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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.

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.

Eva-Louise Goussot
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