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13th Mar 2017

Why women giving birth in Ireland still have shockingly few options

We deserve more, surely.

Taryn de Vere

Doctors are choosing C-sections over fears of being sued

“I just wanted to be treated with respect, to have a good birthing experience.

“I wanted to have options as to where I had my baby, who was with me and how I had my baby. I expected to come out of it as healthy as I went in and to end up with a healthy baby.”

Sinead, Donegal.

To expect choices in how women deliver, where and who is present doesn’t seem like a huge ask and yet most women in Ireland do not have these options. If you live in Galway, Sligo, Mayo, west Clare or Donegal the only option is a consultant-led unit. Women in the rest of the country have the option of a homebirth, though not every county offers this service for free.

Where women give birth impacts not only the choice of what kind of birth is available but also affects the chance of having a c-section or episiotomy. Women who give birth at Holles Street, Dublin are almost three times more likely to be given an episiotomy than those birthing in Wexford.

The National Institute For Health Care And Excellence recommend that: “A routine episiotomy should not be carried out during spontaneous vaginal delivery.”

So what are they doing at are Holles Street that causes so many episiotomies to be performed? Why are women in Kilkenny almost twice as likely to have a c-section as women birthing in Sligo?

The postcode lottery of services can have more serious effects on the lives of women and babies.

Samantha Kenny from Kildare was originally booked in to Portlaoise Hospital for her fourth baby. She requested a homebirth but her consultant refused to issue her notes to the home birth midwives so she could be assessed by them for suitability. Samantha said of her consultant: “I was told by her secretary that she (the consultant) wouldn’t sign off on anything and would delay to the point I would give birth in the hospital whether I liked it or not.

“I requested a transfer as I didn’t want to go to a hospital that thought that behaviour was OK.”

Samantha chose to transfer to The Coombe. She was 32 weeks pregnant when she had her booking in appointment. As she was a transferred patient they gave her a detailed anomaly scan, which had been unavailable in Portlaoise.

It was this scan that revealed the baby had inter utero growth restriction and was measuring four weeks behind her expected weight.

“Ava has a genetic syndrome, her growth in utero would have always been slower and could have been picked up sooner and I could have had choices ie an amniocentesis or blood testing. I could have reached out for support. The lack of anomaly scan etc. meant my choices were severely limited.

“If I hadn’t transferred would the restriction ever have been picked up, would she have been classed as a small baby? This could have killed her. I don’t want to think about what would have happened had I been left to go full term.

“This was all because I live in Kildare and chose my local maternity hospital for convenience.”

I asked Samantha what kind of support received after the diagnosis and birth of her daughter: “People don’t realise that you just get left. You get given a diagnosis and they send you on your way to figure it out yourself.

“No info on specialists, support groups, others like you. Just a sheet of paper and an appointment for family testing. I genuinely thought that because Ava is so specialist we would get family help. We get nothing as a family. No counselling, no peer to peer support groups. Nothing.”

For some women the failings of the current maternity services cost them their lives. There were 38 maternal deaths in Ireland between 2009 and 2012. According to the World Health Organisation between 88-98 percent of all maternal deaths are preventable.

In December 2016 Minister for Health Simon Harris launched the new National Maternity Strategy which recommended wide sweeping changes to the current Maternity services, including consistency of services around the country.

Member of the HIQA advisory committee and Maternity Strategy Steering Committee and AIMS Ireland Chair Dr Krysia Lynch commented: “Without a question the most important aspect to users of the service is its safety and also that it complies with the latest evidenced based research.

As part of the public consultation on Maternity Care in Ireland carried out, the key themes identified by those 1300 respondents in addition to safety were the need to be listened to, the importance of choice in birth setting, the issue of informed consent and refusal and more support for breastfeeding.”

More than a year later the pregnant women of Ireland are still waiting for this strategy to be implemented. It is not too much to ask for choices in childbirth, for consistency of services, evidence based practices and to be treated with respect. How many more women have to suffer, or die before the strategy is implemented?