AS MIDWIVES, WE are dismayed by the recent article describing a study entitled ‘How would Mary Poppins fare in labour? Practically Perfect? Unlikely’ (Bolger, Sweeney, Foley & Mahony, IMJ 2018).
It reflects a paternalistic and patriarchal maternity system in a country with an ongoing history of secrecy and scandal regarding maternity care and women’s rights in health.
The study, undertaken in the National Maternity Hospital, reports from a maternity facility where ‘active management’ of labour has been at the centre of labour care, and routinely practised since 1963.
Medicalised birth process
This is a package of care that includes speeding up the labour process by breaking the waters and using synthetic hormones; this, by its very nature, leads to more interventions during labour, resulting in a highly prescriptive, medicalised birth process.
Not only is any attempt to present notions of the ‘perfect birth’ in such a context highly misleading, but we contest any simplified notion of a ‘perfect’ birth.
A recent qualitative systematic review showed that what matters most to women is a positive birth experience, preferably with minimal intervention. A positive birth experience is characterised by not only having a healthy baby but also feeling safe, supported and reassured by staff who are competent and kind.
A good birth experience is one where women feel respected, rather than undermined, in their choices.
Instead of questioning the outdated practices in a hospital where these outcomes are the reality, the authors of the study instead question women’s ‘unrealistic’ expectations of labour, which can then ‘present challenges to physicians and midwives’. Again demonstrating the unyielding paternalism that appears to accompany the Irish obstetric system.
However, the authors also give an unexpected plug to the midwifery services in the same hospital, which had a much higher rate of ‘perfect births’. Given the evidence, this should have been expected.
Midwifery continuity of care models show excellent outcomes and are an effective model of care for pregnant women of all risk. Studies have shown that one-to-one midwifery care can reduce rates of caesarean section and foetal prematurity and mortality. They lead to increased rates of breastfeeding and maternal satisfaction with their birth experience as well as decreased health care costs.
Increase standard of maternity care
There does need to be a change in narrative around maternity care in Ireland. Not to ask women to lower their expectations, but to increase the standard of maternity care and bring it in line with international best practice.
To do this, we need transparency and accountability from maternity hospitals. We need midwifery-led models of care and alongside midwifery units that support women’s plans for normal birth with clear transfer guidelines and we need effective collaborative obstetric care in emergencies and high-risk cases.
Some of these changes are already being implemented through the National Maternity Strategy. However, we also need maternity care providers who respect women, who listen to women, and who take women’s individual experiences seriously.
By Vivienne Brady, Ashamole Clive, Deirdre Daly, Margaret Dunlea, Louise Gallagher, Patricia Hughes, Felicity Kalu, Elizabeth Newnham, Colm O’Boyle, Magdalena Ohaja, and Jeannine Webster.
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