In March 2014, the HSE released birth statistics for 2012 on our public maternity units under the Freedom of Information Act, which included information on Caesarean section deliveries, instrumental deliveries, the percentage of episiotomies performed, and the percentage of vaginal birth after Caesarean deliveries. The figures were also broken down into first time mothers and mothers who had had a previous birth (multiparous). Breastfeeding rates on discharge from hospital were also included.
Does Your Estimated Due Date Fall Over the Holiday Season?
If so, you may have a chat about induction sooner than you think!
Did You Know….holiday periods are linked to an increase of elective induction of labour?
Choosing a Holiday Induction – Is it Right for You & Your Baby?
What is an episiotomy?
An episiotomy is the surgical procedure that enlarges the opening of the vagina through the cutting of the perineum, the skin and the muscles between the vulva and the anus. Continue reading
Our 42 weeks campaign is now reaching its gestational midpoint and as with any pregnancy it’s time to consider ultrasound scans. Some women will have been offered or may have requested earlier scans to either date the pregnancy or to investigate the chances of Down syndrome, but for most pregnant women the developmental or anomaly ultrasound scan at between 18 and 22 weeks is seen as the main scan.
For some women in Ireland this will be the only scan they have. For many public patients living outside Dublin they will not be offered this scan routinely, but may be able to avail of it by paying for it privately. It is unequal and unfair and we hope that in time this will change so that all pregnant people will have routine access should they choose to.
We’re going to take a look at ultrasound scans over three parts that will examine why mothers are offered scans, what the benefit of scans are, the safety of scans and what the implications of scans are for the rest of their pregnancy and labour. In this first part, we’ll talk about how an ultrasound scan can help you and your baby. The second part will cover the types of scans available and finally, we’ll look at questions to consider when it comes to ultrasound scans. Continue reading
“The only thing as consistent as birth pain has been the search to eradicate it, pharmaceutically” – Tina Cassidy, Birth: The Surprising History of How We Are Born
Pain medications in childbirth have been sought for millennia. Egyptians used opium, the Greeks chewed willow bark and, on a mythical level, Artemis asked Zeus if she could remain an eternal virgin just so that there would be no chance of experiencing the pain of childbirth! Later in history (around the 1850‘s) ether and chloroform became popular medications in childbirth, until it was proven that these anesthetics were transferred to the newborn during labour and delivery. From 1914 to the late 1960‘s, the new fad in pain relief in childbirth was ‘twilight sleep’, or scopolamine & morphine, whereby a woman was rendered completely immobile and/or semi-conscious in labour and childbirth. This method became unfavourable in the 1960’s and 70’s when women began to question their lack of agency in labour and childbirth. There were also dangerous side-effects to scopolamine (mainly hemorrhaging and transference of medication to the newborn), hence it became an unpopular method of pain relief and its phasing out made way for the most common and effective pain relief in labour and childbirth that is still used today – the epidural. (Cassidy, 2006) Continue reading
Lots of people (all of whom have never had a home birth or attended one) are very fond of telling the world that women are not “allowed” have their first baby at home. Has someone said this to you? I am sure that many people said it to me before I ever got pregnant, and some still quote it now.
Reasons people give are usually fairly random but often centre on some kind of notion that a woman’s body is akin to an untested, untried machine. The same people are usually eager to concede that once a woman s body has been “tested” in a pregnancy and birth and performed (one presumes) to appropriate standards, its fine to have a homebirth on baby two. Continue reading
I’ll just say that again in case you didn’t read the title properly or you thought it was a misprint! Home birth is as safe as hospital birth. In fact some studies have shown home birth to actually be safer than hospital birth.
Of course there are caveats, and here are some of them. Firstly, you need to be identified as a low risk mother. This means when you are assessed you do not have any on-going health complications, you do not have any unusual gynecological problems and that your baby is also well (and a singleton). Second, you need to receive professional care from a midwife during you pregnancy, labour, birth and afterwards. Thirdly, you need to have access to a maternity unit should your risk status change during your pregnancy or labour. Continue reading
What is a VBAC?
A VBAC is when a woman gives birth vaginally after a previous Caesarean Section. Sometimes, you will see a number following VBAC – this indicates that a woman has had more than one previous Caesarean Section. For example VBAC2 means a vaginal birth following two previous Caesarean Section.
With supportive and appropriate care, at least 70% of women who choose VBAC, will give birth without complications vaginally. Your maternity unit and individual health care providers should reflect this in their VBAC rates.
Why Choose VBAC?
There are many reasons why a woman may decide to choose a VBAC.
Some of these include:
* difficult or long recovery from surgery
* extended hospital stay
* complications with scar
* worry about recovery from surgery with small children
* disappointment following Caesarean Section
* desire to have control
* not wanting to be separated from your baby immediately following birth
* health concerns for your or your baby
Is vaginal birth following a Caesarean safe?
Uterine rupture is the main concern given to women choosing vaginal birth following a previous Caesarean Section. A uterine rupture is a tear in the wall of the uterus. Uterine rupture is usually associated with women with a previous Caesarean Section, however, this is not always the case. Sometimes, uterine rupture can occur with women with no previous Caesarean history. Vaginal birth, particularly when interventions are used to manage your labour or birth, can also increase your likelihood of other complications such as vaginal pain from stitches or episiotomy, assisted delivery, incontinence.
You are more likely to have a uterine rupture if your previous Caesarean was done with a vertical incision, rather than a low transverse incision.
The rate of uterine rupture in Ireland is low. The rate is 2 per 1000 women overall, or 1 per 1000 for women in spontaneous labour who did not receive oxytocin augmentation (Turner et al, 2006).
VBAC2 – Evidence for VBAC2 has shown that women choosing VBAC vs VBAC2 have similar rates of uncomplicated vaginal birth. The rate of major complications is slightly higher if you have had more than one previous Caesarean Section. However, while the risk of major complications is higher for women with 2 previous Caesarean Sections, when compared to the risks for elective Caesarean Section, the absolute risks of major complications are quite low. (AJOG)
VBAC3+ – There is very little evidence on vaginal birth following 3 or more Caesarean Sections. For women considering VBAC3 or more, your medical professionals need to provide you with information to make an informed decision on VBAC vs repeat Caesarean. This evidence must prove that VBAC3+ is unsafe – more unsafe than a repeat Caesarean.
Repeat Caesareans – Repeat Caesareans have many benefits but are not risk free. In fact, evidence shows us that risks to mothers and babies increase with each Caesarean Section. These risks can affect your current or subsequent pregnancies.
* increased risk of ectopic pregnancy in future pregnancies
* increased risk of placenta previa (when the placenta covers the cervix)
* increased risk of placental abruption (when the placenta comes away from the uterus before the baby is born)
* increased risk of placenta accrete (the placenta grows into or through the wall of the uterus)
* increases likelihood of problems for women – haemorrhage, blood clots, infection, scar pain
* increases time of hospital stay and the instances of re-admission
* longer recovery period
* increases the likelihood of problems for babies – admission to NICU, breathing problems, cuts from incision
What are VBAC guidelines in Ireland?
The Irish Guidelines “Delivery after previous caesarean section” (issued Oct 2011) are available on the HSE website.
You can read them in full here – #5: http://www.hse.ie/eng/about/Who/clinical/natclinprog/obsandgynaeprogramme/obsgyneguide.html
AIMS Ireland is in regular contact with women who choose VBAC2+ in Ireland who are not supported by care providers, even before individual assessment is considered. These guidelines are national guidelines for obstetric practice in Ireland. These guidelines are meant to provide guidance to the local policy of units in Ireland. VBAC2 is included into these guidelines as a care option in Ireland; though in a very restricted capacity.
Recommendations in The National Guideline provides a starting point for women choosing VBAC(2+) to open communication with care providers to aide informed decision making. Recommendations are not compulsory. Your care provider can advice you on any of the practices listed below, but its your decision on the day.
Main Points of recommendations include:
* incision site is low transverse and not vertical
* electronic fetal monitoring during labour
* where loss of contact with abdominal belt during monitoring, foetal scalp monitoring is recommended
* if electronic foetal monitoring shows abnormal results, foetal blood sampling is recommended
* oxytocin may be used if your labour is not progressing as required
* induction of labour is possible following 1 previous caesarean, however should only be based on medical need to mother or baby
VBAC2+ to be supported where:
* head is engaged
* cervix is favourable
* history of prior vaginal birth
* spontaneous labour
Continuous Monitoring in VBAC in Ireland
Continuous electronic foetal monitoring features heavily in the VBAC guidelines for Ireland.
Continuous foetal monitoring measures your baby’s heartbeat in frequency and strength and measures your contractions. Continuous monitoring can be either A) external – by a belt (CTG) which goes around your tummy or B) internal – a monitor which is attached to your baby through the top layer of your baby’s scalp.
The reason for continuous monitoring is that it will show if your baby’s oxygen levels are low or your baby is not tolerating labour well and to prevent cerebral palsy, brain damage, newborn seizures, or death or may prevent a uterine rupture.
However, the evidence shows us:
* CTG has been shown to be less accurate than internal foetal scalp monitoring.
* CTG has been shown to increase your chances of interventions, including Caesarean Section and assisted delivery
* there is no difference between intermittent monitoring and continuous monitoring for “perinatal mortality, cerebral palsy, Apgar scores, cord blood gasses, admission to the neonatal intensive care unit, or low-oxygen brain damage” Cochrane Review 2006
* there was less instance of newborn seizures when continuous monitoring was used
* intermittent monitoring has more benefits with no additional risks in low and high risk women
What women tell us:
* Electronic monitoring makes it difficult to move in labour.
* CTG very uncomfortable
* CTG makes contractions more difficult
* CTG makes women feel tied to the bed
June 2012, the HSE launched a guideline “Intrapartum Fetal Heart Rate Monitoring (issued June 2012)” – recommending no admissions trace and intermittent monitoring in labour for low risk mothers.
Read more on the evidence for intermittent vs continuous monitoring for low and high risk women here:
Evidence Based Birth http://evidencebasedbirth.com/evidence-based-fetal-monitoring/
For more information or to access AIMS Ireland support services please contact us at firstname.lastname@example.org or email@example.com
Period late? Feeling tired? Sore breasts? Over emotional? These are all signs of pregnancy. Most mothers choose to further confirm such physical symptoms with a pregnancy test. Once you have a positive pregnancy test then a world of choice presents itself! Where will I have my baby? Who will look after me? How will I find out how to give birth? Should I breastfeed? For the first time mother the choices seem overwhelming and endless, and what makes it all the more confusing is that everyone seems to have a different opinion on what you should do! Continue reading
Did you know: a healthy full-term pregnancy is measured between 37 – 42 weeks?
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. Continue reading