Birth options are very limited for Irish women - hospital or home. Do women want an alternative? Susan Calnan reports on a viability study into an 'Irish birth centre.
A feasibility study, which aims to assess the level of support for the setting-up of Ireland's first 'standalone' birth centre, has been launched in Cork. The study, which began in January, will measure the financial viability of and level of public interest in a birth centre for the west Cork town of Clonakilty.
The town has been earmarked for a birth centre because of its distance from the nearest maternity hospital, which is in Cork city, and also because of the growing number of young families settling in the area.
At present, there are no standalone birth centres in Ireland. Birth centres are a common feature throughout the world, however; in the UK, for example, there are over 90 centres throughout the country.
A birth centre is a 'home-like' facility, separate from a hospital, where a woman can undergo a natural birth and receive maternity care, provided by experienced midwives.
It offers an alternative to women who are not comfortable with having a home birth but who would prefer not to give birth in a hospital. The service is suitable only for women who have a low-risk pregnancy and who are likely to have a normal delivery.
If the woman needs to see a consultant obstetrician, the midwife will refer her accordingly. In the event of an emergency, midwives are highly trained to deal with the situation and can assess if the woman needs to receive medical attention.
International studies indicate that birth centres have a number of benefits: women can give birth in an intervention-free and drug-free way, in a more intimate and low-tech environment, where they will receive one-to-one care from an experienced midwife. Birth centres also offer other facilities that are not usually available in hospitals, such as family accommodation, water pools, complementary therapies and a generally more relaxed environment. Also, birth centres have a high standard of post-natal care; for example, women are given greater support with breastfeeding and they are encouraged to stay in the centre until they feel ready to go home.
Independent midwife Bridget Sheeran, who is a member of the Birth Centre for West Cork Committee, an independent group overseeing the feasibility study, says the primary aim of a birth centre is to give women greater choice over where and how they want to have their baby.
She also stresses the benefits of having a natural birth in a more relaxed, non-clinical environment.
"Natural birth is based on a social model, as opposed to a medical model of birth, so the mothers are viewed as going through a healthy physiological process," says Bridget.
"Midwives see birth as normal, whereas the obstetricians working in hospitals only see birth as normal in retrospect. The advantage of a birth centre and of natural birth is that, provided there are no risk factors, there is a greater chance that a woman will give birth without intervention and also she will be better equipped to deal with the intensity of a drug-free birth."
Professor John Higgins, head of the Department of Obstetrics and Gynaecology at University College Cork, declined to comment on the proposal to set up a new birth centre in Cork. However he did stress that obstetricians do welcome and encourage greater choice in maternity care for women within the hospital setting. He says developments, such as the construction of a new state-of-the-art Cork University Maternity Hospital (CUMH) would further strengthen his department's commitment to providing the highest quality of maternity care for women.
Bridget stresses the benefits of a natural birth for babies: "Because there are no mechanical instruments or drugs used during the labour, the birthing process is much more gentle.
"As a result, babies tend to be much more alert and less likely to get sick after they are born and they are more likely to breastfeed well. Also, the mother tends to recover more quickly after the birth because there is less intervention and trauma all round."
Although Bridget trained and worked as a nurse and then as a midwife in hospitals in the UK, she has been working as an independent midwife for the past 15 years. For over two years, she has been contracted by the Southern Health Board (SHB) to provide a home birth service to mothers, as part of the Domiciliary Midwifery Pilot Project for Cork City and County, a two-year pilot project undertaken by the SHB to assess the viability of a community midwifery service in the area.
The service has been extended indefinitely, pending the evaluation and recommendations of the National Domiciliary Births Group.
Since she moved back to Ireland more than 10 years ago, Bridget says she has been disappointed with the lack of recognition given in this country to the midwifery profession. Although she stresses that she is not knocking the obstetric profession, which she says provides an essential service for women who require intervention or medical pain-relief during labour, Bridget insists that obstetrics and midwifery are separate professions and that greater support should be provided for midwifery-led services in this country.
"In the UK, for example, midwifery is strongly recognised as a profession in itself and midwives are regarded as being the experts in 'normal birth', as opposed to 'complex birth' which is really the realm of the obstetricians, who can provide intervention and medical pain-relief when it is required," she says.
"What has happened in Ireland, however, is that the realm for birth is in the hospitals only and, as a result, it is solely obstetrician-led; there isn't a separate midwifery context in this country, except for home births."
"I receive a significant number of calls from Irish midwives working abroad, who want to come home but who don't want to work in hospitals," adds Bridget.
As part of this latest study, the results of which will be published later this year, Bridget hopes to assess the level of interest that women in the Cork region have in a new birth centre being set up in their area.
"In Ireland, most babies are born in hospital, although there are a few hundred home births every year," Bridget says.
"There's still a lot of work that needs to be done in this country to inform and educate people about what birth centres are and about the benefits of having a natural birth in an alternative setting to a hospital.
"From the women that I've come into contact with and also from the results of the feasibility study so far, it is apparent, however, that many women are looking for an alternative to the medical model of birth; they still want to be cared for by professionals but in a way that requires less medical intervention," she adds.
For more information on the feasibility study, contact Bridget Sheeran on bridget@bridgetsheeran.com or visit www.bridgetsheeran.com