Marie O'Connor's recent article in this newspaper on routine interventions during labour raises important questions. Certainly, it gave me a distinct feeling of "been there, had that done to me".
She concentrated on a well-nigh routine procedure, amniotomy, where the waters are broken, usually if the labour is not progressing at the rate of dilating at one centimetre per hour. Ms O'Connor says women's views on amniotomy have never been established, but anecdotal evidence suggests many women loathe it.
One person interviewed by Ms O'Connor compared the procedure to rape, which does not reflect my own feelings, but I did find it painful and invasive.
However, many hospital procedures are unpleasant. More importantly, it speeded up the rate of contractions to an almost unbearable level. From feeling that labour was manageable, suddenly I felt overwhelmed. Breaking the waters or giving an oxytocyin drip means usually means that the labour becomes more intense very quickly. This can often lead to a spiral of interventions, from epidurals to forceps or even Caesarean section.
Unpleasant as they are, such interventions might be acceptable if they ensured a better outcome for mother and baby. The frightening thing is that the case for such interventions as routine procedures, at best, remains to be proven.
In my case, I had two full epidurals, neither of which worked properly, and eventually, completely exhausted and shivering from shock, I had an emergency Caesarean. I had the amniotomy on my first labour. Having now had four children, I know that my labours do not progress at a nice, neat centimetre an hour.
Nothing seems to be happening for a long time, despite regular strong contractions, and then I dilate very quickly. There must be many women like me, all of whom would be candidates for having their labour speeded up, despite the fact that there is actually no need. Where do women like me get a chance to represent their reality to the medical profession?
I was desperately anxious to avoid a second Caesarean, and not for frivolous reasons. I had always hoped to have more than two children, and every repeat Caesarean increases the risks for the subsequent child. So, as a direct result of the interventions in my first labour, I delayed on my second child, and became a BBA, or born before arrival (at the hospital).
I did have a midwife present, but only because I had twisted the arm of a homebirth midwife to call in to me and advise me when to go to hospital. She arrived just as I realised that I was not going to make it down the garden path, much less into hospital. She was wonderfully calm and kind, and proceeded to look after me as if I were one of her clients, coming to see the baby and me for 10 successive days at home.
I went on to have two more planned home births. This does not mean that I am a home birth advocate. What I do advocate is accurate information for women and their husbands or partners which will allow them to make informed decisions.
The British House of Commons Select Committee on Maternity Services declared in 1992: "There is no convincing or compelling evidence that hospitals give a better guarantee of the safety of the majority of mothers and babies. It is possible, but not proven, that the contrary may be the case."
Such evidence has been around for a long time. Interestingly, a British lecturer and statistician, Marjorie Tew, initially set out to prove that hospital birth was safer and set her students an exercise to prove it, by analysing data from 1958 and 1970 perinatal surveys. She was completely converted when the evidence showed that in many cases home birth had better outcomes. However, we are very far from the situation where women with uncomplicated pregnancies will be able to opt for home birth. As Ms O'Connor points out, we are still not in a situation where women's wishes not to have their waters broken are respected.
Part of the reason birth has become so unnecessarily medicalised is the increase in litigiousness. Obviously, any parent who feels that negligence harmed their child has a right to redress. However, in hospital or out of it, all births carry a certain degree of risk and, tragically, not every birth will have a happy outcome.
To cover themselves, obstetricians often feel they have to be able to show they did everything possible. This leads to unnecessary interventions, and probably accounts for our high rate of Caesarean section. Defensive medicine is good for no one.
Also, far from wishing to be empowered and in charge of their labours, more and more women are opting for elective Caesareans so as to avoid labour entirely. Caesareans are a life-saving operation which should only be resorted to when absolutely necessary. One would not be able to request an elective appendectomy on a healthy appendix. It amazes me that women can virtually schedule Caesareans for no good medical reason.
However, I am also a bit sceptical of those who would over-romanticise birth. It is the most challenging thing I have ever done, and I am glad to be in my childbearing years at a time when medical intervention can be called on when necessary. What I would love to see is a spectrum of options, from hospitals to small birth centres to home birth. Midwives should be a central part of the birth process. Both here and in the UK there is an exodus from the profession. Midwife means "with woman", and there is an extraordinary level of perception and sensitivity needed to be with a woman in labour.
I have developed immense respect for those qualities in my own midwife, Ms Kate Spillane, whom my children treat as a member of the family.
Sadly, many younger people entering her profession will never develop those skills if they are treated as adjuncts to obstetricians rather than as professionals in their own right. Nor will many women experience the deep satisfaction and fulfilment of a birth without unnecessary interventions.
bobrien@irish-times.ie