If you follow me on Twitter, you probably saw during the week that I attended the rally outside the High Court in Dublin on Wednesday to support Aja Teehan in her case against the HSE to lift the blanket ban on homebirths for women who have had a previous Caesarean section. Aja’s case is based on an individual’s right to self-determination and making decisions about themselves based on informed choice. You can read the details of her application on her website here. Continue reading Aja Teehan: Just because you don’t like it, doesn’t mean it’s wrong
Waterbirth in Ireland was the theme of this year’s Home Birth Association annual conference on Sunday. If you were following me on Twitter, your timeline would have been bombarded with a blow by blow account of the day. Between myself and my fellow Irish Parenting Blogger David who was representing Birthingmamas on the day, I think there probably wasn’t one inch of the conference we didn’t cover!
The biggest take away for me was that water birth – whether you’re talking about just labouring in water or both labouring and delivering your baby in water – is most definitely not the preserve of women planning a home birth. Having access to birth pools in both hospital and home births is a great option for labouring mothers and the over riding recommendation seems to be “get thee to some warm water!”.
We heard great speeches from renowned UK midwifery lecturer Ethel Burns and Philomena Canning, Dublin-based self employed community midwife, who between them have over 70 years of midwifery and water birth experience. Ethel took us through her fascinating 2012 research on outcomes for women using a birth pool and Philomena spoke about her experience and the benefits of water birth.
Here’s some facts you may not have been aware of:
- All midwifery units in the UK have a birth pool. We have very few in Ireland
- Use of a birth pool during the first stage of labour decreases the need for analgesia (pain meds), results in less augmentation of labour, more spontaneous delivery, less infection, reduced pain perception and increased maternal satisfaction. That’s an awful lot of good things.
- Evidence also shows that using a birth pool results in more intact perinae, no increase in extensive perineal trauma, and no increase for minor or major primary post partum haemorrhage
- It is not necessary to wait until you are x many centimetres dilated to get into a birth pool. You can get in when you want to get it in.
- If you are interested in or planning a natural birth, Ethel’s research proves that both labouring in water, or labouring and delivering in water, increase your chance of having a normal birth. Ethel also pointed out that data shows that if you are a healthy first time mother with no complications, you are in a very high risk group for an emergency C-section. Getting yourself into water for your labour will reduce your chances of this happening.
Both Ethel and Philomena gave great tips on the practicalities of using a birth pool:
- Ethel recommended that the temperature of your birth pool should be slightly cooler than your normal bath temperature but said that you shouldn’t get hung up on temperature. Cooler is better and be comfortable. Philomena agreed that your own comfort was key and suggested a temperature between 37 and 38 degrees.
- Philomena stressed that the most important thing about using a birth pool is to make sure that your partner does a trial run of filling the pool beforehand. You need to know how much water you’ll need, how long it takes, that the hose, taps, nozzles etc all work together.
- From a timing perspective, Philomena recommended that if you’re having a home birth, don’t wait for your midwife to arrive before preparing the pool. Have it filled and ready to go before you think it’s time to call her – otherwise you mightn’t make it that far!
Philomena made three really important points about water birth and natural birth. She said that mothers will always benefit by going with nature as much as you can and that the great thing about a water birth is that it keeps your caregivers away from you and “hands off”. She also called water birth the epidural of home birth. Having laboured in a birthing pool myself I can attest to that last one and also add “but much more pleasant”. 🙂
You can access Ethel’s research at this link here if you’d like to read more. As was mentioned a number of times at the conference, birth pools are so widely available now and quite affordable, so there’s no reason why you couldn’t decide to have your own birth pool at home to labour in before going into the hospital if that’s what you wanted to do. Given the relatively few birth pools available in Irish maternity units it’s certainly something to consider.
There were a number of other topics discussed at this year’s home birth conference including policy developments in home birth in Ireland in the last 12 months and women’s rights in childbirth to choose both where and how they deliver their babies. I’ve covered those same issues here myself in the last couple of months so you might be interested in reading my earlier post, Giving Birth Is a Feminist Issue and my guest blog on Feminist Ire.
You might also like to read my Shopping List for a Home birth and for nostalgia’s sake, I started this blog this time last year the weekend of the 2012 home birth conference when Ina May Gaskin was in town so you might like to check out A Lot of Midwifery is about Loosening the Butt!
Happy water labouring!
I had my baby at home. It was a planned homebirth but it was a decision we only made half way through my pregnancy as we learned more about birth options and preferences we might have. I wanted a natural birth without intervention and I have always been extremely uncomfortable in medical settings so I began to question if my anxiety around being in a hospital might impact on my ability to labour effectively. I was afraid this “holding back” might eventually lead to the interventions I desperately wanted to avoid.
I was lucky to be in a position to choose to change to a homebirth option. I was a low risk candidate in the small catchment area of a maternity hospital with a homebirth programme. It’s one of the advantages of living in a city. As with most things in life, the more people there are, the more options are available.
The day I gave birth to my son greatly exceeded my expectations. In hindsight, things that I didn’t realise were important became hugely so. The foremost of these was privacy and as a direct consequence, freedom. There was no one there but myself, my husband and our midwives. There were no unexpected interruptions and there were no strangers. I wandered the house and laboured in the kitchen, on the stairs, in my bedroom, on the loo, in the birth pool and then finally delivered my son on the kitchen floor. I leaned on the counters, on chairs, against the bathroom wall, on my hands and knees, all over my poor husband’s shoulders and arms. I stripped out of my clothes and laboured and delivered naked. There was no calculation or premeditation in my behaviour, I just did.
It was a privilege and a gift.
My expectations for any further pregnancies and births are high and I think they should be.
All women, regardless of location, education, social class, financial status and personal circumstance, have the right to “just do” when they are giving birth. They have the right to choose how they want to deliver their baby and where they deliver their baby. They have the right to labour and give birth in a safe, private setting with adequate, appropriate, supportive medical care. They have a right to feel safe and secure. They have a right to be attended by professionals who they trust and who put their needs and their babies needs first, above all else. They have a right to be properly informed of all medical procedures – both necessary and optional – that may be performed on them and what the pros and cons of those procedures might be. Once informed, they have the right to refuse or consent to those procedures having made an educated decision on what is the best option for them. They have the right to have their refusal respected.
All of these rights are human rights. They are unusual human rights in that they apply only to females. This is probably why they are denied or violated on a routine basis. Men have the distinct privilege of having full body integrity and autonomy when it comes to men’s health. The same cannot be said of women. It is the unique circumstances of having a uterus – and particularly when that uterus is growing and nourishing a new life – that suddenly our bodies seem to be public property, where women are “patients” and we need to seek permission from third parties to make decisions about how we care for and use our bodies, and how we bring our children into the world.
Homebirth in Ireland is currently available on a limited basis. If you have a low risk pregnancy and are in the catchment area of a maternity hospital who runs a homebirth programme it may be possible to have a homebirth if you meet their criteria. There are also a small number of Self-Employed Community Midwives (SECMs) who work independently around the country. They provide homebirth services in a limited geographical area and to a limited number of women, due simply to the fact that there are so few of them. They are fully insured and bound by the terms of a Memorandum of Understanding (MOU) agreed with our national health authority, the HSE. The MOU outlines strict criteria under which the SECM can attend pregnant women and operating outside of these criteria nullifies the SECMs insurance and leaves them open to fines and prosecution. So there is no alternative but to sign the MOU. There are currently plans underway to further limit the criteria under the MOU by requiring the attendance of two SECMs at every homebirth. The logistics of pushing through this change mean that homebirth for women outside of maternity hospital programmes will cease to be an option because the numbers of SECMs required to facilitate this simply don’t exist (There are currently 20 listed with the HSE). This means that the vast majority of pregnant women in Ireland will be denied a homebirth and must deliver their babies in hospital. This lack of choice is a human rights violation.
When giving birth in a hospital in Ireland, women are not afforded privacy. In fact, even those who pay for private maternity healthcare do not have access to privacy and it is pot luck as to whether they will have a private room during their hospital stay. Women labour is large rooms together with a curtain separating them from the labouring woman next door. In some cases, there can be two labouring women in a delivery suite, again with a curtain dividing them – but curtains aren’t sound proof. There usually isn’t an option to dim harshing bright lighting or draw curtains across large windows. There can be a constant stream of strangers coming in and out of your labouring space. In the post natal wards, it is not unheard of for a newly post-partum woman to have another new mother wheeled inside her curtain area in the middle of the night due to a lack of space. There are such huge staffing deficiences in maternity hospitals that one midwife can be attending a number of labouring women or supporting a large group of women trying to establish breastfeeding. Do these sound like the optimum conditions to have a baby in?
When limited to giving birth in a hospital, women may find themselves and their preferences secondary to managing a overburdened maternity system. In this situation, they may experience interventions that are performed to hospital policy rather than in the best interests of the mother and her baby. Of course this is only an issue if a woman is not happy or not complicit in the intervention. The unfortunate reality is that often informed consent is not correctly sought or respected when refused and in other cases, some medical professionals have been known to portray the situation in a way that will ensure the outcome that they desire rather than those of the woman and her partner.
But it’s all okay in the end once there’s a healthy mother and baby. Isn’t it?…
I have no issue with hospital births. For the vast majority of women this is where they feel safest and therefore that’s the best place for them to give birth. Most births take place in hospital, it is the societal norm. Many women have a positive birth experience with trusted caregivers that they were very happy with in hospital. Others feel that they weren’t listened to or respected and their birth was traumatic and largely outside of their control. The problem stems from the fact that women are not necessarily treated like consumers using the services of a provider rather they are treated like patients or children who are told what to do or what is happening to them or given permission to take decisions about their own pregnancy and birth. This has to change. Maternity care in Ireland needs to move to a mother and child centred model. This means women making informed choices about their pregnancies, birth and children. By further restricting homebirth to a privileged few advantaged by their location, we are getting further and further away from this model. We talk large and loud about equality and fairness in the country but it rings more hollow by the day.
Feminism is about choice. It’s about women being free to choose whatever is right for them, whether other people like it or not. Women should be free to choose where and how they give birth. It is their human right. In Ireland, it is currently being denied and the proposed changes to the Self-Employed Community Midwives MOU will further narrow Irish women’s birth rights. Please sign the AIMS Ireland and Home Birth Association of Ireland‘s petition to protect and enforce Irish women’s human rights in childbirth. It’s not about hippies hugging trees and chanting while giving birth (do it if you want though), it’s about freedom of choice.
We should be free to choose.
I love a good birth story! I’ve read hundreds online, in books and love to hear other mothers tell theirs and sometimes shed a tear at the loveliness of it all. So in the spirit of reciprocation, here’s mine. Hope you enjoy it…
When I went to see my GP to confirm my pregnancy at 5 weeks, she went through all my maternity options with me and fair play to her even mentioned I could have a homebirth if I wanted. She wouldn’t recommend it, but it was available if I fancied it. Oh God no, I said, not for me. I was actually already booked into the Domino Scheme in the National Maternity Hospital. Once I got the thumbs up from the pregnancy test, I was on the phone. You have to move quick in this town for community midwife-led care!
But half way through my pregnancy I was in deep with my Gentlebirth programme, my prenatal yoga with Lou and had hungrily devoured Ina May’s Guide to Childbirth. I wondered if I was going to labour at home for as long as possible to avoid any unnecessary interventions and then get discharged from the hospital as quick as possible as was the Domino ethos, why didn’t I just cut out the middle part of the delivery in the hospital and stay at home? I discussed it with my husband, he took a few days to mull it over – because really, he needed to be fully on board – and then decided it was a great idea. So we moved from the Domino Scheme to the Homebirth Programme. It was the same community midwives, just all care was in our house now.
(I’m putting this bit in brackets as an aside but it fits in here in the chronology of things. Once we made the decision to plan a homebirth, we told no one. Firstly, I knew of a few women who had planned a homebirth and it didn’t work out for them for various reasons and I really felt for them. Secondly, it’s considered a pretty radical concept and I didn’t want my head to be infected by the negativity of others who mightn’t approve. It was definitely the right decision for us.)
Fast forward a few months…I was eight days overdue and starting to get a little anxious as I was very conscious that once I reached the 14 days over mark, then my homebirth would be off the cards without negotiation as per hospital policy. It was a really warm day and I was looking forward to going to what would hopefully be my last prenatal aqua-aerobics class that evening. I spent the day pottering around the house and listened to the Gentlebirth gentle induction track for the first time (and then wondered afterwards why I hadn’t listened to it before!) and then listened to it once more before I headed out to the pool.
During the class I started to feel “different”. I couldn’t put my finger on the sensation but as I had nearly convinced myself that something was happening every night since my due date passed, I didn’t pay it too much attention. I also didn’t mention anything to my husband when I went to bed that night but when I woke at 2am with what felt like period pain, I rolled over and told him that maybe he should turn on the water for the birth pool just in case. I then promptly fell asleep and slept through my surges until 10am the next day!
That morning I had sensations of mild period pain – I’ve definitely definitely had worse period pain – from when I got up until around lunchtime. I did some dishes and caught up on some emails. Although the surges were comfortable they were coming consistently every 3-4 minutes and after a few hours, I decided to check in with the community midwives. One of the team was with us within the hour and when she examined me she said that I was definitely in labour but maybe I should go for a walk or a swim, eat something and try and get some rest because we could be here for quite a while. She also said I’d know when to call her back and that she was confident that we’d be having this baby at home!
Very excited but hungry, I ate some lunch and went to take a nap and listen to my gentlebirth tracks while my husband popped down to the shops to pick up a few groceries and some magazines (which I never got to read). I wasn’t ten minutes into my nap when the surges suddenly increased in intensity and lying on my side listening to my iPod wasn’t doing anything for me anymore. My husband arrived back just then and helped me back downstairs but by the time I got to end of the stairs, I couldn’t speak during my surges and needed to stop and lean heavily on him. They were still coming 3-4 minutes apart. It was time to get the midwife back and fill the pool!
We have an island in our kitchen and it proved to be invaluable as I walked around it and held on to it during each surge while my husband filled the pool. I tried sitting backwards on a chair – a position we had practiced at our active birth class – but I jumped up immediately once a surge began. My body only wanted to be standing and upright all the time. It was really comfortable to just stand, walk and sway during the surges.When the midwife arrived, she examined me and told me I was about 6 centimetres and helped me into the pool. Oh the bliss! I spent the next couple of hours kneeling forward in the pool, with the midwife pouring warm water on my lower back during each surge and my husband pressing his forehead against mine as he breathed me through each one. Both our foreheads were very tender for the next few days.
It was at this stage that I felt the baby moving downwards. I initially thought that I needed to poo and I remember thinking “well if I could just get this poo out of the way, then I could get on with the business of having this baby” because I thought I hadn’t been in labour long enough for it to be the baby causing this sensation. Each surge was exactly four long breathes with a huge inhale in at the start – like I was about to dive underwater – followed by really deep, concentrated breathes. At the same time, my voice was drawing a totally involuntary sound from deep down inside my body. It was a little frightening the first time it happened but the midwife reassured me and encouraged me to just go with it. Once I did, it really helped to move the baby down and I got into a lovely rhythm that helped me concentrate and channel my energy. It really didn’t feel like very long until the midwife told me she could see the top of the baby’s head and it was time to get out of the pool to push.
She had set up a lovely area beside the pool with blankets, cushions and my birthing ball. I knelt down on the cushions and leaned into the ball with my elbows. The midwife told me that if I reached down I could feel the top of the baby’s head. With one push, his head was out and the midwife promised me that with one more push he would be here. That was all I needed to hear! One big inhale and a big push later, my beautiful baby boy arrived on our kitchen floor! The midwife passed him straight up between my legs and into my arms. I sat down on my heels and held him to my chest while my husband and I showered him with kisses. The midwife wrapped us with towels to keep the baby warm. While we were just staring at each other, the placenta literally just fell out! Because my labour progressed so quickly – it was just under four hours between the start of active labour and delivery – my second midwife arrived just as the baby did. She took lots of beautiful photographs for us which we have to treasure. After a few minutes the midwives helped me up, still holding the baby in my arms, and brought me into the living room where the two of us cosied up with my husband on the couch under a warm blanket. They left our little family together to enjoy these special moments and baby S latched on straight away and began feeding. It was really wonderful.
Then we got down to business again! My husband took his shirt off and held the baby against his skin under the blanket, while the midwives examined me – no tear or stitches just a tiny graze – and brought me up to my shower for a lovely wash and a change into a new night dress. Then we weighed S. He was 8lbs on the button. One of the midwives stayed with us for a couple of hours and suddenly we were on our own – just the three of us. My husband made us some well deserved dinner, we talked to our families and texted our friends to tell them the great news and we all headed to bed. It was really lovely to be in our own bed cuddled up together…
In the days after S was born even though I was exhausted, I was on a complete high. I felt like superwoman and that I could do anything. In some ways, I still feel that high. His birth was easily the most incredible, intense experience of my life and it changed me forever.