Deirdre Veldon reviews two very different books on childbirth - one by a consultant obstetrician and the other by a birthing assistant
Is it because we're better educated? Older? Wealthier? More sensitive? Or because we have unprecedented access to specialist information? Or more time? Whatever the why, it's indisputable that the modern mother-to-be has an insatiable appetite for literature and advice on pregnancy and childbirth.
And even though childbirth is a universally female experience, having a baby in Ireland is not the same as having a baby in any other country. The average birth rate here has increased by almost one- quarter since the early 1990s and is the highest in Europe with 15.5 births per 1,000, compared with 12 in Britain, 13 in France and 8.5 in Germany.
More than one in five babies is born by Caesarean section here (22.4 per cent), despite recommendations from the World Health Organisation (WHO) that Caesarean rates should not exceed 15 per cent. Most births take place in an institutional setting, with only around 250 home births per annum. Irish breastfeeding rates continue to languish at around 40 per cent for women leaving hospital, which compares poorly with rates of over 70 per cent in Britain and up to 99 per cent in Norway.
This Irish childbirth experience has spawned two books recently - The Irish Pregnancy Book by consultant obstetrician and gynaecologist Peter Boylan and The Better Birth Book by doula (birthing assistant) Tracy Donegan. Though both are undoubtedly targeting expectant mothers in Ireland, there's a marked difference in their respective approaches. It's clear these two individuals would have some very animated discussions, were they to meet. Expectant mothers (and fathers) will buy one or the other of these books, probably based on how closely either writer reflects their own philosophy of childbirth.
As a consultant of 30 years' experience and former master of the National Maternity Hospital in Holles Street, Dublin, Boylan has written his straightforward and practical guide to pregnancy and childbirth as an insider and advocate of institutional care.
On the other hand, Donegan focuses almost exclusively on labour and childbirth and her book is a determined exercise in helping women assert control and individuality and explore alternative options.
In keeping with his pragmatic approach, Boylan patently has little time for many new wave or alternative approaches. For example, he despatches the use of hypnosis during labour with a solitary sentence: "Hypnosis is very rarely used in labour and is probably not a very good idea as you will not be in touch with what is happening and what you are feeling." That's that then.
As a HypnoBirthing educator and quite the hypnosis evangelist, Donegan would not approve. She says hypnosis is the key to an easier and gentler birth, adding, in contradiction of Boylan's assertion: "You will always be aware of what is happening to you and around you, and never detached from the experience, which is a common misconception especially among medical staff."
Again, readers will reject or embrace one or other of the above statements based entirely on their own set of values and belief systems.
Boylan's book is useful, authoritative and clearly born of decades' experience dealing with delivering mothers. He takes the reader through the process from A to Z, from becoming pregnant and choosing antenatal care through general health and pregnancy month by month to specific issues, such as infertility, multiple births and when things go wrong.
Each section is punctuated by the by-now ubiquitous frequently asked questions section which, along with the occasional personal story, makes it more accessible and human. These also rescue it from a fate as a textbook, to which it inclines, thanks to its formal tone and diagrams more worthy of first year biology students than informed adults.
Regular readers of pregnancy and childbirth books will be only too familiar with the on-the-one-hand-and-on-the-other approach taken by the most popular among them, including the What to Expect series. Refreshingly, Boylan doesn't suffer from a need to please both sides of his audience. He is matter of fact, to the point of being blunt. For instance, he says women should not be overweight when they conceive for three reasons, namely: increased risk of diabetes; losing extra weight gained during pregnancy is difficult enough without adding to it; and it's hard to scan babies in overweight women.
Neither is Boylan shy about expressing his views on other issues, such as birth plans, downloaded from the internet or gleaned from templates in reference books and brought in expectant mothers' hot little hands to their doctors for discussion. One suspects these are the true bane of any consultant obstetrician's life, but they're loath to tell their patients so.
I've yet to encounter a mother-to-be who was allowed to talk through their birth plan checklist in great detail with the consultant and have it observed to the letter. Boylan suggests most birth plan stipulations are either redundant or insulting to hospital staff. In short, he baldly says, "birth plans are not necessary". Naturally, Donegan is a firm believer women should carefully document their wishes for the birth and even includes a sample birth plan in her book.
Birth positions show a similar discrepancy between authors. Boylan says: "Squatting or kneeling on all fours confers no advantage, gravitational or otherwise. In fact, these positions make it much more difficult for medical staff to see what's going on and to help accordingly." Donegan advises staying off the bed where possible for the birth and has positive things to say about delivering on all fours or in a supported squatting position. Incredibly, both writers suggest delivering while lying on one side is a good idea.
In contrast to Boylan's authoritative, medical style, Donegan's lively and user-friendly book cleverly targets its market by bringing a woman's perspective to childbirth. And although she's a fan of complementary and alternative treatments, it's not at the cost of sharing her own useful experience of, and research into, the Irish maternity system. It may be a little too touchy feely for some, but there's lots of science here and Donegan quotes liberally. In addition, the case studies peppered throughout add interest and there's a useful little guide to the major statistics from maternity units in Ireland.
The Irish Pregnancy Book: A Guide for Expectant Mothers by Peter Boylan, 2005, A&A Farmar, €14.99.
The Better Birth Book: Taking the Mystery (and Fear) Out of Childbirth by Tracy Donegan, 2006, The Liffey Press, €14.95.