SECOND OPINION:THE MASTER of Ireland's largest maternity hospital claims that lives are being put at risk because of a lack of investment and HSE cutbacks. The hospital, designed to handle 6,500 births a year, is dealing with 10,000 and needs another operating room for Caesarean sections.
Is he serious? Irish women already undergo too many Caesarean sections, so why do we need more operating rooms? Most maternity hospitals in Ireland are bursting at the seams, not because of lack of investment but because the birth model used in virtually all of them sees birth from a disease/risk perspective.
Bizarre health policy and planning means medicalisation of childbirth has become our default position.
Pleas for more investment in the existing maternity hospital infrastructure are usually accompanied by references to how safe our system is, as if this somehow justifies the current model. Unfortunately, like the claims that are made about our great education system, we do not have a top-class birthing model and we need to stop deluding ourselves.
The latest ESRI Perinatal Statistics Report 2009, published in June this year, shows that Ireland is in 14th place among 22 EU countries with a perinatal mortality rate of 6.9 per 1,000 births. Spain is the safest place to give birth in the EU with a mortality rate of 3.6.
Also worrying is Ireland’s growing Caesarean section rate. The World Health Organisation (WHO) says that nowhere in the world should this be more than 10-15 per cent of all births. The ESRI report shows that the Irish figure is now 27 per cent.
Recent research notes that Caesarean section rates are more closely related to the way a health system is financed and structured, and the number of consultants, than women’s needs.
Spontaneous deliveries have decreased from 64 per cent in 2000 to 56 per cent in 2009. The percentage of women having their babies naturally varies dramatically from hospital to hospital, being 100 per cent in the midwifery-led unit (MLU) in Cavan to 45 per cent in Dublin’s Mount Carmel.
The high rate of Caesarean sections and general interference with what is a natural process, is an outcome of the Irish childbirth model and not because women are unable to give birth naturally.
This model, which actually reduces women’s confidence in their own abilities, is based on “actively managed labour and birth”. The pace is decided by hospital policy and if things are not happening fast enough mechanical action is taken or drugs are given to speed things up.
The WHO says that 85 per cent of women will have normal births and need no medical intervention. These women need assistance from midwives only who are the most appropriate care-givers. Despite the evidence, 99 per cent of Irish babies are born in very expensive consultant-led units.
Out of the 76,000 babies born in 2009, only 384 were delivered in MLUs, 148 were born at home attended by independent midwives, and 52 by hospital-administered home birth schemes. Irish women have little real choice when it comes to giving birth and this is where the real problem lies.
The best practice choices that should be available are, in this order, planned midwife assisted home births, MLUs attached to primary care centres or hospitals, and hospital-based consultant-led care. At least 10 per cent of women would like a home birth and thousands more would prefer a midwife-led birth and cannot avail of either option.
In some parts of the State, for example, HSE West, women have no choice at all and must avail of a consultant-led birth, regardless of whether their pregnancy is normal or not. A home birth pilot scheme with excellent outcomes was suspended by the Western Health Board in 2003. The funding allocated to this service was used to appoint two new consultants. Questions were asked in the Dáil at the time to no avail.
The consultant-led model makes no sense from a best practice or financial point of view. Providing home births to the 7,000 women who want this service and “allowing” another 40,000 or so to give birth in MLUs would immediately reduce the pressure on the existing services and would be a lot safer and cheaper.
No doubt politicians will bleat about “downgrading” our maternity hospitals as we seem to be unable to contemplate any health service that does not have a consultant at the helm. But hey, what’s better for women must count for something. Or not.
Dr Jacky Jones is a former regional manager of health promotion with the HSE