Hospital policies on visitors and birthing partners are causing additional anxiety for parents. Hélène Hofmanreports on why the hospitals are clamping down on individual requests
Last month, the Rotunda Hospital in Dublin updated its policy on visitors and birthing partners, prompting a number of women to raise concerns that the range of birth choices available to them is diminishing. In a petition circulated around the State, they are calling for water births and homeopathy to be allowed, and want the one birth partner policy in place in most delivery wards lifted to allow for doulas (labour assistants) or additional partners.
"There is no denying that we have a very medicalised system in Ireland," says Georgina Farren, who has worked in a number of maternity units around the State and is now practice development co-ordinator at the Rotunda Hospital.
"Water births are very rarely available. There are birthing pools in Drogheda and Cavan and we're currently building one in the Rotunda but these are used only to relieve pain during labour rather than birth," she explains.
Water births have been suspended in Ireland since February 2006 after a baby who was born in a water pool at Cavan General Hospital was transferred to a Dublin hospital when complications arose and later died.
Although a subsequent internal review by the HSE Dublin North-East found that the death had nothing to do with the care given during pregnancy and labour, water births have been suspended as a precautionary measure until an external review is completed. Currently, women who want a water birth must opt for a home birth.
Similarly, the one birthing partner rule in place in most hospitals means that although demand for doulas has been growing in Ireland over the past two years, most hospitals, particularly in Dublin, cannot accommodate them. Our Lady of Lourdes Hospital in Drogheda, Co Louth is among the hospitals that does make provision for doulas and allows a maximum of two birthing partners to be present.
The Doula Association of Ireland defines doulas as "labour support professionals who provide physical, emotional and informational support to the labouring women before, during and just after child birth".
There are about 12 doulas working in Ireland and they are hired to help with massages, reflexology, aromatherapy and different birthing positions. Doulas do not perform clinical tasks, but can act as a link between the medical staff and the mother and her birthing partner during labour.
"Going into hospital as a doula is a nightmare at the moment," says Tracy Donegan of Doula Ireland. "It's something that we experience around the country but the Rotunda is the only hospital that has publicly come out and said no to doulas.
"Under the new rules I've been told I can still interchange with the dads, but I can't be there with them in the delivery room. As a result I might end up sitting in the reception area and texting the dad. It's putting stress on the couple, when all I'm there to do is ensure that the mother gets the birth she wants," says Donegan.
Gerard and Michelle Tyrrell had decided to hire a doula for the birth of their baby in the Rotunda two weeks ago. Although they knew there might be difficulties getting her admitted, they were unaware of the new rules.
"Everything else was top notch but having a doula was top of the list on the birthing plan we gave them and we were being denied that," says Gerard. "Luckily they made an exception and eventually let her in after a lot of negotiating, but I would seriously reconsider before going through that again."
According to the Rotunda Hospital, enforcing its one birthing partner policy was necessary.
"Women have only ever been allowed one birthing partner, but in the last year or two we made the exception for doulas," says Pauline Treanor, director of midwifery and nursing at the Rotunda Hospital.
"The difficulty was that it wasn't fair to other patients, some of whom can't afford doulas, and it can be more problematic to manage. We have limited facilities for additional people. The building is old and we don't even have visiting rooms, or enough toilets or waiting rooms, so extra people had to wait in the main reception area and we were getting complaints about numbers - we just don't have the facilities at the moment," says Treanor.
"We do listen to women and do the best to provide services they want, but we have to take into consideration the building we have, and health and safety and infection control," she says.
"As for homeopathy, that has never been an option because we don't believe there is enough research that homeopathic drugs won't have an adverse effect when combined with other drugs we administer," she says.
Margaret Carroll, director of the midwifery programme at Trinity College Dublin, agrees that the birth choices available to women in Ireland are restrictive.
"The choice for women at the moment is limited to centralised hospital births and that's been a policy of the governments since the mid-70s," says Carroll.
"Women are becoming more informed and I think more women would like to take control of the birth but they need to be supported and given the information to make the right decision," she says.
"It's been shown that support has a very positive effect on birth and the women should have the person she feels is most beneficial to her present. I understand that hospitals are constrained by space and I don't know of all the issues they have to deal with. In an ideal world women would have the choice, but in reality it's not always possible in a busy labour ward," she says.
Carroll says she would like to see Domino or Home Birth schemes extended to more women. The scheme is open to low-risk women, enabling them to see a team of midwives for ante-natal care and offers the option of delivering the baby either at home or in the hospital. The service is available in Wexford, Waterford, from the National Maternity Hospital (Holles Street) in Dublin and, more recently, from the Rotunda Hospital.
"In many hospitals there is a medicalised view of birth and in this country there is a sense that things need to be done a certain way. We have very crowded hospitals with the birth rate continuing to go up and we're seeing a lot more interventions, Caesarian sections and epidurals. Interventions speed up labour - there is evidence to show that - but it doesn't necessarily improve the outcome," she says.
"I would like to see more choice for women. People think that if you have a healthy baby then you should be grateful but it's not just that.
"Women should be having a much more positive experience and they should be able to say 'labour might have been bloody hard but it was a good experience after all'," says Carroll.