Labour-saving midwives


More women are opting for a mother-centred style of care than the consultant-led model, which is why the community midwifery scheme at the National Maternity Hospital, Holles St, cared for more than 1,100 women last year

COMMUNITY MIDWIFERY is no longer marginalised within the maternity hospitals in which it operates in Ireland, says Margaret Hanahoe, who heads a team of eight community midwives in the National Maternity Hospital (NMH), Holles Street, Dublin.

The NMH community midwifery scheme started 10 years ago and last year brought more than 1,100 women through the antenatal, birth and postnatal period.

“It’s a cost neutral service because most of our women don’t stay in the hospital so there is a huge amount of bed space saved,” says Hanahoe.

“We had 3,000 more babies born in the NMH last year than we had six or seven years ago and that’s in the same number of beds. The only way to deliver that is with early-transfer-home schemes such as the community midwives scheme,” says Hanahoe.

For the women who choose community midwives for their maternity care, not staying over in the hospital is a small sacrifice (in fact, many are keen to get home as soon as possible) for what is often described as a more mother-centred style of care than the consultant-led model.

Many of the women who opt for the community midwife scheme at the NMH are keen to have lower levels of medical intervention during childbirth.

Actress Carmel Stephens opted for the scheme when she was pregnant with her son, Archie (now 15 months old).

“I wanted to avoid pain relief if at all possible and I felt that the community midwives would take this seriously in my birth plan,” she explains. “They did warn me that it would be tough but they advised me to swim and take hypno-birthing classes during my pregnancy which I did,” says Stephens.

“I was able to manage the labour pain at home before going into hospital and then, the midwives gave me the space to go into my own world which meant that I had the birth I had hoped for.”

The midwife-led service at the NMH takes only low-risk pregnant women who haven’t previously had Caesarean sections.

“We don’t take twins or women who have had infertility problems,” explains Hanahoe, who argues that natural childbirth approaches are a lower risk option for these women than a medical model where inducing childbirth with medication is common, an approach which research has shown often results in spiralling levels of medical intervention.

“Community midwives see the benefits of supporting women both physically and emotionally.

“If women go into labour spontaneously, the chances of ending up with a spiral of intervention is reduced,” says Hanahoe, who acknowledges that some women who choose the community midwife scheme can also end up having a lot of medication – including an epidural – during childbirth.

The community midwife scheme at the Rotunda Hospital in Dublin, which was set up three years ago, operates principally in the Finglas and Cabra areas of Dublin.

“We specifically recruit women from these areas either through self-referrals or via their GPs,” says Fiona Hanrahan, clinical midwife manager for community services at the Rotunda.

“Many of our women are between 19 and 21, have loose relationships and are living with their parents. It’s often the first time they have touched the health service so it’s important that this contact is good. Then, we can build on their trust,” says Hanrahan.

“We’ve seen huge changes in the parenting skills, self-esteem and confidence in these women and we’d love to expand the service if the money and infrastructure was there,” says Hanrahan.

Breastfeeding rates have also risen slightly since the community midwives started work in Finglas and Cabra.

Margaret O’Donovan, director of public health nursing in Dublin South East, says schemes that involve early transfer home of mother and baby offer a good level of support.

“They are seen to be very beneficial for the mother and baby because the midwives can detect, address and resolve problems early and have a direct connection back to the hospital if necessary.” O’Donovan also acknowledges that the continuity of support for breastfeeding mothers is valuable.

Outside of Dublin, community midwifery schemes have developed in only a few areas. These include Wexford General Hospital, Waterford General Hospital and the purpose-built midwifery units in Cavan General Hospital and Our Lady of Lourdes Hospital in Drogheda, Co Louth.

A community midwifery scheme which operated from the University Hospital in Galway has been discontinued.

So, what is crucial to keeping a community midwifery scheme going?

Jo Murphy-Lawless, lecturer in the School of Nursing and Midwifery Studies at Trinity College Dublin, says: “Above all, the research evidence points to how confident women feel as new mothers with this kind of care to support them.

“The unfortunate problem we face in Ireland is the relative anonymity of the midwife.

“Because of the predominance of private consultant obstetric antenatal care, women tend to have much less of a sense of the midwife as the deeply skilled professional who knows most about normal birth,” she says.

Meanwhile, Margaret Hanahoe’s one gripe is that even though the majority of women who opt for the community midwife service at the NMH have private healthcare insurance, it is a free service.

“At the moment we can’t take any women who are over eight weeks pregnant because we have so many women opting for the scheme. If we had more funding, we could have another team in place.

“The insurance companies are getting off scot-free for these women. Why can’t we have some of this money?” she asks.