March 07, 2003

Government funded home births in Ireland

The workshop in Cork has finished. It was quite a challenge because maternity services in Ireland are still very medicalised and midwives are still very involved with the active management approach. Midwives working in hospital settings have little experience of normal birth so many of the ideas we explored were quite new.

Some autonomy is being gradually acquired, but much of it is far from satisfactory. I was told that midwives could now choose when to rupture the membranes for example (the assumption being that they will always be ruptured not being challenged) and it appears that the fear of litigation has been so drummed into them that no-one would dare to circumvent the protocols, even of the woman insists she wants something different.

The obstetricians are all-powerful in Ireland and it seems their resultant rigidity and unwillingness to embrace evidence based care is the same old story. “It’s a cultural thing” was said several times during this workshop, and I would certainly agree. Change will come eventually when women and midwives stand up for each other and demand something better for mothers and babies.

One highlight of Cork is the government funded home birth scheme that has just finished as a pilot project and is being evaluated. The approval rating from the women is very high, as you would expect, and the midwives involved, several of whom I have now met, are doing magnificent work. In Dublin, the community midwifery program that the Government funded at Holles Street (the home of active management) has been disbanded, because it was overwhelmingly approved by the women. It seems they have been punished for their success by the powers that be (probably the doctors) and rather than extend what has proven to be a successful and popular service to a wider community, it has been deemed easier to “dumb down” the maternity services again. I hope the Cork project doesn’t suffer the same fate.

On to Drogheda tomorrow, for another Active Birth workshop. I wonder what has happened there since my last visit?

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