Two midwife-led units are leading the charge for a new type of maternity service in Ireland, writes RONAN McGREEVY
ON APRIL 8th, Carl Cummins became the 1000th baby to be born in the midwife-led units which were set up in Our Lady of Lourdes Hospital in Drogheda and in Cavan General Hospital.
The experience of Carl’s mother Sarah is something she would recommend to others.
“The level of care and attention I received was excellent from prenatal care, to the birth of baby Carl, to the postnatal care and home visits I received from the midwives,” she says.
“Carl was born in a peaceful environment and my birth plan was followed exactly as I had requested. I would highly recommend this experience to other expectant mams and dads.”
Almost all maternity care in Ireland is obstetrician-led and hospital based. Midwife-led care is, as the name suggests, led by midwives.
It is grounded in the philosophy that birth is a natural process and not a medical condition and the intervention of a consultant doctor should be the exception not the norm.
The practice is widespread internationally but, to date, the midwife-led units at Our Lady of Lourdes Hospital and at Cavan General are the only ones operating in the Republic.
They were initially set up on a pilot basis and as part of a research study in conjunction with the School of Nursing and Midwifery Studies in Trinity College Dublin (TCD).
Cecily Begley, professor of nursing and midwifery in TCD, says: “The obstetric-led and midwife-managed” model of care in Ireland, as identified by the World Health Organisation [WHO], is going against international trends and denies women real choice.
TCD is currently carrying out a comparative study between traditional obstetric-led care and midwife-led care in the northeast region.
The results will be published later this year, but they are expected to conclude that, in the critical issues of patient safety and cost, the midwife-led units compare very favourably with the consultant-led units.
“There is no indication at the moment that it is any more expensive. All the research internationally has shown that midwife-led care is as safe and women are generally more satisfied with it,” she says.
Studies in the UK have found that these services are more cost effective giving obstetricians time to care for women with high-risk pregnancies, while midwives care for healthy low-risk women.
The emphasis is on natural pain relief. Interventions, which are common in hospital settings, are much fewer.
Results from quality questionaires filled in by women who gave birth at the unit indicate an extraordinary level of satisfaction.
Every woman who attended reported they had been given enough privacy during labour, 97.5 per cent felt they were in control of the decisions made during labour, and two-thirds ended up breastfeeding.
The average among Irish women in general who breastfeed after giving birth is less than half.
Carol McGowan, who gave birth to her first child Aoibhín at the midwife-led unit two years ago, says she did not realise how lucky she was until she spoke to mothers who had given birth elsewhere.
“It was brilliant. A lot of your antenatal appointments are in the room that I gave birth in. I got to be familiar with the space I gave birth in.
“A lot of women get to see the labour ward just once. I would have been in there a few times before giving birth and you get to know the midwives on a personal basis. They are your care provider, whereas the majority of women only see the midwife or the obstetrician when they are giving birth.
“It is a very holistic place and what is crucial in a normal birth is a trusting relationship and when you have that trusting relationship, all the research shows that you are a lot more likely not to have to avail of any drugs to give birth.”
As a lecturer in social care in Dundalk Institute of Technology (DkIT), Carol says she is familiar with the arguments for more midwifery-led units which, she points out, was recommended as far back as the 1992 Review of Mother and Infant Care Scheme.
There are two birthing rooms in both units. These rooms are used for labour, birth and the postnatal period. The mother has all her care in the room from admission to discharge home.
The midwives in the unit are the lead professionals caring for women during the antenatal, intrapartum and postnatal period and share the care with the woman’s GP.
As the lead professional, the midwife is responsible and accountable for ensuring women receive care that is agreed in partnership, which in turn facilitates midwives in practising autonomously without the need for the intervention of a consultant doctor.
Eileen Whelan, the director of nursing at Our Lady of Lourdes Hospital Drogheda, says most women who opt for midwifery-led care do so because it provides them with greater choice in relation to their care during labour and birth.
“The interest in the service has been phenomenal and the feedback from the women who have used the service remarkable,” she says.
The 1000th baby was an occasion of celebration in Drogheda last Friday, with staff and parents in attendance. The units are confident that the comparative study will vindicate them and lead to more choices nationally for expectant mothers.
To that end, supporters of midwife-led units received a boost from the Independent Review of Maternity and Gynaecological Services in the Greater Dublin Area (2008) which recommended that similar units be set up in Dublin’s three maternity hospitals.
Stephen Mulvany, the HSE hospital network manager for the northeast and Dublin north region, says the midwife-led units are a “very good example of an excellent high-quality service” which give women a real choice and have proved to be no more expensive than consultant-led care.
He says the HSE will await the outcome of the comparative study being carried out by the HSE, but he anticipates that the results will be positive.
“I would see the HSE trying to expand this type of model in the future. The key issue for us is choice,” he says.