The best places to give birth (Ireland isn’t in the top 20)

Chotti lost three babies shortly after they were born. During her pregnancies, she did not receive any prenatal care and the deliveries took place at home without a skilled attendant. “I didn’t know. . . I didn’t get check-ups, nothing,” she said. “All three children were born and then they died.”

In the slums of Delhi, India, her story is sadly commonplace. Among the poorest 20 per cent of women in this city, only 27 per cent receive recommended prenatal care and only 19 per cent have a skilled attendant at birth. In a city where the affluent enjoy a very high standard of living, statistics like these make Delhi one of the most unequal cities in the developing world.

When Chotti became pregnant a fourth time, her neighbours told her to go see Rima, a Save the Children community health volunteer in the VP Singh Camp where both women live. Rima became like a wise older sister to Chotti, coaching her on when and where to go for prenatal check-ups, how to have better nutrition, and danger signs to watch for. Rima accompanied Chotti to the hospital and helped her register so she could have her birth there.

“In the hospital, the baby was born properly,” Chotti said. “I liked it there. The people helped me. They made me lie down and after that the baby was born and everything was fine. If I had gone to the hospital before, my other children would have survived.”

Rima visits Chotti at home now and helps her care for her new baby boy, whom she named Naveen. Rima advises Chotti about breastfeeding, cleanliness and vaccinations. Chotti has been following Rima’s advice and Naveen is doing well.

“I used to feel sad earlier,” Chotti said. “But now my baby is fine. My heart is happy.”

(Save the Children State of the World’s Mothers Report 2015).

Ranking motherhood across the globe

Compared to new mothers like Chotti who tragically lost three babies shortly after birth, women in developed countries like Ireland are extremely fortunate. To some extent unlike Chotti, we have a choice as to where we would like to give birth and more importantly we are guaranteed expert antenatal and postnatal care.

Ireland’s recently published National Maternity Strategy commits to providing even more choice to women as to where they would like to give birth and the level of support they would like to receive.

The strategy proposes one model of care with three care pathways; Supported Care, Assisted Care and Specialised Care. According to the strategy across all pathways, care will be woman-centred and provided by a multidisciplinary team.

In the delivery room or operating theatre of a maternity hospital or unit attended by expert obstetricians, nurses and midwives; at home in your own bed with the help of the community midwife, in a birthing pool labouring by candlelight; wherever a woman chooses to give birth; once that choice is informed by best practice and is safe and appropriate for her and her baby, surely that is all that matters?

According to the World Health Organisation (WHO), despite a 44 per cent reduction in maternal deaths between 1990 and 2015 approximately 830 women still die every day due to complications in pregnancy and childbirth. The vast majority or 99 per cent of these deaths occur in developing countries.

The WHO also says that skilled care before, during and after childbirth can save the lives of women and newborn babies.

Save the Children’s 16th annual State of the World’s Mothers report (2015) contains the Mothers’ Index; which assesses the wellbeing of mothers and children in 179 countries worldwide.

Using the latest data on women’s and children’s health, educational attainment, economic wellbeing and female political participation, the index shows which countries are the best for women to give birth and those in which they and their babies face the greatest hardships.

In the most recent Mother’s Index, produced in 2015, Norway was the top country followed by Finland (2), Iceland (3), Denmark (4) and Sweden (5).  The other countries in the top 10 were the Netherlands (6), Spain (7), Germany (8), Australia (9) and Belgium (10).

The 11 nations at the bottom of the index were Somalia; which came last (179), DR Congo (178), The Central African Republic (177), Mali (176), Niger (175), Gambia (174), the Ivory Coast (173), Chad (172) and Guinea-Bissau (171) while Haiti and Sierra Leone were joint 170th.

According to the report, “the conditions for mothers and their children in the 11 bottom ranked countries are devastating”. On average in these countries, one woman in 30 dies from pregnancy-related causes, one child in eight dies before his or her fifth birthday, approximately seven out of 10 women are likely to suffer the loss of a child in their lifetime and children can expect to receive just eight years of formal education.

The index ranked Ireland 22 out of 179 countries; just above our nearest neighbour, the UK, which came in at number 24.

The Save the Children State of the World’s Mother’s Report ranked Norway as the top country and it was closely followed by a number of its Nordic neighbours. Scandinavian countries have consistently held the top spots in the Mother’s Index; Finland was the top country in 2014 followed by Norway, Sweden, Iceland, the Netherlands and Denmark.

Dr Marte Cameron studied medicine in the RCSI in Dublin and is currently working as an oncologist in Norway. A number of years ago, Dr Cameron and her husband were living in the US, however Norway’s reputation as a family-friendly country was one of the main reasons they made the decision to move there to have their family.

Their three children were born in 2005, 2007 and 2009 and Dr Cameron, who is originally from Norway, says the decision to move home was the right one given her hugely positive experience of becoming a mother in Norway.

“It was part of the reason that we timed it like we did to come to Norway because we were living in the States and we thought well just hearing and seeing what goes on for a physician in America versus a physician in Norway, trying to be a mom and a doctor at the same time, that was the reason we came here. . . I knew that it was much easier to combine the two. If we were in the States we would have needed to have an au pair and long working hours while here it is a lot more flexible and family friendly,” she says.

Dr Cameron explains that all maternity care in Norway is public and there is a big emphasis on preventative care. All three of her deliveries went smoothly and the culture in Norway means breastfeeding is almost a way of life.

One of the biggest differences Dr Cameron says she sees in Norway is the generous maternity benefit. Mothers can chose to take 12 months of maternity leave at 80 per cent of their pay or 10 months at full pay. The mother must take the two weeks prior to the birth off work and the father must take the first two weeks post-birth, after that the leave can be shared any way the couple decides.

For her first two children, Dr Cameron took 10 months off and then on her third she took 12 months shared with her husband, so in essence they both had six months off. This leave can be divided up between the parents in whatever way best suits their needs. Dr Cameron took 50 per cent of the maternity leave (six months) in the first year allowing her time to work on a research project and her husband took his 50 per cent (six months) in the second year.

When Dr Cameron was on maternity leave it was up to the mother how she wanted to divide out the leave, however a recent change means that the mother must now give a certain number of months of the leave to the father, which Dr Cameron said was very welcome.

“The men have to be home with their infants, which I think is great for the dads, for the infants and for job opportunities for women. Suddenly all these young males are just as absent from the workplace as we are which makes it a lot easier,” she says.

For Dr Cameron it was no surprise to hear that Norway was one of the best countries in the world to have a baby.  “I don’t know how it can be any better,” she smiles.

Welcome your little prince or tiny princess in style

The Lindo Wing of St Mary’s Hospital in London is a private obstetric facility truly fit for royalty. This was where the Duchess of Cambridge gave birth to both Prince George in July 2012 and his little sister Princess Charlotte was also born there three years later.

First established in 1937, more than 800 babies are born in the Lindo Wing each year. The facility was fully refurbished in 2012 and expectant mothers can chose from a range of superior or deluxe rooms and for those who need a little extra room there are also entire suites on offer.

The basic package cost for the first 24 hours of a normal delivery is £5,215 (€6,107.35) with additional nights costing £945 (€1,106) per night.

The Lindo Wing provides satellite TV with major international channels, a radio, bedside phone and fridge. Free wifi is also available, and a choice of daily newspapers every morning is also provided.

While most new mothers in Ireland toast their new arrival with, well, toast and tea (it is however the best tea and toast you will ever have), new parents in the Lindo Wing can opt for afternoon tea, which according to the facility’s website is “a welcome treat to celebrate your new arrival”.

Before it closed as a maternity hospital in 2014 Mount Carmel was a private maternity hospital in South Co Dublin that had a reputation as being one of the most luxurious places in Ireland to have a baby.

Journalist and broadcaster Barbara Scully, who gave birth to her three daughters in Mount Carmel in 1987, 1998 and 2000, jokes that she would still be there today if they hadn’t asked he to leave.

One of the things Scully liked about Mount Carmel was its size – being a smaller hospital she felt had many benefits. “One of the things I liked about Mt Carmel was it was a small hospital with nice grounds around it that you could wander around and it was extremely comfortable,” she says.

“The first time I was there in 1987, I was in a semi-private room. There were four of us in the room so there was lots of space – it was comfortable. On the second two, I was lucky enough that I had a private room I couldn’t fault it at all,” she adds.

According to Scully, the hospital was very much focused on the mother and ensuring that she got her rest and was well looked after. She recalls one of the more unusual traditions of the maternity hospital was encouraging the new parents to go out for dinner together on the last night of the mother’s stay, leaving the new baby in the expert care of the nursery staff. While Scully never took up this offer, she says that a lot of women and their partners did.

“So you got up and you got dressed and you went out. You had a meal with your husband and then you came back to the hospital into bed and that was meant to be your first and possibly last night out for a while. They were very conscious of making sure you were well looked after.

“You felt very cossetted in Mount Carmel and the staff were fabulous. You did all the things, giving your baby the first bath and any questions you had or any kind of things you were nervous about you kind of crossed most of those hurdles by the time you left the hospital,” Scully says.

All new mothers should feel cossetted and their new babies deserve the very best of care. No matter where or how you give birth, the very best place for your new baby is right there in its mother’s arms.

Irish Times Abroad would like to hear from Irish parents who have had their babies overseas about the facilities and care available to mothers where they live, and their personal experiences. What options were available to you? Did you have to pay, or was it free? What could Ireland learn from the maternity services where you live? If you have given birth in Ireland and abroad, how did the experiences compare?

[ abroad@irishtimes.com ]