’t want; legal action; or a free birth, which means giving birth unassisted at home, for which he says there is anecdotal evidence.
“I’m not convinced that any of these are optimal,” he says. “Where a woman wanting a home birth decides to give birth without professional support, there are no winners in that situation among healthcare professionals, women or society.”
He calls for more individualised assessment of women by the HSE.
“At the moment there is a long list of criteria that require women to give birth in an obstetric unit. A better way of looking at this would be that these are criteria that require individualised assessment of the mother to determine the most appropriate place of birthing for her. There’s a stark difference.”