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Giving birth in Dublin

My trip to Dublin this week has left me with very mixed feelings. Whilst I very much enjoyed being with this group of Irish midwives and public health nurses, I was dismayed by what they told me about the state of maternity care in Ireland, especially in Dublin. I guess that in some ways I was not surprised by this - Dublin is after all the home of the “Active Management of Labour” protocol that forces women to accept a predetermined management plan for their labours, whether they like it or not.

The most disturbing aspects of the workshop discussion for me were the group’s acceptance of the status quo, their unwillingness to consider the suggestion that this could be challenged to any degree and the outright fear of labour that these educators, on the whole, expressed.

The rigid management of labour, as set down by the Master of each hospital in Dublin, requires that women spend no longer than 12 hours in the first stage of labour and one hour in the second stage. This is achieved by the routine use of rupturing membranes, liberal use of oxytocic drugs and instrumental deliveries if the birth is delayed beyond the given time frame. Whilst there is a pretence of “allowing” choice, “informed consent” is often obtained under duress, such as in the transition phase of labour when a women is required to listen to the anaesthetist explaining the pros and cons of epidurals before requiring her to sign a consent form. If a woman decides that she doesn’t want a standard procedure, or questions a policy in any way, she is labelled a trouble maker and will be subjected to verbal abuse, intimidation and harassment during labour. It is no wonder that given these circumstances, childbirth educators are unwilling to encourage women to speak up for themselves during labour and that preparing for this regime is seen as preferable to leaving women potentially vulnerable in labour.

I was surprised that so many of these educators were frightened of birth. Given that they will have had their babies withing this system themselves, much of this fear will have come from personal experience. Quite a few were public health nurses, and would not have had any direct experience of maternity care for some time, and this places them at a disadvantage, as they have to reply on their colleagues who work in the maternity hospitals to relay information. What they are being told to pass on are the policies and procedures that the hospital want women to accept without question. Very few of these educators were aware of the evidence surrounding birth issues or used the research in their classes as a basis for encouraging informed decision making. Parent education programs were typically 3 or 4 sessions of 2 hours each - far too short to provide any real educational experience for parents, but enough time to explain the procedures they would face.

It is hard to know what will stimulate change in the Irish system of maternity care. Given the subjugated position of pregnant women, I think it is unreasonable to expect them to force change through their questioning or requesting of alternatives - they fear very real retribution, and no woman wants to risk this when she is at her most vulnerable during labour. The midwives have seemingly given in as well - no doubt because of similar threats - and appear to have lost touch with their professional role as the protectors of normal birth. They don’t seem to have appreciated the fact that they are colluding with the doctors in the shameful exploitation of pregnant women when they fail to challenge what is going on.

The doctors will not force change - they are making squillions of Euros each and sit very comfortably at the top of a chain of command that bestows huge power over women (both the pregnant and the professional) and the health care system. My good friend Doris Haire, American birth activist extraordinaire, suggests that the best solution is to “sue the pants off them” as money si the only language obstetricians understand. Given the amount of emotionally and physically damaged women will be leaving these birth factories, perhaps this is a likely solution. The litigation rate in Ireland is certainly very high.

I am returning to Dublin in June to present another Teaching Skills workshop for a further group of educators. I wonder if there will be any fall out from my visit this time, and whether the next group will have many of the same characteristics as this one. I am not blaming these women for their approach to parent education, I am just sad that they have not been given any opportunity to embrace and pass on the joys of birth to the women they serve and to use the influence they have to encourage and stimulate change. I will try and get these messages across with my next group.

Posted by andrea at April 24, 2005 07:30 PM