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Childbirth and unsought interventions

Sir, – On behalf of the Midwives Association of Ireland, we should be grateful if you would consider publication of our response to Laura Kennedy’s recent article “The natural childbirth movement has a lot to answer for” (Life, April 17th).

Midwives complete a four-year honours degree programme and are specifically educated to support women in normal pregnancy, labour and in early parenthood. We know the many benefits of supporting women to be confident in their own ability to birth without routine, unnecessary and unsought interventions. This is especially important in Ireland, because the default position is a highly prescriptive, regulated medicalised birth. This became entrenched in the early 1970s with the introduction of Active Management of Labour (AML) protocol. This led to all Irish women in labour in our 19 maternity units, regardless of wellness, being set strict time limits for each stage of labour: induction if labour does not start “on time”, waters broken and a drip with oxytocin if not dilating quickly enough, pain relief, episiotomy, assisted vacuum or forceps delivery all follow on inexorably.

This is not to negate the role of the obstetrician nor the use of technology for women who have genuine problems and need medical assistance to birth safely. However, not all pregnant women require medical intervention nor do they want it.

Laura Kennedy, quoting Dr Amy Tuteur, an American obstetrician, states that “childbirth is not inherently safe – obstetrics, anaesthesia and C-sections have made it safe. Thank goodness for that.” We would disagree. Far from making birth safer, best international evidence shows that routine interventions associated with the biomedical model of birth for all women, are creating risks and problems where there were none. In fact, the US is the only high-income country in which maternal mortality rates are rising, and this is due in part to over-intervention in a litigious and highly medicalised birth culture. In what is one of the most significant and empowering events in many women’s lives, the physiological process of birth is being undermined by the highly interventionist, time constrained and throughput focus of the AML protocol. The majority of women entering the maternity services start off low risk, but can end up high risk because of their encounter with this industrial model of birth.

The Irish Childbirth Trust revealed that in 2017, seven out of our 19 maternity units had induction rates of 42 per cent and over for first time mothers. Caesarean section rates are likewise increasing at an alarming rate averaging at around 30 per cent, with only one hospital below that at 28.6 per cent, and three hospitals with rates of over 40 per cent.

Laura Kennedy decries a proud husband who “was heaping praise upon her [his wife] ‘Trojan effort’ and ‘steely resolve’ in bringing their child into the world without the helpful effects of pain medication”. Her assumption is that pain is bad and should be avoided and pain medication is helpful. The hormone that causes labour contractions, oxytocin, is known widely as the “love hormone” or the “hormone of trust” which gives a sense of calm and wellbeing. The endorphins which are produced in tandem with oxytocin in labour are the body’s natural painkillers, which enable women to manage labour pain without medication if they choose. These hormones also promote postnatal feelings of euphoria, maternal-infant bonding and breastfeeding.

Whether or not a woman opts for an epidural is her choice. Women state consistently that they need to be in control and to be supported to make the decisions they want about their care throughout the birth process. Midwives are not opposed to the epidural. Midwives respect women whatever their decisions in labour. The core problem is how and whether women get to make their decisions supported by their midwife, because there are simply too few midwives.

What Laura Kennedy has missed is that the acute shortage of midwives, along with our national reliance on a badly out-of-date medical model of birth (which is out of step with international best practice) and an acute lack of resources to fully utilise all that women should be able to draw on, including birthing pools, is depriving women of the supported care they need in order to labour as they feel is best for them. For the sake of comparison, Northern Ireland with 23,000 births last year has eleven midwifery-led units. We have two for over 60,000 births.

And we have a stalled National Maternity Strategy which has just had its funding cut.

The more than a thousand women who rang into the recent RTÉ Liveline programmes about their distressing experiences, deserve decent maternity services. Until we correct the grievous problems which afflict our services, midwives will not be there at critical moments to support women to own their birth experiences. – Yours, etc,

MARGARET

DUNLEA,

Assistant Professor

in Midwifery,

Trinity College Dublin,

Committee Member,

Midwives Association

of Ireland,

LIZ NEWNHAM,

Lecturer in Midwifery,

Griffith University,

Australia,

Midwives Association

of Ireland International

Adviser;

JEANNINE

WEBSTER,

Co-founder,

Midwives Association

of Ireland;

JO MURPHY-LAWLESS,

Sociologist and Activist;

PATRICIA

HUGHES,

Chairwoman,

Midwives Association

of Ireland.

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