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Comment #1468291 by Karen McNamara

Karen McNamara Aug 10th 2013, 1:13 PM #

Hi sinead. I’m 1 of the afore mentioned obstetricians in Ireland and I love my job.. I’m all for normal deliveries ( as actually are most obstetricians i know) and would love to see our cs rates reduced – the majority of us think its too high and recognise the serious consequences that can happen in future pregnancies. However given the fact that I see what goes wrong with labour on a regular basis home birth is definitely not for me- this is based on 6 years of undergraduate medical training and 7years of postgraduate obstetric training- losing one baby during labour is all it takes to remind you of the dangers of it. Yes the majority of women if left alone will be absolutely fine but alas that’s not the case for all. Saying that I do think mothers and fathers are entitled to make up their own minds about what is right for them.. And if that lady in Kilkenny wants to go ahead and try for a home birth then that’s what she should do. But dont expect the HSE/hospitals to shoulder the blame if something goes wrong. Personally even if there was a less than 0.1% chance of her uterus rupturing(and I’m not saying that wouldn’t happen in hospital- it’s just it would be recognised and managed quicker in hospital) I wouldn’t take that chance- statistics are all well an good until you are the 0.1% and then it becomes 100% to you. And no matter what ppls views are on obstetricians – if we didn’t come to work in the morning the perinatal and maternal mortality rates would soar!

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Column: The HSE has launched an assault on our birthing rights

Column: The HSE has launched an assault on our birthing rights

Ahead of the High Court ruling this morning in the case of pregnant woman Aja Teehan, who has been told by the HSE that she is ineligible to have a home birth, campaigner Sinéad Redmond discusses the implications of the case.

REPLIES

    Favourite Sinéad Redmond
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    Aug 10th 2013, 1:18 PM

    Hi Karen,

    I love hearing from medical staff who support normal birth and women’s choice in it. Many obstetricians out there do fantastic and supportive work within a system that actively works against them doing that! Thinking that parents are entitled to make up their minds about what’s right for them is entirely what this is about.

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    Favourite Stephanie Fleming
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    Aug 10th 2013, 1:31 PM

    Karen you’re absolutely right, like Sinéad said its great to see an obstetrician supporting patient choice like that. Especially right about the HSE taking the blame for something going wrong. I’m quite certain that when a patient goes against medical advice and something goes wrong as a result then it is no fault of the practitioner but here the HSE hasn’t even given her the option of doing so, they’ve said either do what they say or get no care at all and that simply isn’t right.

    86
    Favourite Blondie Girl
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    Aug 10th 2013, 1:39 PM

    I agree with you Karen.
    I had my daughter in Holles Street and I have nothing bad to say about them. She was my first, I was never made feel like I wasn’t not involved or that my opinion didnt matter. I wouldn’t have a home birth if something went wrong I would rather be in a hospital where a quick intervention might save mine or my babies life.
    As for not being informed they do classes so if you do choose to go to them you get plenty of information about labour, pre labour and about your newborn.

    73
    Favourite Stephanie Fleming
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    Aug 10th 2013, 1:52 PM

    Blonde that depends heavily on the class you get. I’ve know a lot of women who said their classes were completely crap. My sister went to one where they separated women from their birthing partners. She never did find out why. Said there was a load of men on one side of the room and all the pregnant women on the other doing different things and neither she nor her partner were given info on positioning during labour, natural methods of pain relief or the circumstances under which they might expect surgical intervention. Said the woman running the class was late, completely disorganised and finished the class early.

    One of the big problems Sinead has highlighted in the article is inconsistency throughout the country, why is the c-section rate so much higher in Kilkenny?

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    Favourite Blondie Girl
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    Aug 10th 2013, 2:06 PM

    I am just speaking from my own experience I was well informed before I went into labour. My husband was informed and I knew what to expect.
    The high rate of c-section surprised me because I was always told its the last case scenario.

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    Favourite Stephanie Fleming
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    Aug 10th 2013, 2:14 PM

    That’s fair. Yeah the high rate of c-sections here is what I find particularly worrying. It also annoys me no end that so few c-section patients are given adequate physio afterwards. I must look up the incidence of chronic back pain post c-section but I’d say its high if no physio is given.

    48
    Favourite Jo Murphy
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    Aug 10th 2013, 2:33 PM

    You get a lot of information about hospital births, Blondie Girl. You don’t get a lot of information about having a natural physiological birth or why hospital interventions cause problems or why they’re often done in the first place.

    I’m so happy you had a great birth – I know lots of people do. That doesn’t mean hospital is the place that feels safest for everyone. I had a home birth on my first child – had I been in hospital I would have been induced and sectioned. As it was I had a safe home birth.

    There is a world of information about birth out there that you won’t learn in hospital ante natal classes. If you’re only interested in the hositpal info and you trust the system and would rather be there, then, yes, it’s the place for you to have a good birth. If not, you should be able to have other choices, ones which are proven, consistently, to be as safe.

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    Favourite Sorca O Brien
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    Aug 10th 2013, 2:34 PM

    It may not be their fault but they will be expected to sort it out afterwards . Rupture is something that happens quickly and can be catastrophic for mother and baby . There isn’t time to phone an ambulance and get into hospital .

    51
    Favourite Stephanie Fleming
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    Aug 10th 2013, 2:46 PM

    Do you think Aja Teehan hasn’t been told that already?

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    Favourite karen
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    Aug 10th 2013, 5:44 PM

    Karen, you have completely missed the point about homebirth. Women are assessed for homebirth and continuously monitored on a one to one basis, more so than when they are in hospital. The midwife is there to recognise the first signs of deviation from normal and transfer in to hospital before a serious event occurs. In Hospital the mother is then cared for by a midwife who often has more than one mother to look after in labour. Therefore one to one care is not given. In fairness as you are an obstetrician you are called by the midwives when abnormal birth occurs. You are never ever called for normal birth do you haves minimal experience in it. Get some midwife experience and you will change your views.

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    Favourite Lisa Shanley
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    Aug 10th 2013, 5:46 PM

    I agree Blondie, had 3 babies in Holles street and couldn’t fault them. My opinion was asked throughout and I was asked my permission before any treatment. As for monitoring? I was monitored on my first child as there was meconium in the fluid but never on my other two. I’ve had three natural births but personally wouldn’t even consider a home birth because I would fear that something could go wrong. We sadly live in a land of people who’ve sued over various things so I can’t really blame the HSE for their cautiousness.

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    Favourite karen
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    Aug 10th 2013, 5:49 PM

    Uterine rupture most likely to occur when oxytocin is used, like in the hospital.

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    Favourite Silver Fern
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    Aug 10th 2013, 6:30 PM

    Karen
    I have a good friend who spent 10 days in icu after a uterine rupture following vbac (no oxytocin used) had a spontaneous labour in a hospital thank god or otherwise two children would have lost their mom a husband his soulmate and so on.

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    Favourite Julie Tiernan
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    Aug 10th 2013, 8:38 PM

    Hi Karen and Silver Fern,

    Only 5 weeks ago my uterus ruptured during a VBAC, both my DD and I are ok. Although this can happen without oxytocin it is far more likely to occur when oxytocin is used. I pleaded with the staff on that day not to give it to me as I could feel how strong my contractions were but they did, without telling me. 20 mins after the rupture occurred and I only felt the pain because my baby had passed meconium earlier in labour. For me, I was not listened to and the consultant admitted that it was the oxy that caused the pressure but said he’d been in the business nearly 30 years and he had never seen a uterine rupture and that I was the unlucky stat. Indeed he said that this was standard practice, this is flawed and too black and white. I knew my body and did not want to be managed using oxytocin. As a result I may not be a candidate for any further children and I have a very long road to recovery ahead of me. Now, all of this said I do not blame any individual, it is the system that is flawed and I agree with the sentiment of the author although I do not agree with all points made, it is important to have these conversations.

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    Favourite Maria
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    Aug 10th 2013, 8:47 PM

    Not surprising at all. I remember the master of one of the Dublin maternity hospitals saying that the high C-section rates are due to the high numbers of women of “advanced maternal age”, which itself is associated with higher risks of complications.

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    Favourite Debbie Duffy
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    Aug 10th 2013, 10:42 PM

    Julie this is shocking and frightening. I’m glad to hear that you and your baby are okay, it sounds like you were lucky to survive. I am shocked that the doctors put you on oxytocin despite your objections! That is horrendous. I’m hoping for a vbac in a few weeks and I was told months ago by the obs that I shouldn’t be put on oxy either. Now I’m just terrified that they’ll go ahead without my consent.

    Also, with hindsight I think my emcs was a little rushed last time because I didn’t dilate at the rate they expected. Neither the baby nor I were distressed/tired or in any danger when I was brought to theatre. I was too upset at the time to ask enough questions, but I will definitely be on my guard more this time. All that said, the most important thing is that baby and I will be healthy and well after the birth.

    I wish you a swift recovery and a happy life with your new baby.

    37
    Favourite Julie Tiernan
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    Aug 11th 2013, 11:21 AM

    Thanks so much Debbie. You’ll be fine, as the consultant said, I was very unlucky. That said you can cite my case and ensure you are not given oxy. Good luck!

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    Favourite Barbara Western
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    Aug 11th 2013, 12:08 PM

    Julie, I am so sorry for your experience. The current RCPI Guidelines on VBAC state that “oxytocin augmentation of labour should only be administered with clear instructions following full clinical assessment, including vaginal examination, by a senior obstetrician”. It’s shocking and ethically questionable that you were given this treatment without your consent and without an adherence to clinical guidelines. Guidelines can be found here: http://www.rcpi.ie/content/docs/000001/652_5_media.pdf
    I agree wholeheartedly that it is not individuals to blame as much as the flawed system in maternity care.
    I sincerely wish you a full recovery from what you have endured.

    29
    Favourite Jo Murphy
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    Aug 11th 2013, 12:47 PM

    Healthy and well and happy – not suffering from stress or PTSD or PND or any general feeling of loss that last for years and mars your memories of your birth… these things are important too.

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    Favourite Silver Fern
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    Aug 11th 2013, 7:32 PM

    Julie
    I am sorry to read about your experience. I wish you a speedy recovery and every joy and happiness with your new baby and your family.

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    Favourite Julie Tiernan
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    Aug 11th 2013, 10:40 PM

    Many thanks Barbara, I was unaware of these guidelines.

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