Your experience of labour and birth should be just that — yours. Every birth is unique as each woman will approach childbirth in her own way. It is important that you have the information you need to decide what is right for you and your baby, and that your experience of labour and birth reflects these wants and wishes. Knowing all your care options and your rights, asking questions and, ultimately, finding a supportive care team, you can combine the ingredients for a healthy and a positive birth experience.
The following tips may help:
1) Take time to understand your options and choose where you are going to give birth.
It is important that you choose the type of care that is right for you and your needs as it will help shape your birth experience and transition to parenthood. Explore all possibilities and discuss them with your midwife, GP or consultant. That said, the range of care options open to you largely depends on where you live. Consultant led care in large regional maternity hospitals is the norm throughout Ireland, though midwifery-led care options are becoming available in some areas.
An option for all women living in Ireland, free under the Maternity and Infant Care Scheme, is combined care split between your GP and your hospital. Virtually all GPs participate in the scheme and are paid directly by the HSE for a set number of antenatal and postnatal visits; this includes your first visit to confirm your pregnancy. This combined care, also called “shared care”, is an option for women availing of public, semi-private or private care, and for women planning a home birth.
To find a GP
• Contact your local HSE community care office for a list of GPs who take medical cards.
• Go to the Irish College of General Practitioners website where you can search for ICGP members in your area.
• Ask friends, family and neighbours for recommendations.
Opting for a planned home birth means your lead carer will be a self-employed community midwife (SECM), who may be part of a team or may work independently. These midwives are fully trained to manage your antenatal, labour and postnatal care, as well as to care for your newborn baby. You will see your own experienced midwife at each antenatal visit, usually in your home. They attend the birth of your baby in your home and visit you daily for between a week and fourteen days after the birth. Please note that if your midwife becomes unable to attend the birth and alternate arrangements with another midwife cannot be made, transfer to hospital care may become necessary. Women who are deemed “low risk” according to a set of criteria set by the HSE are eligible for a home birth. Your midwife will assess you individually to see if you are suitable for a home birth. If you become “high risk” at any time during the pregnancy, the labour or after your baby is born, you will be referred to consultant-led care where appropriate. The HSE pays the midwife a set fee for home birth services. If a midwife has additional charges the mother must pay these herself. All private health insurers cover home birth costs. Please note there are a small number of independent midwives working in Ireland, so booking early in pregnancy may be necessary.
For more information on home birth in Ireland and to find a a listing of practising independent midwives, contact the Home Birth Association.
Currently in Ireland, the large majority of hospital-based care is under the direction of consultant obstetricians, regardless of whether your pregnancy is low or high risk.
Every woman is entitled to free maternity care. This is irrespective of whether or not you have a medical card, private health insurance or are a member of a healthcare cash plan. Public care includes all antenatal care, care during labour and childbirth, and postnatal care. It covers all hospital accommodation costs for you and your baby. Continuity of carer (seeing the same doctor/midwife at each visit) is not guaranteed in the public antenatal clinic. The hospital midwives will care for you during labour and birth and, in most cases, you may not need to see a doctor at all. If you require an assisted birth or Caesarean section, the doctor on duty will attend you. You may not have met any of these midwives or doctors before going into labour. After your baby’s birth you will stay in a public ward sharing with other mothers.
Midwives’ Clinics for Antenatal Care
Midwife-managed antenatal clinics, available under public care, are staffed by experienced midwives and are an option for women with normal, low-risk pregnancies, as assessed by the consultant. The antenatal clinics offer continuity of carer where possible.
Early Transfer Home
This is where you receive individualised care at home from a hospital midwife in the first week after having your baby. Under this scheme, if you have a normal birth and feel well, you leave the hospital between eight and twenty-four hours after the birth. You will be offered a full assessment in the hospital to make sure that you and your baby are ready to go home. One of a small team of hospital midwives will visit you in your home everyday for between five and eight days, depending on the hospital.
Private Care (consultant only) and Semi-Private Care (consultant-led)
If you have private antenatal care, you will see your consultant at each antenatal visit either in the hospital or in the consultant’s private rooms. The private option means that you see the same doctor at each visit, and while he/she is usually present for the birth of your baby, there can be no guarantee. If your consultant cannot be there, he/she will either make alternate arrangements with a consultant colleague or the midwives/doctor on duty will provide your care. After the birth, you will usually stay in a private room but this depends on availability. Some hospitals offer semi-private care, which is a
combination of private and public care. As each hospital delivers this care differently, check with your maternity unit for details if you are interested in this option.
To find a private consultant obstetrician:
• Request a list from your maternity unit.
• Ask your GP for a list.
Midwife-Led Care for a Healthy Pregnancy and Birth.
The midwife is the expert in normal birth with extensive professional training and specialist skills. The World Health Organisation recognises the midwife as the most appropriate caregiver for women with healthy, normal pregnancies and births (WHO 1997). Obstetricians have special training in high-risk pregnancy and surgery and are therefore appropriate caregivers for women with established serious medical conditions or who are at high risk for developing such conditions.
The WHO says that at least 85% of pregnancies are low risk. With appropriate care, 70 – 80% of all pregnant women will have an uncomplicated labour.
What Is Midwife-Led Care?
The Royal College of Obstetricians and Gynaecologists defines midwife-led care as where “the midwife is the lead professional in the planning, organisation and delivery of care given to a woman from initial booking to the postnatal period” (RCOG, 2001). Currently in the Republic of Ireland midwife-led care is available at two midwife-led units (MLUs), in home birth with a self employed community midwife (SECM) and through some community midwifery schemes.
What Are the Benefits? The Evidence
A review of relevant scientific research found that midwife-led care offers the greatest benefits to pregnant women and their babies and recommends that this care be offered to most women. (Hatem et al., Midwife-led versus other models of care for childbearing women, Cochrane Database of Systematic Reviews, 2008) A recently published study of Ireland’s two MLUs at Cavan General Hospital and Our Lady of Lourdes Drogheda by Trinity College Dublin praises the midwife-led care practiced in these units, finding it as safe as consultant-led care and with lower intervention rates and higher satisfaction among women. Plus, the study found the MLUs to be more cost-effective. The authors recommend that MLUs be established throughout Ireland. (Report of the MidU Study, HSE, 2009)
Community & Domino Midwives Schemes
Domino/Community Midwives Schemes are free hospital-based services where a small team of midwives offer full antenatal, birth and postnatal care to women with pregnancies deemed “low risk for complications”. Antenatal visits are made either to the Community Midwives’ Clinic at the maternity hospital or at local health centres, and some may be made to the woman’s home. Depending on the scheme, the woman may have the choice to give birth in hospital or at home cared for by the midwives. If she chooses to birth in the hospital, she has the option of Early Transfer Home. The schemes are free but may be confined to specific catchment areas. (DOMINO stands for DOMiciliary IN and Out. Domiciliary means taking place in the home.)
This option is not currently available to women in the West of Ireland. Until 2003 a successful Domino/Home Birth Scheme operated out of University Hospital Galway but was suspended at the end of 2003. The existing Community & Domino Midwives Schemes are in Dublin (NMH and Rotunda), Waterford Regional Hospital and Wexford General Hospital.
Midwife-Led Units (MLUs)
A midwife-led unit offers women with low-risk pregnancies who are likely to have a normal delivery the opportunity to birth in a home-like environment with a team of experienced midwives they have come to know during their pregnancy. Mothers can give birth in a uniquely designed birth room where they can avail of facilities such as music, a water pool, supportive aids (gym ball, bean bags etc.) and Entonox (gas and air) if required. The two MLUs in Ireland (Cavan and Drogheda) offer public care in integrated units attached to centralised hospitals. There are currently no freestanding MLUs or birth centres in Ireland.
This option is not currently available to women in the majority of Ireland.
If the service you wish to have is not available locally, let your care providers and representatives know!
* Contact the Director of Midwifery and/or Hospital
Manager at your local hospital
* Contact the HSE through Your Service Your Say
* Write to your local politician
* Contact the Office of the Ombudsman
* Join AIMS Ireland in campaigning for more choice
in maternity care: http://www.aimsireland.com or email
Having read through the options, ask yourself: What is important to me in my maternity care? We all have different needs and it is important to find a care provider who will best support you in your birth.
Ask around. Talk to other women with similar needs about their experiences in your area before choosing. Ask for experiences and opinions of doctors, SECMs and midwives. Women talk! If a lot of women seem to have similar experiences (positive or negative) with a particular consultant, midwife or hospital, you might reconsider your options. Finding a supportive care provider is key!
TIP: Choosing Public Consultant led Care? If you have a preference, you may specify to your GP the consultant team you would prefer to be under (or avoid) when confirming your pregnancy.
Not Sure? Check out Cuidiu’s Birth Statistics to compare policy and statistics between individual units in Ireland. http://www.bump2babe.ie/
2) Surround yourself with positive birth stories and images.
We are bombarded by the tv, movies, soaps, newspapers, all trying to out-do themselves to show birth as dramatic and dangerous. And sometimes, even our loved ones unknowingly pass on negative ‘horror’ stories without realising the effects it can have. Horror stories serve no purpose to you in pregnancy. It is one person’s experience. They will not make you more informed. But they will make you more nervous or fearful. Stress and fear have negative effects on your emotional health, you pregnancy, labour, and even your baby. Try to surround yourself with positive birth stories and images during your pregnancy.
TIP: Check out the Positive Irish Birth Stories on the 42 weeks website!
3) Create a strong support network
Similar to #2 – try to surround yourself with women with similar birth choices to support one another, bounce ideas off, rant to! Sometimes, especially if this is a first baby, women can feel alone, unsure, or overwhelmed in pregnancy. A strong support network with like-minded women can be extremely reassuring. Women supporting other women is invaluable.
TIP: Social media can be an effective way for women in similar circumstances to connect. There are closed groups on Facebook for a wide variety of care options in pregnancy; from homebirth to VBAC. Join pregnancy activity classes, antenatal classes, attend breastfeeding groups in pregnancy to help network with other women in your area.
4) Be informed
Being informed will help prepare you for birth and help you make decisions on what is important to you in labour. It can also help you make important decisions should changes arise in your labour. Your care providers should present you with information but many women also like to read up on options at home first. It is important that information is from a reliable source and based on evidence. You might consider writing a list of questions for your care providers or write out a birth preferences page (birth plan). Writing your preferences can be a great way to open communication between you and your care provider.
Making informed decisions means that you have been presented with all the information available at that time to assist you in making a decision. You should be given the benefits, risks, implications and future consequences of the action. You should be made aware of all the possible information available before consenting or refusing the action. All information should be presented to you impartially, without bias or persuasion. Informed decisions are an essential part of every woman’s maternity care and you should be given the opportunity to make informed decisions before any test, treatment or procedure.
Whether discussing issues or concerns with your caregiver, making a care plan for labour or deciding whether to have a procedure carried out on your newborn, it can be helpful to use the following:
Use your BRAIN
B – what are the benefits?
R – what are the risks?
A – what are my alternatives?
I – what is my intuition telling me?
N – what if we do nothing and just wait a while?
TIP! Check out the AIMS Ireland “Informed Decision Making” and “Birthplans” Factsheets.
Looking for evidence? Evidence Based Birth website can help! Evidence Based Birth is run by a researcher, Rebecca L. Dekker, PhD, RN, APRN, who looks at all the research available and writes about it for women to assist with decision making. “The mission of Evidence Based Birth is to promote evidence-based practice during childbirth by providing research evidence directly to women and families.”
5) You Matter
Look after your body and your mind. Poor nutrition, poor posture, and stress can take its toll on a pregnant woman. Make sure you take plenty of healthy food, exercise, and get plenty of sleep. Stress has been shown to have a negative impact on pregnant women and babies react poorly to stress in the womb. While stress may not be something you can avoid, it is important to have a way to release stress. Going for a walk, ringing a mate, having a warm bath, yoga, reading, reflexology, art, blogging, relaxation courses for pregnancy such as Hypnobirthing/Gentlebirth are all great ways to take some time for yourself and find calm!
TIP! Try to find ways to celebrate and enjoy your pregnancy. Be kind to yourself! Treat yourself! You will feel more positive coming into labour if you are well rested, feel prepared, and are looking forward to the experience. Fear and stress can have a negative impact on your labour and your emotions. If you are feeling fearful, anxious, stressed about labour or in general, try to address these issues in pregnancy. There are many options and places of support which can help. Contact us at email@example.com and we can help you with a list of options which you may find helpful.
6) If it’s not a good fit, make a change.
Unless you are having a homebirth with a Self Employed Community Midwife, the majority of women will not meet their main health care provider until they are booked into labour. As in all workplaces, there are good health care professionals and bad health care professionals. There can also be personality clashes. If you feel that your health care professional is not a good fit, request a new one! A supportive care provider is an essential part of a positive and healthy birth experience. Birth is not the time to ‘make do’ with something or someone you are not happy with.
TIP! You can change maternity units at any point in your pregnancy. You may book into the MLU (Midwife Led Units) up until 20 weeks but must be referred by a Consultant.
7) You are an individual with individual needs. And your needs matter.
Only you know what is important to you for the birth of your baby. You are the expert of you. You are the expert of your body. You are the expert of your baby. You know how you are feeling or how you are coping.
TIP! If something doesn’t feel ‘right’, don’t ignore it. Please remember that any concern you have is worth raising.
8) Understand your rights.
From the AIMS Ireland Healthy Birth Directory for the West of Ireland
• You have the right to be treated with respect and dignity by your healthcare provider.
• You have the right to receive care provision free of discrimination based on race, membership of the traveller community, gender, marital status, family status, sexual orientation, religion, age or disability.
• You have a right to free maternity care, irrespective of whether or not you have a medical card or private health insurance. This entitlement includes antenatal care, care during labour and childbirth, hospital accommodation and postnatal care.
• You have the right to appropriate medical, surgical and midwifery services free of charge.
• You have the right to choose, or change, your healthcare provider (GP, consultant, SECM, hospital).
• You have the right to ask for a second opinion if you are not happy with the care or advice you are getting.
• You have the right to receive complete, truthful and accurate information about your condition, about the risks and benefits of treatments and procedures proposed by your healthcare providers, in a language you can understand.
• You have the right to expect that your written records are kept in a safe place and that any discussion about your health is not overheard. As this is sometimes difficult in hospital ward environments, you can ask for a private space.
• You have the right to expect that information regarding your treatment is confidential. Information will not be given to anyone, except those involved in your treatment and your own GP, without your permission. Healthcare professionals involved in your care can share information with other healthcare professionals involved in the care and treatment, on a need-to-know basis, unless you expressly refuse such sharing.
• You have the right to consent to or refuse disclosure of confidential information. Being a relative by blood or marriage does not confer an entitlement to access information about your condition.
• You have the right to be involved in making decisions about your care and to understand what you are being told about your care and treatment.
• You have the right to receive the information you need to give informed consent or refusal for any proposed medical test, procedure or treatment. Your healthcare provider must give you information on what the proposed treatment or medical procedure broadly involves, the risks associated and alternative forms of treatment.
• Your consent, except in exceptional circumstances, must be obtained in advance of lawful medical treatment.
Consent: 1. Must be given (or withheld) voluntarily. 2. Must be given (or withheld) by an individual who has the legal capacity, in terms of age and mental competence. 3. Any decision relating to the giving or withholding of consent should be based on sufficient relevant information.
• You have the right to access a copy of your medical records, including your birth notes, if you are a patient in the public system (attending a publicly funded hospital and/or a medical card holder for GP services).
• You have the right to make a formal complaint if you are unhappy about any aspect of your maternity care. This is the main way in which you can ensure that the negative experience you had will be acknowledged and hopefully, will not happen to someone else. The most straightforward way to make a complaint is to contact the healthcare provider/hospital directly and ask for a copy of their complaints policy and procedure and follow that. Alternatively you can write a letter to the General Manager of your maternity hospital, the Director of Midwifery (DoM), Patient Services Manager or a Complaints Officer.
• You have the right to complain to the Medical Council, An Bord Altranais (Irish Nursing Board) and/or the Ombudsman’s Office, which can be in addition to making a complaint directly to your provider/hospital.
For more information on your rights, contact AIMS Ireland at firstname.lastname@example.org
9) Choose A Supportive Birth Partner
The role of a birth partner is to give you practical, emotional, and sometimes physical support throughout pregnancy and during childbirth. The birth partner should be an active participant in pregnancy, attending appointments, antenatal classes, scans. The Birth Partner needs to be supportive of your choices for childbirth and help you in finding coping tools during labour. Childbirth can be a very emotive and vulnerable time and your birth partner plays an important role.
Your birth partner should be the person you feel will provide you with the best support without trying to influence your decisions in labour. Birth Partners can be the baby’s father, your partner, a sister, your mother, a friend, or a combination of people. Sometimes, a doula is hired to provide support.
A doula’s primary role is to the pregnant woman. Their sole focus is on the emotional well-being of the woman in labour. Unlike a midwife who may be assigned several labouring women and whose focus in on physiological/medical birth issues, the doula’s primary focus is on one woman and is undivided emotional support. This support is reflected in the doula ideology and doula promises.
Research has shown that due to the individual emotional support provided, women labouring with a doula may prosper from a range of benefits. Recently, in the USA, doulas have been sited as a positive obstetric technique for mother and carers.
Evidenced-based benefits – Research has shown:
• women using a doula have a 50% reduction rate in Caesarean section
•women using a doula have a 40% reduction in the rate of forceps deliveries
•women using a doula have a 60% reduction in request for the epidural
•women who used a doula had a decrease in labour length by 25%*
*(Klaus, Kennell and Klaus, Mothering the Mother, 1993)
TIP! Some Irish units operate a 1 birthing partner or alternating partner policy. This means in some units you cannot have the baby’s father AND an additional birth partner or doula with you, OR, you may have to swap in and out between the two. Ask your unit what their policy is or contact Doula Ireland or The Doula Association of Ireland for more information.
Most pregnancies go to full term, which means that a woman will go into spontaneous labour some time between the 37 and 42 week mark. Our campaign is called 42 weeks to reflect that the vast majority of babies will arrive when they are ready – not on an estimated due date (EDD) but some time during this 5 week window – up to and including 42 weeks gestation.
Term Pregnancy: 37 – 42 weeks
Postdates Pregnancy: A pregnancy any time after the estimated due date (EDD)
Prolonged Pregnancy: 42+ weeks of pregnancy
Most of the time, labour will begin on its own by the time you are 42 weeks pregnant. Women are offered to have their labour artificially started (induced) once they go over 42 weeks, as the evidence has shown that after 42 weeks there can be a slight increased risk to your baby.
Induction may be suggested before 42 weeks if there is a medical reason for you or your baby. These reasons may include: by request from you, on suggestion of your health care provider when there is no medical reason, or due to hospital policy.
Inducion is a big decision that can effect you and your baby. It is a decision only you can make. Its important to weigh the risks and benefits in order to make the best decision for you and your baby in your circumstances.
Tools to help you make a decison.
Asking simple questions can help you make a decision.
Is my baby OK?
Am I OK?
What other suggestions do you have?
Another helpful tool is to “use your brain”.
B – what are the Benefits involved?
R – what are the Risks involved?
A– what are the Alternatives?
I – what does my Intuition tell me?
N – what would happen if we do Nothing?
Using the Evidence to help you make a decision.
The National Institute for Health and Care Excellence (NICE) in the UK recommends that induction of labour has a large impact on the health of women and their babies, and so needs to be clearly clinically justified. If you are considering an induction of labour or have been offered an induction of labour without medical necessity, it is worth looking at the risks.
Induction of Labour:
* higher rates of Caesarean Section
* increased risk of your baby being admitted to NICU (neonatal intensive care unit)
* increased risk of forceps or vacuum (assisted delivery)
* contractions may be stronger than a spontaneous labour
* your labour is no longer considered ‘low risk’ – less choices in where and how you birth, restricted birth positions, continuous monitoring CTG, time limits for which to labour in.
If induction has ben offered to you for post-dates or prolonged pregnancy, and you decline, you should be offered increased monitoring to check your baby’s health.
You may be offered a membrane sweep to induce labour. A sweep is a vaginal exam in which a health care professional will sweep their finger between the cervix and bag of waters surrounding your baby. Sweeps may or may not induce labour. Evidence shows us that sweeps are more likely to work if your cervix is favourable for labour already. Sweeps can bring on a bloody show, irregular contractions, and can accidently break your waters.
“Frequency of membrane sweeping does not influence the likelihood of remaining undelivered at 41 weeks of pregnancy”
Royal College of Midwives: How to Perform a Stretch and Sweep
For more information, contact AIMS Ireland support services: email@example.com
This article contains information from the AIMS Ireland Publication: Healthy Birth Directory for the West of Ireland.The Healthy Birth Directory is an independent resource with information on care options and rights, evidence-based articles, links to MotherBaby-Friendly providers, and listings of state and independent services. More information and a full downloadable version is available on http://www.aimsireland.com