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Dublin: 13 °C Wednesday 19 June, 2013

Column: New HSE plans will further limit women’s choices in childbirth

Last summer, the Minister for Health endorsed home birth and said more women should be offered the choice of giving birth at home – but new HSE guidelines will have the opposite effect, Eva-Louise Goussot writes.

Eva-Louise Goussot

LAST JUNE, I wrote here about giving birth to my daughter at home. It was a planned home birth, with a Self Employed Community Midwife (SECM) and although I had a long labour that was pretty uncomfortable at times, it was, without question, the most empowering experience of my life. But what was really most amazing about my home birth was not that I gave birth at home, but that I was guided by my trusted midwife who I had got to know personally over a number of months and who took care of my baby and I for weeks afterwards.

In Ireland, for women seeking continuity of care before, during and after the birth of their child, their only option is to employ an independent midwife and plan for a home birth. Hospital-run home birth schemes, while on the whole very good, do not offer continuity of care and have very limited catchment areas. Only last summer, the Minister for Health Dr James Reilly endorsed home birth and said that more women should be offered the choice of giving birth at home. However new plans to be put in place by the HSE will further limit women’s choices in childbirth and take away from the unique continuity of care I experienced.

The most stringent criteria for home birth Europe

The criteria for home birth in Ireland is already more stringent than in the UK or elsewhere in Europe but under the new Memorandum of Understanding (MOU) to be imposed on Community Midwives some women who have had successful home births in the past will no longer be eligible. Furthermore the proposed MOU will now insist that two midwives attend each birth and in places like Dublin where the demand for home births is greatest, and the number of self employed midwives the lowest per capita, it means that women will find it almost impossible to secure a midwife and their chance of transferring to hospital during an uncomplicated labour will double.

The HSE is making decisions not based on the evidence but based on fears about home birth and the assumption that hospitals are safer and, crucially, that women are not equipped, or do not have the right, to decide for themselves. Time and time again, the research both in Ireland and abroad shows that midwife led care and continuity of care ensures better outcomes for low-risk mothers than obstetric-led care. Fact. And while home birth continues to be scrutinized our maternity hospitals remain in chaos, with dangerously high levels of intervention that frequently lead to negative outcomes for women with low risk pregnancies. One more fact: contrary to the frequently touted statistic , Ireland is not the safest place in the world to give birth. From this year, Ireland will now record its maternal mortality statistics in line with the UK and other countries. It is expected that overnight our “safe” rate of one death per 100,000 will increase by a factor of 10 to a less safe 10 per 100,000.

Informed consent

More and more women are reaching out to the Association for the Improvement of Maternity Services in Ireland (AIMSI) using terms like ‘violation of my rights’ with regards to the HSE criteria for home birth and standard maternity care in general. Women are being coerced by hospital officials, door stepped by risk assessors and made to endure mental health assessments, visits from social workers and court orders because they have refused consent.

AIMSI the has seen a huge increase in the numbers of women confiding in them that they have planned or are planning an unassisted birth. A small percentage of these women have birthed birthed unassisted in Ireland because of a lack of availability of, or access to, skilled birth attendants. AIMSI feel this is primarily down to the disregard for autonomy/informed choice/informed refusal found in Ireland and they have long campaigned about the need for recognised “informed choice” and “informed consent” in Irish Maternity Services. As with any other healthcare procedure, it should be every mother’s right to give “informed consent” or make an “informed refusal” about any care that she might undergo.

She has the right to unbiased and accurate information based on what is good for her and her baby, not what suits her care provider. She should be treated with respect and dignity, whether or not she consents to a recommended treatment or procedure and it should be recognised that labour is simply not a suitable time to introduce new information to the pregnant woman about medical procedures. And though it is much quoted, it remains true. ‘It is not informed consent, if you make me afraid to say no.’

An opportunity to offer women real choices

AIMSI who sit on the National Steering Committee for Home Birth are very concerned about how the proposed MOU was contrived without their input. Jene Kelly from AIMSI says, ‘When we were invited to the table it was with the understanding that the new MOU be more woman-centred. We understood that we would look at new criteria for women hoping to give birth at home after a section, but this has been completely ignored and as with many other elements of the new MOU, it is not in keeping with best standard practice across Europe. Indeed there was so little consultation that when the final draft was eventually presented to us, we were unclear as to whom had written it”.

An independent audit conducted by HIQA has urged the HSE to review training for second midwives and to take responsibility for implementing a mentoring programme that will see more midwives practice in the community. If the HSE take this seriously then they should implement the training and mentorship programme before they make the second midwife mandatory.

Rather than limit women’s choices, they have an opportunity to offer women real choices, that can take many low risk women out of a hospital setting and ultimately ease some of the pressure on over crowded maternity units.

Eva-Louise Goussot is a member of the Home Birth Associaiton. For more information on home birth see homebirth.ieBump2babe is the consumer guide to maternity services in Ireland. Anyone looking for support around maternity issues in general can contact Aims Ireland.

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Comments (154 Comments)

  • The emergency back up for home births is just not robust enough in Ireland. It’s all well and good when everything goes according to plan , but when it goes wrong through no fault of mother or midwife , it is a matter of life and death. And our emergency services and other backups are too thin on the ground and probably not trained to deal with advanced obstetrical emergencies. Having said that , our maternity hospitals are so understaffed, those midwives working there are for the most part doing the job of three people. They are not able to provide all of the care that women need. The basics are done but much is lacking and the midwives are frustrated and angry that they haven’t the time or staff cover to do their jobs as they should be done.

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  • Well I’m due in 3 weeks and I’m considered “low risk ” but not a hope would I have a home birth! I want every drug available :) ! Plus if something was to go wrong with me or baby I don’t fancy waiting around for an ambulance ! Fair play tho to the women who feel they can make these choices but not for me thanks !

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    • Best of luck Sharon and I hope you get to make all the right informed choices for you regarding your birth.

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    • So long as you are educated on the effects on your baby of choosing that path, and you are making an informed choice on that basis, best of luck with your choice. See http://chriskresser.com/natural-childbirth-v-epidural-side-effects-and-risks
      I knew when I had my baby that if I had an epidural there would statistically be a worse outcome for my baby, but in any event because of him being the wrong way round I had a very long and difficult birth that ended in epidural and caesarean. Because we know that the actual birth through the birth canal is important as it squeezes the fluid out of the baby’s lungs and there is some bacterial thing that happens too, I was upset by my baby missing this vital step. Not to mention the hard recovery from surgery, and my baby being born into bright theatre lights and noise – when their first moment on this earth should not be about searing light after nine months of darkness, noise after being muffled in the womb, and being taken away immediately to be weighed in a cold scales. I still wonder whether I would have had a natural birth if I had been at home with a midwife. It’s obvious that natural birth has worked itself out over thousands of years, but I suppose in the end we all just do our best. Good luck with whatever choices you make for yourself and your baby.

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    • Nikki 18/03/13 #

      Can I ask genuinely what effect you believe there is in the long-term for babies whose first view of the world is theatre lights?

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  • Was there not a case of “informed refusal” last week or thereabouts where a hospital had to bring a woman to court for refusing treatments re childbirth? There had been 2 different consultants giving her the information that her baby was at serious risk and yet she felt she knew better?
    I’m all for informed choice and decisions but when 2 practitioners are giving me the same information, is it not arrogant, ignorant and dangerous for me to assume that a few months of googling trumps their years of medical school + their on the job experience?
    I don’t believe the HSE trying to “nanny state” and control women as this article suggests, I do believe they are trying to limit women who are clearly uninformed or misinformed from making disastrous decisions. Just because we are capable of carrying a child and birthing it does not mean that our choices are infallible.
    This article is one sided and very short on hard evidenced information. If you need to bring neary in to prove your point, you should just accept defeat. You should argue on merit not scaremongering.

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    • Exactly the health of the baby should be paramount

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    • No Martina – the health and the baby and mother should be equal.

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    • So if anything did happen you would your own ideas over having a healthy child

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    • Wynner I answered that elsewhere. No, my choices wouldn’t take priority over my baby’s health. I’d have done anything to make sure my baby was born safely. In fact she was breech for a long time and I would have been in the hospital if she had stayed that way.

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    • Yes, it might be arrogant and dangerous. But at the end of the day, you’re the one who will have to live with the consequences. Doctors are more than welcome to strongly recommend a course of action and explain why…but I’m uncomfortable with forcing a mentally competent person to accept medical treatment and violate their bodily integrity.

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    • Sinead, if it were a case where on one side of the scales you had the health of the baby and on the other side the health of the mother then fair enough I’d agree with you.

      In this situation however it’s the health of the baby on one side of the scales and the mothers right to “feel empowered” on the other, there’s no contest the health of the child is paramount.

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    • I agree with Nick that ultimately the consequences for the mother are far more serious than for the obstericians involved. She is the one who would have to live with the guilt, and with the practical problems of dealing say, with a child with disabilities or injuries that could have been avoided. It makes no sense that women who resist medical intervention in birth are all doing so just so they can “feel empowered”. It’s possible that some are, and often medical intervention is justified but Irish rates of C-sections etc are extremely high by international standards.

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    • Nikki 18/03/13 #

      Well said.

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    • Have you looked at what those quoted risks were in that case? And that statistics that actually respond to what the obstetricians were threatening? That woman agreed to the operation but asked to wait one more day for her husband to be present and they sectioned her anyway. Can you imagine the effects of a forced operation like that? Without the support of your partner?

      We all want a healthy baby, but I’m not sure how healthy it is to have a parent suffer years of PTSD or PND as a result of the treatment she receives. I would not have emotionally survived that experience, though of course I would have had a section if I was confident my baby would be in danger otherwise. Why be so quick to write that mother off as selfish or stupid?

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    • I don’t know where I said anyone was selfish or stupid but feel free to ignore what was actually said and replace it with your interpretation.
      I did read the facts of the case unfortunately and my points still remain the same. 24 hours can be the difference between life and death for that baby. Imagine the guilt, pnd & PTSD if the mother was responsible for the death or ill health of her child because she wanted to was “just” 24 hours

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    • Tom, the rights of the born trumps the unborn. If a woman wants a natural birth, thats up to her to decide. No one should interfere. They can advise and make the woman sign a waiver to the effect that she has gone against medical advice but as its her body and shes the one going through the process of pregnancy and labour, then its HER CHOICE.

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  • Can I ask what would happen in a home birth situation where the baby suddenly becomes distressed- in a hosp situation, this would lead to an emergency c section, which would need to be carried out pretty quickly. This has happened for at least two people I know, and is therefore a real risk even for “low risk” pregnancies. Is it a risk worth taking just because the mother doesn’t like or approve of the hospital system here? When I was pregnant with my two, on both occasions my mantra was whatever is best for my baby- I made sure that I was satisfied that there were adequate facilities in place (in the hosp) to cover any eventuality.

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  • My wife and I are the furthest thing I can think of from ‘hippies’. We have two children, one born in the Rotunda and one born at home.

    For our 2nd child who was born at home, we researched and read up a lot about home birth before making an informed decision. Like all parents, the safety of our unborn child was paramount. There are risks for delivery in the hospital and there are risks for delivery at home.

    Our daughter was born safely at home.

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  • The idea of my wife having to give birth anywhere other than in a modern fully equipped and staffed maternity hospital would scare the life outta me. Cant understand how its safer at home!

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    • My husband felt exactly the same as you before he met our midwife to discuss out options. He was always clear that hospital would be an automatic choice if anything changed during our pregnancy. His change in mind set following the birth was astonishing, and I know he would and has recommended home birth now to anyone who is interested.

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    • ‘Modern fully equipped and staffed hospital’? We don’t have those in Ireland.

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    • Friend of mines exact the same. Her husband was an anesathist at maternity hospital. Very anti home birth. Post wife’s home birth he changed his practice in hospital. At home you have some control of who is coming and going around you. This for many women is very important.

      If we can’t afford home births could we at least have birth centres.

      Irish maternity hospitals are dangerous. Operating at way over capacity. For a low risk pregnancy (the majority) home is definitely safer, you get a higher level of care (dedicated midwives) pre, during and after. And it is free!

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    • Nothing is free Emma.

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  • Had two home births in Belfast. One breach-competent midwives gave me confidence. Ambulance on standby. 14days follow up home visits then care handed over to public health nurse. All provided by NHS. Astounded by lack services in 26. Financially impossible for ordinary mothers.

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    • Poppy 18/03/13 #

      A breech birth is not a straight forward delivery. I’m surprised at any mother who would put first her own preferences over the safety of her baby and any midwife who would facilitate it. The risk of cord prolapse is significantly increased which could lead to oxygen deprivation. In a lot of cases breech presentation is reason enough for a section. To have a home birth for a baby in this position is irresponsible. I’m so glad it went well for you.

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    • The Irish state cannot afford to have an ambulance on standby outside a home where there MAY be a difficulty. Nor can it afford such midwifery care to mothers who wish to have their babies at home. If the state and the HSE wish to endorse and provide for home births for low risk mothers , then a root and branch change would need to occur. The supports like emergency transfer , flying squad obstetrical care , funding of home midwives , and careful evidence based screening protocols for the identification of low risk mothers. If all aspects are not put in place, most women will not qualify for home delivery by virtue of maybe their distance from the nearest maternity unit , the average response time for ambulances in their area etc etc. I think it’s something to aspire to but until a safe plan is constructed , agreed and funded , like in the NHS , we remain in a hospital based set up. Where despite all the problems , it might still be the safer place to take this most precarious of journeys for both mother and baby. It’s far from perfect but it’s all we have.

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  • What if your doctor turned around to you and said, listen, I know you don’t want it and you won’t feel safe but you have to have this baby at home?
    That’d be pretty scary wouldn’t it?
    What happened to freedom of informed choice?
    If you don’t want a homebirth, don’t have one. It doesn’t mean you should get to decide that no one should have one. Statistically it’s just as safe as a hospital birth. Check out the NICE guidelines for the data.
    If you’re curious about having a homebirth, have a read of the HBA website http://www.himebirth.ie
    Whatever you do, make the decision that’s best for you and your baby. Your gut will tell you.

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  • I was lucky enough to have a straightforward delivery on both of my girls, the first in hospital and the second at home, but the hospital experience was clinical, bright, had too much intervention from obstetricians – who I honestly believe a woman should only see when something is actually life threatening for baby or mother. I had my waters broken, was put on a trace, was prone on a bed and had a second degree tear. I was on my back and not allowed to move from that position, even when i begged. All for a straightforward birth. At home on my second daughter, I was allowed to do my own thing under supervision from a fantastic SECM. I had another quick birth but it was at a different pace too, if that’s possible. I had my own, safe, known environment, which I believe is key. Instead of being wheeled out of the room within an hour of delivery, I was tucked up on my sofa with my baby. Instead of using ancient shared shower facilities, I was in my own shower.

    The frustration comes because both sides have valid points. Home births SHOULD be properly managed but the HSE should therefore allocate more resources to support SECMs and expand domino schemes. Midwive-led care should become automatic first choice and private care should be banned. (in reality its just about the room!) Free up hospital resources for mothers and babies who really need it. Allow obstetricians to do what they do best and focus their attention on those who really need their help.

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    • Eleen 18/03/13 #

      What I think is really horrible is being forced to lie on your back! What the hell is that about!? That’s the worst position to be in if you’re giving birth, puts extra strain on you and the baby, and can cause not only extra pain but actual damage too.

      All because it’s easier for the doctors to see what’s going on. That alone would put me off going to the hospital to give birth.

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    • Sinead
      You want your choice which is a home delivery yet you want to get rid of private obstetric care which is a choice for other women?? Where do you get off advocating for your choice and effectively wanting to stop other women having a choice that’s an extremely arrogant view point.
      @ Eileen
      I think you’ll find only women with epidurals ( again a choice for some) need to lie in bed. Most midwives and obstetricians encourage their women to mobilise use birthing balls ect during labour the choice is the woman’s.
      Having read both your posts I had to respond you can’t have choice for one group of women and remove the preference of an other group because it doesn’t fit into your ideal.

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    • And before anyone jumps down my neck I am pro woman’s choice to decide what is best for her and her baby be that home or birthing centre or hospital.

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    • Eleen 18/03/13 #

      Cliodhna thanks for the clarification, I was a little shocked about that info, although I’ve heard women complain about it.

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    • Your welcome Eleen. It’s all about informed choice and best out come for mom and baby.

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    • Cliodna that’s a fair point (re my comment on private care) , I guess it just comes from private care being the only option actively advertised to mums, especially those on their first child who have to make decisions on how they will birth their child under time pressure (your consultant will be booked up, etc) before they’ve announced their pregnancy and can chat to other parents openly. It was an option we felt we almost ‘had’ to choose if we could afford it. However your point is right and it should be a valid choice people can make.

      However I will say one thing – you’re totally wrong on the back position only used for epidural. That absolutely wasn’t the case for me. I was basically put on a trace because my midwife recommended oxytocin to start labour and wanted to monitor the heart rate. At no stage did she say to me that a choice to accept oxytocin would affect my birthing position in that way. In fact talking to many people afterward they were quite surprised oxytocin was offered so early to me. And yes it’s a horrendous position to be in when all you want to do is walk around or shift onto all fours and I couldn’t. I wasn’t even allowed off the bed to use the loo!

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    • I’m a midwife Sinead and bar a woman has an epidural I encourage them to walk, use the birthing ball ect all fours or left lateral are best for deliveries; but I give women the choice as do my colleagues, I’m sorry your experience wasn’t like that.
      But you shouldn’t paint all midwives or doctors with the same brush you’d be surprised at how pro women’s choice we can be.

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  • Personal choice…..
    We have two kids, one born at home one in hospital, the home birth was by far the easier/least stressful, but that was because of a complication (hospital midwife couldn’t use her equipment didn’t help) , we are lucky and live 25 mins from hospital and had 2 very experienced midwives to call on, so had lots of options … Doubt I’d go for homebirth if I lived up a mountain ….
    The Cork system seems to work well for home births, but there aren’t enough confident trained home birth midwives , it’s huge responsibility and commitment…

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  • From my observation of the comments, women are widely supported in their choices within the obstetric/medical care model, regardless of risk. So too should a woman be supported in her choice for non-medicalized birth and the choice to birth at home – without being labeled as “selfish” or “risky”.

    We have a consultant based maternity system in Ireland which is considered by many expert obstetricians to be of a high standard for safety; yet there were 4000 perinatal incidents and more than 100 obstetric claims reported to the Irish state claims agency in 2009 alone and we have seen continuous calls from leading obstetricians in Ireland that staffing levels are at unsafe and inadequate levels. Midwife to woman ratios are soaring – The Rotunda reported levels at 1:47 – safe practice shows it should be 1:28 for low risk women and 1:25 for high risk women.

    Homebirth has been shown to be a safe alternative – as has midwife led units.

    There are no absolute risks in childbirth. We all have to consider the relative risks when making decisions on our maternity care. Choice is choice – respect should be mutual. Women choosing homebirth and hospital birth alike deserve the right to have their choices respected.

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  • I had my son in Holles St and it was pretty traumatic.l. I was induced, given oxytocin, epidural and after all that, emergency C-section. Right after having my son, I felt I couldn’t breathe as the anesthesia reached my lungs. I spent 5 hours in recovery without being able to see my son. He never got the chance to cuddle skin to skin and it made really difficult the breastfeeding process. The after care was very bad too. I couldn’t move after the c-section, and had no help from the staff. I would be crying my eyes out in a room with other 6 women. 5 years later and Im still not sure why all these interventions happened.

    I think that women should have a lot more information about labour and the birthing process than what they get now. Pre natal classes should also cover the different options like home birth, or water births. They should also talk about other methods to help you coping with labour, like Gentle birth (not only drugs, but im completely NOT opposed to them)

    Giving birth is an experience like no other, there are no words to describe. It can be very scary and traumatic, and I think a lot more information about the process and all the options possible would be really beneficial. Then, if there are no other health risks involved, the woman should have the right to decide how and where to birth her baby.

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  • This is not the dark ages and yet we are being brought back to the dark ages. All of a sudden choices are being made for women again?! It’s nothing to do with ‘hippyish’ ways what a load of crap. If the HSE are going down this route then they need to provide proper natural surroundings for birthing. I.e less stressed environment lower lighting, birthing pools that you can give birth in not just labour in and much more. No mother goes into a home birth without making sure the baby is favourable for it. And at the end of the day every mother wants the best for their baby. It’s just ignorance to make these decisions without discussing it with the people first. But again we live in a country where we have a government who don’t give a toss what their people want.

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  • Have any of you who are against home birth actually gone on to the Home Birth Association website and read the frequently asked questions section? It astounds me how people have such strong opinions about a subject they have obviously not read up on and are making gross assumptions about.

    The likelihood of a need for an emergency c-section is quite low in home birth. Why would that be I wonder? Could it be because when you birth at home you are less likely to have unnecessary interventions pushed on you to speed up the process (induction methods, epidural, oxytocin)? Those interventions that happen every day in hospital increase your chances of needing a section because they are the cause of the baby going into distress in the first place in a LOT of cases.

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  • Every woman has the right to choose how and where she gives birth. If you don’t want a home birth that’s your choice but that choice should not be taken from others. It is heartbreaking to see that women have lost faith in the natural ability of their bodies and those that do trust their bodies are not allowed claim the right to bodily integrity. This is about controlling women and is a very serious human rights issue. The state had no right to control our bodies.

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  • Personally wouldn’t take the risk!

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  • Congratulations to the obstetricians of this country for convincing women that what happens to them in hospital is in the interests of their baby and not the interests of the hospital. Michael Neary had his patients in Drogheda thanking him for performing Caesarian hysterectomies because he told them it was a life saving decision. Do you honestly think the WHO criticises our inexplicably high Caesarian rate because we’re so good at doing what’s right for mother & baby?

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    • I was in labour for fourteen hours before the decision was made that, given my son was not making a move on his own, and was 10lb 4oz, a c section might be the best route to take. Even at that, the decision was mine to make, no-one coerced me into it, but common sense told me that if I insisted on natural birth, it could lead to my baby becoming distressed. Can we hear from some people who actually feel that they were forced into some sort of treatment that they didnt want(other than the author of this article, obviously) ??

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    • I was in same situation I had spent 20 hours stuck on 3 cm and my now darling 12 yr old is here it could have been so different , she went in to distress, my needs were met the hospital I picked were superb and I went on to gave 2 more kids there

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    • The WHO criticises our RATES of Caeserean sections; not the fact that we do them! They reckon that for 10 to 15% of births, C-section is the safest option. But Irish rates are much higher than this- meaning that some Irish women are having Unnecesereans.
      Quality of care should mean approriate care, based on what is best for the individual. Our current regime of medical. interventionist birth for all (except those who are ultra-low risk, live close to a maternity unit and can afford a SECM) is among other things outragously expensive.
      This article is about home birth, the right to which I support, but we also need to improve hospital birth for those who don’t have the choice to stay at home eg because they live too far away. Birth is not an medical condition.

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    • Irish women are older, fatter and generally less healthy than women in other countries when they become mothers. This can lead to increased chances of gestational diabetes, high blood pressure and fetal growth problems- all of which can result in increased medical intervention . It’s not by personal choice that any doctor/ midwife recommends an intervention, it is a decision driven by the welfare of mother and baby, based on experience and evidence from the scientific literature.

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    • I always find it so strange how people speak about interventions during labour/delivery as if they are some sort of indulgence of the ‘evil’ obstetricians. Bizarre.

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    • Very well put Joanne!

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    • Indeed Joanne, with the homebirth hippies trying to make out that a woman who undergoes a section or an instrumental delivery has somehow failed. Ludicrous.

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    • Comment of the thread Joanne, I’d rather have a life baby it’s like breast feeding is best but feeding is better… Roll on the red thumbs.

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    • Hang on. I’ve never nor would I ever make a woman out to be a failure for any aspect of her birth. Nor do I know any other women who would. It’s ridiculous to suggest we somehow feel superior for not having intervention. Rather I consider myself lucky and blessed. If intervention had been required then I’d have absolutely wanted whatever it took to deliver my daughters safely to the world. However no intervention is risk free, to either the mother or baby. And unfortunately the medicalisation of birth has resulted in interventions being required where they might not have been in the past. This is not a failure on anyone’s part – either the parents or the healthcare professionals all of whom want the best for the mum and baby – but is perhaps indicative of the society we live in.

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    • Rkmr 19/03/13 #

      From reading your comments I’m glad you were not my midwife cliodhna.

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    • Why?

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    • You have me totally wrong I am very pro breast feeding I am compassionate I am pro women making their own choice in their care and I am not dismissive of anyone but I also have sense of humour forgive me for that.
      I accept you may not see that from a few random posts, also I may not have replied to some posts as didn’t go back to articles as I work full time and don’t always have the time.
      I believe in skin to skin delayed cord clamping and kangaroo care I wouldn’t leave any baby cry for prolonged periods.
      I am a realist life is not perfect and sometimes with the best laid intentions things go wrong and interventions are required.
      I can only speak for where I work also.
      But thank you for being so interested in my life and what I have to say that you have kept count of things.

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  • I know a couple who lost their baby due to the incompetence of the midwife who failed to measure the lack of growth in the few weeks and then failed to send the mum to hospital despite the husband begging when their were clear problems as a result the baby was still born

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    • With all due respect, if that was the case and they were that concerned, why not just go to their local GP/hospital for a check up? Whilst I don’t want to seem insensitive, I actually find your comment very hard to believe.

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    • It is absolutely true she never measured the bump and so did not notice the lack of growth for a few weeks before of the baby and said their was no need for an ambulance when husband became concerned he eventually called one anyway and baby was still born in hospital it is the subject of a complaint. Baby may have been still born anyway but if she had done her job and noted the lack of growth the birth could have been induced eArly and Baby survive

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    • That sounds to me to be a case of gross medical negligence. That could equally happen in a hospital.

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    • Not really Alain as the woman would be palpated on each visit by a midwife and be scanned at least twice in the ante natal period.

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    • HI Betty Lou,

      What happened to your friend is very sad, but any mother who signs up for a home birth, also has to register with a maternity hospital and so your friend would have been measured regularly by hospital midwives also. If the hospital midwives had any concerns they would have changed your friend’s status from low risk to high risk and she would not have been allowed a home birth.

      Reply
    • Rkmr 19/03/13 #

      Yes my sister had home birth she had check up with her independent midwife and check ups at the midwifes clinic in her local hospital

      Reply
  • Tommy C 18/03/13 #

    Some women get far too stressed out by hospitals and my missus got so stressed out in a room with 5 other new mums.
    When she was in labour, the noise of other women around her in labour was very distressing, the whole hospital environment and random medical staff walking in and out of her room stressed her out too. Its not a normal, relaxing, natural state or place to be in.
    All women should have a choice as to where they give birth. Theres no need to turn what is 99 times out of 100 times completely normal and without event, into a circus. If mother is stressed, baby gets stressed.
    We should be treating childbirth for what it is, a normal natural state and one that we dont need to be stressing women out about anymore than they already are.

    Reply
  • Have your baby for free in a public hospital, pay for the privilege to go a little more upmarket in a private hospital.
    If you want to have your baby at home… organise and pay for it yourself.com

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    • Rkmr 18/03/13 #

      Mags that’s exactly what you do. If you want a home birth you organise and pay for it yourself.

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    • Rkmr, to the best of my knowledge, that’s not exactly true. There is (well, was when I was having my girls anyway) a grant available which covers the majority if not all of the midwifery costs, however any additionals like hiring a birthing pool etc are at own expense.

      Reply
    • HSE grant provided in most areas. Please get your facts right like I did when I placed my comment.

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    • Lisa is right. You do organise it yourself but there is a grant available. My health insurance also covered some additional costs.

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    • Rkmr 18/03/13 #

      Yes there is a grant available because you have to offer people freedom of choice. My sister got a grant of €1000 she paid €2500 on top if that.

      Reply
    • Oh for god’s sake, Mags.

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    • I’m a tax payer. Tax should provide the same general system for all i.e. maternity service in public hospitals. If you want to have a baby at home by your own choice, I don’t expect the tax I have paid to fund grants for home births.

      Reply
    • Tommy C 18/03/13 #

      Mags, what if all childless people decided they didnt want their taxes used for funding child care? How would you feel about that?
      Id like all pregnant women to make an educated decision for themselves as to where they have their babies. Their bodies, their choices and Im happy to help fund their choices.

      Reply
    • Mags
      To be fair it probably costs more to have a baby in hospital than at home when you factor in all the costs.
      All women should have a choice.

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    • Tommy, I am the proud Mom of two. Not childless as your comments suggests. So no, I am not a bitter childless woman. I had both my children in Drogheda Hospital as a public patient. So I think I have the right to voice my opinion, you may not agree but I work hard and pay tax and would like to think that the tax I am paying will someway go to lowering the debt in Ireland so hopefully my children might have a good future and not be left paying back banks as I along with everyone else is currently doing. I personally think if you want a choice that is outside of the norm that you should be expected to fully fund it yourself.

      Reply
    • But Mags your care during pregnancy childbirth and afterwards cost other tax payers more than the grant given these women to have their babies at home their choice just like yours was to go to hospital.
      You can’t use my tax my say on how it is spent I’m afraid.
      We all have a choice public v private healthcare, home v hospital no one can dictate to an other.

      Reply
    • Rkmr 18/03/13 #

      Mags I believe breastfeeding to be the norm as this is how your baby is meant to feed naturally so then that would mean formula feeding to be outside the norm. So does that mean that women should not be given free formula in hospital? After all it’s my tax that pays for it and the vast majority of women are able to breastfeed so why should I have to pay for their choice??

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  • Rkmr 18/03/13 #

    There have been many studies showing home birth to be just as safe as hospital. Please educate yourself first.
    http://www.naturalbirthandbabycare.com/farm-statistics.html
    http://www.cbc.ca/news/health/story/2009/08/31/midwife-home-births.html
    http://articles.mercola.com/sites/articles/archive/2012/07/26/hospital-birth-vs-home-birth.aspx
    http://www.bmj.com/content/330/7505/1416
    It’s about freedom of choice, we live in a free world and should be free to make our own educated choices. There have been studies that show epidural can have a negative effect and that formula feeding increases the risk of many different things eg SIDS, allergies, obesity but we are still free to make these choices ourselves. How is choosing to have a home birth any different?

    Reply
  • I do believe in having a choice but i also believe the choice should be limited to how close you are to a maternity hospital. I know that maybe unfair if you dont live within 15mins of a hospital but that said in case of emergency you wouldnt want to b 40mins away. I have had two hosp births. Heart rates on babies were low halfway through labour and first delivery needed a forceps so home birth is not something i would consider but the option should b available

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  • the HSE have a nerve. ‘for your own good’ isn’t a basis for legislating somebody’s options. nanny state fascism. aren’t people who opt for a home birth capable of researching it? and even if they aren’t? they don’t vet who is allowed to be a parent. why should they be vetting what happens around the process of giving birth?

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  • No I do not have children which is irrelevant but I am a midwife. Having worked both here and in Australia I can tell you that irish women in general are much less informed. And I can assure you I would love to change this. I have nothing but respect for women and a love for the normality of childbirth and pregnancy.

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  • I know but do you not think alot of that behaviour comes from a lack of education? Perhaps it is partially dependent on location.

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  • Perhaps it is where I am working at the moment, however it is in one of the busiest maternity hospitals in Ireland. However it may also be that you are fortunate to be surrounded by well informed women and do not see the majority.

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    • I don’t know Danielle I work in a very busy maternity hospital mind you out of Dublin. There are still women who will insist on lying in bed or push for lscs and won’t try to see how they go without epidurals but you can’t force them.

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  • Maria 19/03/13 #

    I wanted a home birth for my first child, but the look of pure fear and worry on my husband’s face when I told him made my change my mind. I was all for a natural birth and was adamant I wouldn’t have an epidural or any drugs. Fast forward 17 hours of awful labour and I asked for the epidural! I cried asking for it – felt like such a failure.

    Then the baby’s heart rate kept dropping – it turned out the cord was wrapped around his neck and that he was coming out sideways (think about it – a head coming out side first!) The baby had to be manually turned by the obsetrician and then the vacuum had to be used. My obsetrician was excellent and kept me so calm.

    Now I’m so glad I didn’t have a home birth. I still like the idea of it but and I’d never risk it for myself knowing what I know now.

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  • Rkmr 18/03/13 #

    It those saying that home birth is more dangerous than hospital birth please educate yourself. Here is some links of studies showing home birth and hospital statistics. Although I doubt a lot of you will bother to read them, people like you don’t care about knowing the truth you just want to carry on believing what you believe even if its false. Home birth is just a safe as hospital birth. My sister had a home birth, they had a fully detailed plan o what would happen in most common outcomes and transfer to hospital. Transfer to hospital would have taken app. 10 mins. A friend of mine having a hospital birth was told she was not progressing, baby was in distress and would need a csection, she then had to wait 40mins before being brought to theatre!!
    http://www.bmj.com/content/330/7505/1416
    http://articles.mercola.com/sites/articles/archive/2012/07/26/hospital-birth-vs-home-birth.aspx
    http://www.cbc.ca/news/health/story/2009/08/31/midwife-home-births.html
    http://www.naturalbirthandbabycare.com/farm-statistics.html

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  • So disappointed to see this. Definitely a step backwards!

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  • The statistics around the world shows that home delivery is not safe at all, because every delivery is unpredictable. And some midwives are said “to know better“ if something is wrong or right during delivery and they do not listen when woman in labor tells them she feels that there are some problems to deliver a child. And what about situations when child has a lack of oxygen and there is c-section needed? Mostly like emergency c-section. And with all those traffics and time to get to hospital, the child will be brain dead or something like that. I would never recommend home births to any new moms.

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    • I wonder how many of the home birth brigade have ever been involved in an obstetric emergency.

      Reply
    • Rkmr 18/03/13 #

      Hi Julia could you please provide evidence of this? Thank you

      Reply
    • I wonder how many of the home birth brigade have avoided an obstetric emergency by having their baby at home? Common hospital interventions like ARM (breaking the waters) and epidurals actually increase the risk of having to have a Caesarian.

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    • ‘The home birth brigade’. This is insulting bullshit, and I’m so sick of it. The home birth brigade are well educated about risks and the necessity of transfer. The head of the Domino scheme herself told my ante natal class that there is no problem that arises druring birth that they can’t see coming two hours before it gets critical, and they transfer very fast.

      As to emergencies, my first home birth took a long time – had I been with the Community midwives I would have ended up transferred, induced, and section as a result. This has been confirmed. It would have been an emergency, and everyone would have said, thank god you went to hospital, see? See?

      As it was, I had an experienced Midwife attend who monitored the baby’s progress and finally delivered her safe and sound – without intervention.

      Read some studies, do some research about what home birth provides – no it’s not for everyone, every woman should give birth where she feels safest, and have the choice to do that without coercion. The hospitals are grossly understaffed and underfunded and I have heard too many women’s horror stories to count. I’m DELIGHTED to hear of women having good hospital experiences, and that’s as it should be. However, it all too often isn’t.

      No, homebirth here isn’t perfect, the major issue being lack of choice and resources and co-operation from the HSE and hospitals. Seriously. Do some research, look at other countries and their stats.

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    • Rkmr 18/03/13 #

      Still waiting on Julia’s evidence for these statistics she claims?? Would love to see this Julia

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  • My wife had our 1st son at hospital at WHR and recieved great carebefore and during the birth but she hated the ward experiance after the birth. the toilets were in a poor sate and with a number of women on the ward all havving had dfifferent experiances and numbers of babies she found it imposible to sleep and almost imposible to cope with and left as soon as she was allowed out.

    Our second son was born at home with care from midwifes from WHR again, and while the labour was long and she was close to being taken into hospital due to lenght of labour the care was 1st rate from midwifes with long experiance of home births both in Ireland but also the UK. My wife was able to move around and be in any possition she found most comfortable etc. the experiance was totaly different and at the end she had the night in her own bed a totaly different and far better experiance. It was a shame that while the midwife was fully qualified to carry out after birth checksetc, the HSE does not permit this because they think doctors know best, this forced my wife to take our son into hospital a day or so later for simple checks that the midwife could have signed off on.

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  • It’s no coincidence that Ireland has one of the lowest birth mortality rates in the world. Our criteria for home births is better (not more stringent) than the UK and the rest of the world.

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  • it’s funny and arrogant the way the state just assumes control of these things. and how many people jump on the 2nd or 3rd story of the argument without considering that rotten foundation.

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  • Women have no choice in the Irish maternity system. They are controlled by obstetricians and warped into believing that they are uncapable of doing what women are designed to do.

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    • Danielle that is both untrue and unfounded. It portray’s Irish women in a very negative way and implies most birthing experience’s in this country are negative and led by doctors not in fact the case. Have you any children yourself?

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  • I personally think that any woman opting for a home birth in this day and age is putting their own selfish hippy needs ahead of their babies even with low risk births something can go wrong .i wouldnt take that risk with my childrens lives

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    • Martina, all I wanted was to be able to give birth to a healthy child and I felt that the hospital setting actually increased, for me, the risk of tearing, a c-section, trauma. I wanted a midwife who had a single focus on me, not one who was rushing from patient to patient and totally overworked and stressed. I wanted a midwive who would make the best choices for me and my baby, not because hospital policy demanded that a woman have her baby within a certain time frame. i wanted a midwife who would also, if needed, send me into hospital to have appropriate obstetric care. That’s a personal choice and one I was lucky enough to make. I think people who know me would say I was the opposite of selfish or hippy.

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    • Poppy 18/03/13 #

      Sinead….what would you have done if you needed an emergency C section where every second counts ? I know a lady (who coincidently is a midwife) having her 5th child, all straight forward pregnancies & deliveries. During labour the baby’s condition changed so rapidly that she had to be rushed to theatre for a section under GA. the doctors literally ran as they pushed her bed up to the theatre. There was hardly time for her to sign consent. She would have passed all the criteria for a home birth. My view is if you don’t like the hospital environment then sign yourself out immediately after the birth. Congrats on your baby

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    • Ive had two babies in hospital one nine days overdue one thirteen days over both with the dominos midwifes so came home shortly afterwards and got great care at home.i never felt rushed or that i recieved less care than i should have from any midwife.i would hate to think of the result of one birth if i had thought of myself and opted for a home birth.I put my childrens health before any of my needs or wants

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    • Poppy, that’s a good question and I’m sorry to hear about your friend’s experience and hope she and baby are well now. Yes, the time delay in going for a emergency section is definitely a major factor to consider in having a home birth,but I believe SECMs are much quicker to recognise distress and would transfer as quickly as possible if there was any reason for concern. I balanced up that need vs the concerns about increased rates of sections involved once you enter the hospital setting. I think in many instances hospital interventions actually increase the risks of an emergency section.

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    • I am so grateful I was in hospital for the births of both my children.
      On my first he got stuck and had to be delivered by forceps with a room full of doctors, he’s cord blood had to be tested immediately for lack of oxygen, luckily he was perfect but in that situation every minute counted.
      On my second, the delivery was much easier, but I bleed a lot and required 2 hrs treatment including stitching.
      If I had been at home for either the outcome would have been disastrous.

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    • Sinead what makes them better equipped or quicker off the mark? I find that comment outrageous and insulting to their colleagues who work in hospitals.
      I had a great experience in hospital, I didn’t try to micro manage the experience I just wanted my baby safe in my arms. I had no interventions and could move around and do as I pleased. My midwife was brilliant, encouraging, supportive, caring, funny and most of all competent. I had a straightforward, textbook birth that honest to god frightened me with its ease. I had expected, from reading rubbish online that I would be forced into waters being broken, practically tied to a bed with no say in what went on and that I’d end up with tears & cuts(I had neither) but the complete opposite happened. I listened to so much scaremongering beforehand that I realised its no wonder there are interventions with women going to hospital stressed out and prepared for a battle that only exists (at that point) online and in their head. I understand not everyone has such an easy experience but I despise when people say I was “lucky” I wasn’t it was average, because there were 21 other labours that night and 19 others were the same as me.
      As for bright lights etc I don’t personally subscribe to low lighting & whale sounds or see how they could help but different strokes etc.

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    • For my 3 pregnancies my midwife only ever left my side to get help/second opinion. She never saw another patient, I was her only focus. And I also allowed student midwives in and they were great.

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    • Sorry Martina I accidentally gave you a green thumb as I was scrolling there. I had no intention of endorsing your dreadful, insulting comment.

      Reply
    • Rkmr 18/03/13 #

      Wow karla, 3 pregnancies and each time the midwife stayed with you the entire time and had no other patients?? What hospital was this in? This is not usually what happens.

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    • Wynnner 18/03/13 #

      I was the same I had one midwife who stayed with me all the time, she was amazing, and that was in the Coombe

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    • Limerick, it’s the norm and No I wasn’t private.

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    • Martina, you mention that your experience was through the domino midwives. The philosophy of the domino scheme is a mother-centred, natural birth one. There is very little difference between how the domino midwives practice attending to labouring women and what happens when a woman has a home birth. The main difference is the location. Women who have their babies through the standard hospital policies have very different care and a very different experience. You’re not comparing like with like. There are many, many women who would absolutely love to have domino care in their pregnancies. You were very lucky. Delighted it went so well for you.

      Reply
    • Two births in the Rotunda, public care and the midwife never left my side on either except one 5 min break where another stepped in immediately and had a quick chat : )
      How do you think it’s not the ‘norm ‘?
      How many hospital births have you had ?

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  • Thos is an ad for the home birth group, not journalism.

    Reply
    • It’s an opinion piece… What do you not understand about that?

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    • “Opinion” pieces about health issues require better standards of editorial care than a diatribe against the latest celebrity hairdo or a litany of the perceived failings of a football team.

      Hippy ideology is presented here as fact. Poor showing from the Journal.

      Reply
    • There is lots of fact, if you have any interest in looking.

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    • Tommy C 18/03/13 #

      Hippy ideology? Doing what your body was designed to do? Doing what women have done for thousands of years without the aid of a full room of doctors and midwives?
      Childbirth is THE most natural thing in the world. Whats hippy about doing it outside a hospital?
      Significantrisk, sounds like youre jealous of those women who do it without assistance.
      Relaxing on your couch or getting into your own bed in your own room after just giving birth sounds very empowering and natural to me.

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  • Elizabeth Ó Ruanaí

    How many midwives check the woman during all her delivery time? from 5 to 10, and all of them have their own opinion and experience, thats why its more safer to stay at the hospital. And this article is about world statistics I was telling before about and I was asked to bring some evidences about. With my experience i woulndt even trust hospital much, but if to choose from 2 opitions, hospital is at least safer. Thats what I was trying to say. Thx

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    • Rkmr 18/03/13 #

      Julia during my birth in hospital the midwife was not with me all the time, she had other women to look after too. She came occasionally and stayed no longer than 10mins a time. When at home your midwife is there by your side throughout all of your labour. So who is going to notice any compilations quicker? The midwife who is looking after several women and popping in and out of your room or the midwife who is by your side all the time?

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  • Rkmr 18/03/13 #

    Well done on being able to google! Although a blog is not the best place to go for information as the writer has written with their beliefs in mind. Your other comment said statistics in all European countries show that home birth is not safe. You must have read studies that prove this if you are willing to make such a statement, so please show me these studies that prove it.
    The link you posted show deaths in developing countries where there is limited medical care, there is also the issues of malnutrition, lack of education, lack of clean water and sterile instruments and poor living standards so of course deaths are going to be higher than in developed countries. Thankfully here in Ireland we have a fully trained experienced midwife at home births, we also have access to hospitals if needed. Generally women are more educated about birth, our diets are healthier, we have clean water, warm homes our midwifes have access to sterile instruments and had better living standards.

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  • Childbirth isn’t meant to be “empowering”, its meant to be safe.

    So much hippy twaddle.

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    • Tommy C 18/03/13 #

      My wife found it empowering and so she should! She was amazing and I have more love and respect for that woman since I saw her give birth to my 2 kids.
      If you dont find it empowering, dont bother doing it.

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  • I’m sorry I know this is about choice but even the most routine of home births can be so dangerous for mum and baby and I don’t think the HSE should have to fund it.

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    • What’s your evidence base? The plural of anecdotes is not fact. Happy to discuss factual research and statistics

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    • If the cord is around the babies neck or the head is too large for the pelvis, the baby will get no oxygen and could suffer long term problems. There just is time in this scenario to get to a hospital. It just shows by the number of ‘dislikes’ how emotive this topic is and people in favour of home birth don’t want to listen to another side of the argument at all. As much as hospitals have their downsides, I couldn’t put my baby at that risk.

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    • Up to one third of babies are born with the cord around their neck however it is quite rare that this causes complications.

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  • Rkmr

    Agreed, this midwife will be the one calling for ambulance brigade to take woman to hospital in case of the emergency delivery, because there will be none standing outside the house. And what can happen in situation like this , with all traffic and time to get to woman`s house and then to hospital i already said before.

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    • Rkmr 18/03/13 #

      Any women who has made a choice to have a home birth will have fully investigated what needs to happen if she does need transfer to hospital. She will get all of this information and use it to make the best decision. If it is a case where transfer to hospital will take a long time then probably she would decide against a home birth. As I said at home you have a midwife right there all the time, do you not believe that at the first sight of a problem the midwife will make a decision to transfer to hospital? If anything I would say that secms are even more aware of potential problems and ways to deal with them as they do not have a consultant to call and make a decision for them

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    • Rkmr in previous comments you were demanding that anyone who disagree with you produce corroborated facts to back themselves up. Now you’re making unsubstantiated blanket statements about what every single woman will do. You can’t have it both ways

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    • Rkmr 18/03/13 #

      I didn’t demand anything from anyone who disagreed with me, a poster stated that worldwide statistics show home birth is dangerous. I asked for evidence if this. I know many people in Ireland and abroad who have had home births, they all spent a great deal of time educating themselves on the benefits and risks of both options. I can not imagine anyone opting for a home birth without doing this.

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  • My children’s births with an independent midwife were the healthiest, happiest events. I fully recognised the midwife’s exceptions which could have meant having to go to hospital and was reassured by her as to how to have the best birth possible, if any of those circumstance had arisen. It seems there is now a non-scientific aim of increasing the limits on what is considered normal birth. Ridiculously pushing more births into already dangerously overcrowded and understaffed hospitals. The Home Birth Centre and AIMS are much more factually based and honest than the government. And the HSE is supposed to be embracing evidence-based medicine!

    Reply
  • Interesting link. Includes comments from Cecily Begley, an Irish professor of midwifery.
    http://www.oneworldbirth.net/videos/the-problem/the-problem-2/
    see also
    http://www.oneworldbirth.net/videos/the-solution/what-is-the-solution/

    Reply
  • http://www.sciencebasedmedicine.org/index.php/the-tragic-death-toll-of-homebirth/

    But please, yes, do whatever makes you feel the ‘most empowered’ whatever that is.

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    • A blog, talking about North America and referencing only US stats.

      The way the European healthcare system in general works is different to the US. Not really comparing like with like in any way shape or form.

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  • Myself and my sister were had at home 23 and 21 years ago. We were delivered by an experienced midwife, who my mother talks about all the time, and there was a trainee at my birth. My mother was very happy with both and I’m very glad she had a positive experience.

    For most medical procedures I would prefer to be in a public teaching hospital, though we’re not funding them properly at the moment, but for a process as long as giving birth where the expertise of a midwife or two is all that’s usually needed I’d prefer to be at home or at the very least in a midwife led unit.

    I desperately hope home birth is an option when I decide to have children. The idea of being pressured by staff to lie down or even not have the space and privacy to move in the way I want and make the noise I want etc. without upsetting other women really turns me off hospital birth.

    If we stopped bailing out private banking and property debt and used tax payers money to have a world class health service this wouldn’t be an issue. We need massive investment across our maternity services and the health service generally, not cuts that risk people’s health and lives.

    Though in a country with no choice as to weather or not you are pregnant, no abortion and expensive contraception, it should come as no surprise that women aren’t allowed to control where they give birth either.

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  • For sure it will be each mom`s to be choice which birth to have, home or hospital one. I am not trying to put my opinion to every woman`s heads, the comments are all about to say opinion to any news or article, to answer others peoples involved in discussion questions, are not they?

    Reply
    • Have you actually read this article? It’s talking about births in developing countries with little or no obstetric assistance. Home births in Ireland are attended by midwives and the mothers attend Irish hospitals for all their antenatal screening.

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    • Rkmr 18/03/13 #

      Well done on being able to google! Although a blog is not the best place to go for information as the writer has written with their beliefs in mind. You other comment said statistics in all European countries show that home birth is not safe. You must have read studies that prove this if you are willing to make such a statement, so please show me these studies that prove it.
      The link you posted show deaths in developing countries where where there is limited medical care, there is also the issues of malnutrition, lack of education, lack of clean water and sterile instruments and poor living standards so of course deaths are going to be higher than in developed countries. Thankfully here in Ireland we have a fully trained experienced midwife at home births, we also have access to hospitals if needed. Generally women are more educated about birth, our diets are healthier, we have clean water, warm homes our midwifes have access to sterile instruments and had better living standards.

      Reply
  • Bring on the red thumb brigade!!

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  • Rkmr

    i already posted a link to WORLD statistics i was telling about from the beginning, dont see a point to repeat myself many times.

    Reply
    • Rkmr 18/03/13 #

      Yes you posted a link to a blog containing some info from who on mortality rates in developing countries which you can not compare to Ireland. See I have a problem with people who post such bold statements like yours without any evidence or actual facts. I’m curious as to where you learned that worldwide statistic prove home birth is dangerous, because if its true I would like to see and so educate myself more. I’m sure you must have some actual studies proving this or did you just make this up as its what you personally believe?

      Reply

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