Starting a family: “Just as the ambulance crew arrived, I had a huge urge to push”

The first man to see my second child emerge into the world wasn’t my husband. That honour, if you will, fell to Dave the paramedic. Not that this was an emergency. Dave was training for such a situation, but from the way the midwife tentatively inquired if he could be present at the birth, I got the impression I was the first to agree.

Maybe it was that it was my second baby but I didn’t mind a bit. In fact, as the other man in the room was busy having tea and toast, as well as being the whole reason for my discomfort, I was delighted to have someone new to chat to.

It probably goes to show how relaxed I was, and that was definitely a key part of my own experiences. Not that the births weren’t painful (an epidural late on definitely helped there) or scary from time to time, but my overriding feeling was excitement. While both births were great, the second was probably even better as I knew what I wanted. The first had become a bit chaotic after our baby arrived. I had an injection to induce the placenta, which made me sick, so I had a preference for a natural third stage – with delayed cord clamping and a natural delivery of the placenta – which the midwife was happy to facilitate.

Recognising that birth should be seen as a normal physiological process and facilitating a woman's choice where possible is one of the stated aims of the National Maternity Strategy, which was launched this year by acting Minister for Health Leo Varadkar. It resulted from a Hiqa recommendation after the death of Savita Halappanavar due to pregnancy complications at University Hospital Galway in 2012, and was designed to develop models for a national service that "reflects best-available evidence" and ensures all women have "informed choices and access to the right level of care".

Dr Sharon Sheehan is the first female master of the Coombe and was a member of the steering group that developed the strategy. She says that, having never had a national maternity strategy before in the State, the onus now is on implementation.

“So many excellent reports end up gathering dust, it behoves us to implement it. It’s woman-and-baby-centred, really progressive. It is de-medicalising the whole approach and looking to enhance the role of midwives in the community. Pre-pregnancy education will be important, going into schools and educating about things like nutrition, exercise, breastfeeding and taking folic acid. The Minister has ring-fenced funds to implement it and that will be the key, critical investment in staffing and facilities.”

Asked about the difference between having babies in Ireland now and a generation ago, Sheehan says a different set of challenges exists: "The average age of mothers has risen, C-section rates are rising, there are obesity issues, more significant medical problems: for example, women having babies after transplants who just wouldn't have done so before. Homelessness is an issue – we are dealing with more complex mums."

On the flip side, she says, there have been huge advances in care, particularly neonatology. “When I was in college, a foetus was deemed viable at 28 weeks – now it’s 24 weeks and some can survive at 23 weeks. The care is so specialised.”

For the system, Sheehan says the aim should be empowering women. Care at the Coombe has evolved and this has “been driven by patients. Our mums are really informed. An information-hungry generation, they want to actively participate in their birth. In the past, people didn’t really know or think a lot about it. Now we have a really interested cohort of patients and they want to have their baby and have a really positive experience.”

For Muireann MacMahon, a craniosacrial therapist from Kerry, there was only one plan for her when she found out she was pregnant – a home birth. Her husband Donal did ask “seriously?”, she laughs, but he was happy to go for it. They attended hypnobirthing classes which “really helped us focus on the positives”.

MacMahon contacted home birthing midwife Sinéad Murphy and told her GP, who was a little taken aback as “it probably isn’t the norm for a first-time mum.”

Antenatal visits were at home, which the couple found brilliant, and they developed a relationship with Murphy. When she went into labour, the midwife arrived at the house in the early hours of the morning.

A birthing pool was “amazing”, allowing MacMahon to change position easily, and during the first stage she walked around listening to hypnobirthing tracks, climbing up and down the stairs and bouncing on a gym ball. The pushing stage was long, however, and when she had been pushing for over two hours, Murphy decided to transfer her to hospital.

MacMahon was happy to do that but, “just as the ambulance crew arrived, I had a huge urge to push. Sinéad said: ‘I can see the head, you’re going nowhere! Baby Harry was born in the sitting room and it was such a relief, such a rush of love and joy.”

For their second baby two years later there was no question where the birth would be or who would be their midwife. This time was much quicker: “My first labour was long and, I’ll be honest, tough at times, but my second was just amazing.”

At her second check MacMahon was 8cm dilated and her waters were bulging; they broke shortly after. Ten minutes later baby Amelia arrived. “I was squatting with my husband supporting me. It was such an amazing, empowering experience, as both births were.”

Asked about her favourite part, she doesn’t hesitate: “Going upstairs to my own bed, bringing my new baby in beside me. The three of us being so comfortable and contented.” Her husband agrees that the best bit was: “Going to bed for a couple of hours together and waking up as a little family.”

In MacMahon's work as a craniosacrial therapist she meets lots of parents and babies who have been traumatised by their experience. That, coupled with her own births, spurred her on to train under Tracy Donegan to teach Gentle Birth workshops which she now runs in Tralee. Rather than prescribing a set way for everyone, she says it's about being informed so you and your partner can make the right choices for you – "home or hospital, medicated or non-medicated. It's about taking the fear out of birth and replacing it with confidence" she says.

This was the approach taken by Eva Clifford and her husband Darragh from Wexford when they had their son, Conor, last April. Clifford took classes in pregnancy yoga, hypnobirthing, antenatal classes and listened to Gentle Birth tracks – "the works" she says.

She found the hypnobirthing classes brilliant. “She addressed things I had been anxious about and was great for general advice. I wanted to keep myself as relaxed as possible. I wasn’t ruling out medication, but I planned to see how I was going and I really wanted to stay at home for as long as possible.”

That plan went out the window, however, when a scan showed she was carrying a lot of fluid. Because of that her consultant didn’t want to let her go overdue and said the safest thing would be to have the baby, either by induction or C-section. “I really didn’t want to go down the induction route. Having had an examination and seeing nothing was happening, my doctor felt it could be a long struggle.

“Our consultant told Darragh a [caesarean] section was the safest thing. We really respected her opinion – I had a few scares during the pregnancy, different bleeds, so at this stage all I wanted was a healthy baby.”

Clifford describes her caesarean as “extremely positive. I did deep breathing which really helped. They put Conor on my chest before taking him away but I focused on the fact that I’d have him soon, and that Darragh could do the skin-to-skin, which was really special for him.”

Skin-toskin is where the naked newborn is placed on the bare chest of a parent after birth to help them adjust to the outside world and facilitate bonding, among a whole host of other benefits. This practice is now commonplace in Ireland’s hospitals.

“I thought positively throughout,” says Clifford, “and I don’t know if it helped but I recovered quickly and healed really well. I think your attitude definitely has a lot to do with it all.”

For Aoife Molloy, a pharmacist in Limerick, her birth plan was very simple. "I was going to say 'epidural please' to anyone who came within six feet."

Aoife and husband Ciaran have four children, Zoe (5), Aaron (3), and twins Ben and Dylan, born last July. Becoming pregnant with twins was a total shock as Molloy didn’t know there were genetic twins in her family. “I never saw it coming, I wasn’t sick, I wasn’t tired ... It was a purely routine scan, I didn’t bring anyone and I had work an hour later.”

She had had normal births, albeit with assistance, with her first two babies and knew she wanted to go the same route if possible with the twins. Having the other two at home also influenced her desire not to have a C-section if it could be avoided. Molloy had the same consultant each time and says it was a huge psychological help when having the twins. “I trusted him. He was so calm and, even towards the end, the midwife was saying ‘I don’t think this is going to happen. Have you any crowns, any nail varnish? [standard questions before a C-section]’ But he said ‘no, no, there’s no problem here.’”

Molloy was induced for all her births and each took a long time, “around two days”. Three out of four of her babies also required a vaccum, which was tough, she says. “The one I had without it, Aaron, was actually borderline pleasant,” she laughs.

She swears by the epidural, which she had each time. “It wasn’t so much about preventing pain, it was the thoughts of intervention at the end. I had three inductions, three episiotomies and vacuums so I just don’t know could I have coped without it.”

While her births were all similar, one thing surprised her with the twins: “I didn’t expect it but you obviously have two sets of waters so Ben was born and they said, ‘we’ll break your second waters now’. I was like, ‘seriously?’ Dylan arrived and afterwards the consultant pulled the two cords and two placentas came together. I almost felt like I’d been disemboweled.”

Asked if she’d have any advice for prospective parents, Molloy says to keep an open mind. “Aspire to a certain type of birth, definitely, but you hear people saying they feel a failure if plans don’t work and it’s nothing to feel a failure over; we all do our best.”

And her favourite part? “For me it’s being wheeled back down and everyone congratulating you. Some people say when the baby is handed to them they feel a rush of love but I never got that, I was probably so exhausted. But an hour or two later when you are recovering and your baby is in your arms and everything is okay, that’s lovely.”

For Spanish native Isabel Rubio who lives in Clonsilla, the birth of her son, Liam (five), prompted her to look into alternatives.

There was “no big trauma” but she felt she couldn’t be herself. “I couldn’t do what my body wanted me to. The midwives couldn’t have been better and I would absolutely praise all the staff in the Rotunda but it was very staged.”

Rubio felt supported in the first stage and was largely left to her own devices but found the position she was asked to lie in for pushing – on her back with head and legs raised – extremely uncomfortable. She says both she and her husband Kevin felt like witnesses to the whole thing. “I was pushing for an hour and then it was discovered my waters weren’t really released so I had been pushing against them. After they were released I needed another hour or hour-and-a-half so I was beyond exhaustion.”

Afterwards, Rubio did some research and when she became pregnant again, the couple decided to attend a Gentle Birth workshop and seek the support of a doula – a trained professional who provides support to a woman or couple during pregnancy and birth. They met a few but "clicked instantly with Liz Farsaci. "

On the night she went into labour, Rubio put Liam to bed and decided to sleep herself for a while. “When I woke I texted Liz and said ‘it’s happening.’”

They were in the Coombe this time – Rubio had heard they were very pro-natural births – and on arrival the midwife read her birth plan. “They followed it to the letter – I was very impressed,” she says.

Once Rubio went into active labour, Farsaci took charge of the details and liaised with the midwife, leaving Rubio and her husband to focus on doing things as they wanted. This labour was quicker, “more furious”, with Rubio pushing for just seven minutes before Alex arrived safely. Her husband Kevin felt much more involved – “the Gentle Birth process helped my body but it also helped my husband because it tells the father ‘you have a role here’.

“I wouldn’t say I had the birth I wanted as that would probably have been in water at home with candles but it was how I wanted it to be managed. Reality hits and you need to know your limits. I feel deeply respectful of my husband’s feelings because he’s as much a parent as I am and he was more comfortable with a hospital delivery.”

Farsaci explains: “A doula’s role is to be that trusted person who helps a mother feel safe, to support her and her family and help her make informed, empowered decisions.”

She describes working with Rubio as “such a delight. It was an honour to be with her as she birthed her son, to share in the moment when she was so vulnerable and yet so incredibly powerful, and to support her and her family throughout this special time in their lives.”

On birth, Rubio says: “Nobody can really describe it, you have to feel it, but one thing is for sure – we are born to birth. We should listen to our bodies more and know how capable we are. There are options for everybody. Gentle Birth suits me very well but a more managed birth will suit another and that’s great so long as our choices are our choices and there’s no pressure.

“It’s scary but it’s more exciting because a birth that is well managed and goes how you would like is the most wonderful experience. There is a certain amount of pain but there are tools for that – medication or mental tools – and it shouldn’t stop us believing we can have the birth we want. I always say my first child made me a mother but my second made me a warrior because it was really powerful to feel in such control. It was just wonderful.”