With less than 50 per cent of all births recorded as normal, Caesarean sections and routine epidurals will become part of our birth culture, finds Sylvia Thompson
Childbirth in the Western world is in crisis, an international expert in birth practices has claimed.
"The ability to do normal birth [ without drugs or other interventions during labour and birth] is fast diminishing in countries such as Britain and Ireland," said Dr Denis Walsh, independent midwifery consultant and lecturer in normal birth at the University of Central Lancashire, England.
"With less than 50 per cent of all births recorded as normal, the problem is that Caesarean sections and routine epidurals will become part of our birth culture," he said.
Walsh was the keynote speaker at Normalising birth in Ireland - motivation for change, a conference in Dublin last week organised by Cuidiú - Irish Childbirth Trust.
At the conference, Walsh said no decrease in perinatal mortality was associated with rising rates of Caesarean sections in the United States, Britain and Ireland. "If obstetricians are involved, intervention rates in normal birth are higher," he said.
Walsh suggested that it was time to move away from a model of labour based on progress (ie in which increases in cervical dilation were expected at hourly intervals) to one of rhythms in which there was an expectation of individual variation in how each woman laboured.
"The approach to labour in large maternity hospitals produces an assembly line model which requires organisational imperatives [ eg admission rooms, first stage rooms, delivery suites] to remain efficient. The clock is the dominant feature of the landscape in modern maternity units," he said.
Walsh argued that such a model increased the likelihood of women in labour having drugs and other interventions to speed up labour. With such a model, the hospital was the worst place to be when a woman was coming into labour, said Walsh. "It's better for women to stay at home, attend a triage facility or a birthing centre or see a midwife when they are coming into labour," he said. He added that the World Health Organisation had also recommended a move away from the "labour progress mentality to one of labour rhythms".
In his talk, Walsh suggested that when pain in labour was regarded as normal, the woman could be offered a more supportive and empowering approach to labour and birth in general. He also said that there was not enough discussion about the adverse outcomes of epidurals such as more episiotomies, more assisted vaginal births and a more painful perineum which made it harder to breastfeed.
Attendants at the conference got a sneak preview of the forthcoming consumer guide to maternity services in Ireland which Cuidiú will publish on its website (www.cuidiu-ict.ie) shortly.
Niamh Healy, an ante-natal teacher with Cuidiú, said the aim of the guide was "to show that the choice of care-giver impacts on the type of birth a woman has".
"For instance, the spontaneous onset of labour for all births varies from 40 per cent in some hospitals to 70 per cent in others and for first-time mothers, there are lower rates in most hospitals," said Healy. "There is also a variation of between 20 per cent and 35 per cent for instrumental deliveries with the highest rate of Caesarean births reported [ 37 per cent of all births] in Mount Carmel hospital in Dublin."
Ante-natal teachers from Cuidiú said it was up to women to ask why such variations exist.
Access to birthing aids (eg birthing balls, floor mats, birth stools and chairs), practices on eating/drinking during labour and skin-to-skin contact between mother and baby and the use of alternative therapies were also compared across the 20 maternity units which responded to the questionnaire.
"A lot of women who have a Caesarean section don't have skin-to-skin contact with their newborn babies which affects rates of breastfeeding, said Claire Bulfin, ante-natal teacher and midwife in Waterford Regional Hospital.