Colette Fitzpatrick's (TV3) experience of Irish Maternity Care

Das Kitty

Hannibal Smith wrote: »

If you think this is an acceptable way for a woman to be treated, fair enough. I'm not going to be sucked into an argument about it. Consider your own experience and what you went through and then remove all small elements of privacy and dignity that you tried to cling to. That's how it's different.

I'm not trying to argue, I'm genuinely interested.

I view my experience as much the same as hers, the only difference I see is that what she was lying on was a trolley and I a bed. I was in a ward with 5 other women either in early labour or having emergency checks. My waters were broken there and I had 2 internal exams.

My only problem with what she's saying is that she's using the buzz words of trolley and corridor together in reality she seems to have had as much privacy as anyone else. There is no way a midwife would have broken her waters in an uncurtained area, and even if one did, she would not be praising them in the next paragraph.

I agree that our maternity system is not the best going, however it's not the worst by a million miles. Even though the privacy was not really there for me I found the care I got second to none from midwives and doctors alike. And for free!

I think the system in spite of its faults is a very good one. Comparing it to a puppy farm is hugely unfair.

I do think though instead of paying to go private people should put that cash into homebirthing where possible.

January

I have to agree with Das Kitty on this one, in early labour in both the Rotunda AND the Coombe I was on a bed in a room with 8 other women (Rotunda) and 4 other women (Coombe), the only thing separating us was the curtains around the bed, that was it, there were people coming and going while I was having my waters broken on both occasions but it didn't bother me.

I think back to my mothers experience 23 years ago in the Rotunda and she gave birth in the same room that I had my waters broken in with just a curtain separating her from the woman next to her giving birth! And you weren't allowed to have a partner in either!

No, it's not perfect, but I'm sure they wouldn't have broken her waters in a corridor (with a curtain around her, not like she was on show to the rest of the hospital) unless it was needed and I also think she should be very thankful too because she had meconium in her waters which could have been harmful to the baby if left for a longer period.

Jinxi

I did say "from reading on the boards" as I have no experience of it yet!
But from watching birthing shows in the UK where people have a large room to themselves to walk around and scream is they want, and by every instinct in me wanting the birth of my forst child to be a nice and private one, I still think that we are too accepting of the standard!
especially when midwife led clinics have been proven to be nicer and more cost effective!

Hannibal Smith

Lol well fair play to the woman for speaking out then. There's a huge difference between the care of the staff and hospital procedure. And when even women find stories like this as acceptable and something that shouldn't be remarked on she and otherslike her are sure fighting an uphill battle.

Cat Melodeon

I'm with Hannibal on this. Some people may be comfortable having procedures done in a curtained public area - I certainly wouldn't have been and most first time mums wouldn't be.
The hospital I attended had one labour ward with two beds in it - all the others were single patient rooms. I was in this two-bed room on a couple of occasions during my pregnancy for monitoring. My experiences when there was someone else on the other side of the curtain were very different from when I was alone. I did not feel I could speak freely to the doctors/nurses, I did not feel I could question anything or complain in case the other patient thought badly of m, I did not want to delay the staff if the other girl was waiting to speak to them.

I'm not usually backwards about these things, but pregnant women lying on a bed/trolley are vulnerable beings, so quite apart from the physical and emotional discomforts, it has to be asked if it is ethical to ask women to consent to certain procedures when they are feeling exposed like this.

In addition, the stress levels resulting from this exposure have consequences for labouring women - stress produces adrenalin, adrenalin blocks the release of natural oxytocin which is essential for relaxing the muscles and is responsible for causing contractions.

Too long;didn't read?
Being exposed and uncomfortable = fear & stress = slowing of labour = increased likelihood of interventions and injury to mum/baby.

Surely it would be more cost effective to partition a few rooms than have thousands of unnecessary interventions and unhappy mothers each year?

Das Kitty

I agree with you fully. Unfortunately it's the reality for most people at the moment, private or public. You were very fortunate to have the privacy you got Cat. I think the article is good though because when you know what to expect you can prepare yourself as much as possible rather than being taken by surprise on the day.

Personally when I was in labour I didn't give a flip, but when I was trying to breastfeed I found it very disconcerting to have someone else's visitor peering through the gap in the curtain. I told him to F off in the end!

Can I just clarify that I agree with the article that privacy levels are very low. My only issue was that there was a perception that she was out in the middle of a corridor in full view of passers by when she never said that.

mumtoe&e

Its sad to see so many people think this is acceptable.
Childbirth is the most precious thing that a woman & her partner will ever go through. Every woman deserves dignity & respect before, during & after labour.
It is not acceptable that a woman has to endure having her waters broken on a hospital corridor, be it quiet or hectic.
The hospitals are not to blame - they are doing their best with the staff & the resources that they are working with.
But people should not just sit back and accept this and perceive it as the norm.
Colette was right to write the article - if more women spoke out, then maybe things would eventually change!

crazy cat lady

I've worked and given birth in Holles st. I know exactly what the conditions are like, and unfortunately services are stretched to the limit so much that women do not always get the 'ideal' birth experience they would like.

However, my little girl is here and safe and I have lived to tell the birth tale with my health and much of my dignity intact!

Programs like 'One Born Every Minute' show the ideals of a birthing environment. They have to! Its television! And the UK system is quite different in that maternity units are usually attached to hospitals and so are much smaller and less busy. Midwifery led units are also very common in the UK. Holles St covers such a wide area - Dublin, Wicklow, Kildare, Meath, Wexford, as well as being a referral centre for the country. Its no wonder its as busy as it is!

I just want to say that the Doctors and Midwives all have the health and safety of the woman and baby at the centre of every decision they make. Her waters would never have been broken on the corridor, but in a curtained area outside a room is very possible. Its not ideal but I'm sure they had their reasons for doing it, especially if there was mec present. At the end of the day, what do you care about more? The welfare of your unborn child, or your dignity? They could break my waters in the middle of Grafton Street if thats what they had to do to ensure the safety of my baby!

Its great that the issue of the sub-standard conditions are being highlighted in the media. Do I think it'll change anything? Not at all! Everyone everywhere in whatever job they are in, are making the best of what they have to do the best they can at the minute. The system we have if far from Ideal but its all we have for now, so unless us poor women want to stop having babies, or choose to birth at home, I'm not sure there is much we can do to change anything!

lynski

crazy cat lady wrote: »

I just want to say that the Doctors and Midwives all have the health and safety of the woman and baby at the centre of every decision they make. Her waters would never have been broken on the corridor, but in a curtained area outside a room is very possible. Its not ideal but I'm sure they had their reasons for doing it, especially if there was mec present. At the end of the day, what do you care about more? The welfare of your unborn child, or your dignity? They could break my waters in the middle of Grafton Street if thats what they had to do to ensure the safety of my baby!

Its great that the issue of the sub-standard conditions are being highlighted in the media. Do I think it'll change anything? Not at all! Everyone everywhere in whatever job they are in, are making the best of what they have to do the best they can at the minute. The system we have if far from Ideal but its all we have for now, so unless us poor women want to stop having babies, or choose to birth at home, I'm not sure there is much we can do to change anything!

While agreeing that the doc and nurses are usually doing what they can under circumstances that are not the best, however i dont agree that women should ever accept the conditions she was expected to.
I think there are efficiencies and changes that could be made under stressful conditions at are not done, because procedures and routine are followed. I have seen docs and nurses 'just doing their jobs' but no more, not doing one or 2 small things that could make a patient more comfortable , or make a stay more easy. I would also say that the my experience of agency staff at weekends or night is that they rarely are as good as the full-time staff or as dedicated.

crazy cat lady

You're right there about agency staff. Generally they just turn up to do their job, and the bare minimum at that!

Every woman that has a baby in Holles St is given a patient satisfaction survey. If they are unhappy with anything, or feel that there are small changes that could make a difference, this would be the first place to voice anything. I can guarantee you that every returned survey is read by the Management and these surveys are thenleft in the Midwives sitting room and are frequently read. I can't speak for the other maternity hospitals as I've had no experience of them.

No woman should have to endure poor conditions for labour and childbirth. Its not a perfect system but for the most part, babies are delivered healthy, and a lot of women do have a positive experience.

I wonder what Collette would have written had she had her baby on a good day! Because they do happen... rarely... but they do!

Jinxi

Its not just holles street that have this issue. Even since before I got pregnant, I have had an issue with hospital staff/policies of time managing womens labour. Breaking waters to speed up labour, oxytocin to make comtrations more intense(usually needing an epidural going hand in hand with this). The procedure to give women injections to speed up the delivery of the placenta(which should at most take 45 mins) is the most pointless off all.
It is all an abuse of power. Women who are stressed, vulnerable and just terrified of anything going wrong being manipulated into accepting sub standard care and un nessacry procedures so beds can be freed up.

crazy cat lady

The active management of labour should have been abolished years ago!

SanFran07

crazy cat lady wrote: »

The active management of labour should have been abolished years ago!

But it hasn't.

First time Mums attending H.Street are told to expect this as part of their care when they attend the hospital's classes and a successful active management class results in a compliant, co-operative first time Mother.

As a first time Mum attending H.Street you are lead to believe that AML is normal.....that having your waters broken is normal, and if you don't progress according to the 'chart' you have a deficient uterus and need to be augmented with synthetic hormones. These routine practices were abolished years ago in the UK. The NHS has it's own problems but at least they have national maternity guidelines that are based on science....

Here are a few quotes from the Active Management of Labour guide

'A first labour is unique and the sequence of events that takes place on that occasion has no relevance to later births. The lesson is simple: provide a high level of care and attention the first time around and women will require little attention on the next occasion. Conversely, the damage inflicted by a low level of care and attention first time around is usually irreversible’ (Obviously not Colette's experience...)

The philosophy of AML includes..

'Defining a woman's role in labour and teach her how to fulfill it...'




expectant mothers deserve to be treated as adults and be made fully aware that childbirth is primarily their responsibility. However they must be provided with adequate educational services so that they can learn how to achieve their goal. Obstetricians must realise that few mature women want to be treated like irresponsible children on this momentous occasion”
(‘O Driscoll, 1993)





'women in labour must be encouraged to keep their eyes open at all times, closed eyes usually mark the first step along the road to total disintegration”



(‘O Driscoll et al, 1993)


It's a very interesting read for anyone attending NMH.

Yala

This is a very interesting thread having had my kids in HS but I think the hospital has some issues over and beyond the far from ideal labour/delivery room shortages. Mother's with threatened or actual loss in the same room as those in labour, the lack of clean facilities, the overcrowding, the long waiting lists for post delivery physio, when needed. advocating breastfeeding but help with it dependent upon the midwife's who are available.

I do think the hospital needs some policy changes - AML was pioneered in HS, which is why they advocate it/ have it as a standard procedure. At my antenatal classes it was billed as the best thing ever - other hospitals let poor mothers labour on for days, exhausted but we help you. There's a balance at HS that is missing, as with most maternity facilities in Ireland. After no.1 there was no way I was going down that route again so I'd a birth plan, and to be fair, while there was some bemusement when I made anyone who came near me read it before I'd let them touch me, it was respected.

I did go private. I ended up sharing a cubicle after the birth and had to ask this woman who I'd never seen before could she watch my precious newborn while I got a shower as there was no staff who could keep an eye on him while I got clean. I'd waited hours but they were unable to do so. That frightened me...

The end goal for all staff is healthy babies & healthy mums & they do a great job with limited resources. I found the vast majority of Midwives great but some policy changes, women educating themselves and a birth partner who can be the advocate for the mother and is not intimidated by officiousness all would help. So even if there is overcrowding then the experience can be that much better.

Hannibal Smith

SanFran07 wrote: »

But it hasn't.

First time Mums attending H.Street are told to expect this as part of their care when they attend the hospital's classes and a successful active management class results in a compliant, co-operative first time Mother.

As a first time Mum attending H.Street you are lead to believe that AML is normal.....that having your waters broken is normal, and if you don't progress according to the 'chart' you have a deficient uterus and need to be augmented with synthetic hormones. These routine practices were abolished years ago in the UK. The NHS has it's own problems but at least they have national maternity guidelines that are based on science....

Here are a few quotes from the Active Management of Labour guide

'A first labour is unique and the sequence of events that takes place on that occasion has no relevance to later births. The lesson is simple: provide a high level of care and attention the first time around and women will require little attention on the next occasion. Conversely, the damage inflicted by a low level of care and attention first time around is usually irreversible’ (Obviously not Colette's experience...)

The philosophy of AML includes..

'Defining a woman's role in labour and teach her how to fulfill it...'




expectant mothers deserve to be treated as adults and be made fully aware that childbirth is primarily their responsibility. However they must be provided with adequate educational services so that they can learn how to achieve their goal. Obstetricians must realise that few mature women want to be treated like irresponsible children on this momentous occasion”
(‘O Driscoll, 1993)





'women in labour must be encouraged to keep their eyes open at all times, closed eyes usually mark the first step along the road to total disintegration”



(‘O Driscoll et al, 1993)


It's a very interesting read for anyone attending NMH.

To be fair, I've had a child in Holles Street, and I've also attended their Ante Natal Classes and you're right insofar as they give you a chart which shows the expectations on how your labour is to progress and if it doesn't they'll administer oxytocin (sp) etc etc etc to help you along. Whilst the skeptical ones might say this is to get you in and out as quickly as possible, speaking as some one who was a week in hospital before they decided to induce me, I'm one of the people who has actually been there and from a PATIENT point of view as long as they got my baby out, they could take as much of an active role as they liked :D

I accept that this may not be the most 'mother earth' approach to child birth and labour, but I was a week in hospital with pre-eclampsia at 36 weeks and if they hadn't induced me the alternative would have been to stay in hospital for the next 4 weeks till baby came naturally.

I accept that my circumstances may not be the 'norm' but next time around I hope they do the very same thing, get the baby out as quickly as possible, by whatever means so I can get along with cuddling it :D

So whilst you may be able to quote statistics and on paper it all sounds very nice...bring on the breaking waters, bring on the oxytocin, bring on the drugs and whatever else it takes to get us all out of hosp as quick as possible!

lynski

Hannibal AML in your case was the most appropriate choice, probably, because you had a serious health condition. For most healthy mothers and healthy babies it is not the most appropriate choice, and it is proven to not be the most appropriate choice.

SanFran07

lynski wrote: »

Hannibal AML in your case was the most appropriate choice, probably, because you had a serious health condition. For most healthy mothers and healthy babies it is not the most appropriate choice, and it is proven to not be the most appropriate choice.

As Lynski has said - there are times when a Mum and baby needs help and are very glad of it! Nobody is disputing that.

Of course nobody in their right mind willingly signs up for a long labour and long hospital stay but the routine practices in H.Street aren't best international practice even though it is the National Maternity hospital.

I'd take my chances with a longer labour rather than outdated medical interventions especially if my baby and I are healthy! As long as H.Street give Mums all of the information about the risks of speeding up labours then Mums can make informed decisions about their options....but they don't....it's 'sold' to first timers as a simple little 'popping of the waters' that is medically necessary.....bending the truth a little so you'll just do what you're told. Not exactly ethical practice.... Unless you make it clear that you prefer NOT to have your waters broken artificially unless there is a compelling reason you'll become part of the production line and another number. There are amazing Midwives in H.Street and they really are caught between a rock and a hard place because their regulatory body the ABA supports evidence based, mother centered holistic care.....and sadly active management of labour is neither....

Hannibal Smith

As I said in my post, I appreciate that my circumstances weren't the norm, but next time around I'd say bring in on. I don't want to be in labour and agony for hours on end. If they can move things along for me, I'd be delighted to accept anything they have to offer.:D:D

aniascor

Each to their own Hannibal Smith. But I'd see a big difference between all the interventions that were needed in your case to induce labour artificially due to a medical concern, and simply inducing for the sake of it because X number of days have passed.

My waters went naturally when I got to 10cm, and I had a great labour - very manageable, and no drugs needed. And I think it's because I wasn't interfered with while everything was going well.

I have friends whose waters were broken as soon as they arrived at the hospital, who thought the pains were unbearable from the minute that happened.

Personally I'd rather deal with the manageable labour pains with waters intact, even if labour lasts a bit longer.

lynski

That is the thing though isn't it, 'agony for hours' is a more likely outcome of interventions then of natural labor. Induction, Artificial rupture of membranes, EPIs, all lead to longer labors and more cs, and that is a fact.

Just because we don't have the money now to ensure that every woman has the right to private rooms, midwife led care, birthing pools, home births, dignity and complete care in all areas does not mean we should not try to ensure our daughters have this things.

crazy cat lady

I read one of the early editions of the AML and I can't remember what it said word for word, but something along the lines of

'a labouring mother should recieve one-to-one attention from a midwife or student midwife at all times, preferably a young pretty girl'

What significance does whether your midwife is young, pretty or even a girl have on your labour??

It just goes to show that the AML was thought up by men and while maternity services are mostly dominated by men, the service provided is not going to be very woman centred!

There is a room in Holles St with portraits of every Master of the hospital. Every single one of them men! Its sickening!

Hannibal Smith

aniascor wrote: »

Each to their own Hannibal Smith. But I'd see a big difference between all the interventions that were needed in your case to induce labour artificially due to a medical concern, and simply inducing for the sake of it because X number of days have passed.

My waters went naturally when I got to 10cm, and I had a great labour - very manageable, and no drugs needed. And I think it's because I wasn't interfered with while everything was going well.

I have friends whose waters were broken as soon as they arrived at the hospital, who thought the pains were unbearable from the minute that happened.

Personally I'd rather deal with the manageable labour pains with waters intact, even if labour lasts a bit longer.

There were plenty of women in the labour ward when I was in Holles Street pleading for intervention and the midwives were trying to tell them they were no where near ready. Seems like they can't win

Hannibal Smith

crazy cat lady wrote: »

There is a room in Holles St with portraits of every Master of the hospital. Every single one of them men! Its sickening!

not the delivery room I hope

Moonbeam

also a holles st mammy and had a look back and can't find a post already made by me on this subject despite being convinced I had replied.

I am also a Holles St mammy had my 1st there in 2009 and about to have my 2nd not public but semi private.
Last time things could not have gone better I wanted no intervention unless it was a medical necessity,I ended up with a lovely midwife who was actually a community midwife but was doing her few weeks in the hospital.
It did probably help that I know her daughter but didn't know her.
She was amazing,I wanted no intervention and no medication.She literally held my hand all the way through and made the experience of birth a nice one of course it was painful but I felt safe and to me that is all that matters.
Due any day now and terrified because I know I will be very lucky to get treatment that good again:)
After the birth was on the merrion wing and the midwifes there were lovely and so helpful.

lynski

my first in coombe was nightmare - induction/long painful labor in shared labor room/many drs/epi/ecs/infection/ long stay
My second in the coombe was a dream - natural (well acupuncture helped)/short manageable labor in single room/no drs just midwives/no pain relief just gentle birth/natural delivery/ total stay 36 hrs
This story about HS has made me nervous, I just planned in my head all along that this birth was going to be like the second on, ie private and short and calm and not exactly easy but doable. Now I am trying to prepare myself for private bit not happening, shudder.

Lily10

I notice everyone is praising the midwives, not sure what they're like in ireland but here in the US, they're a little over the top. The leave the mother hanging in pain for days, telling her to do it naturally and that their body is made for this, woman have been doing this on their own for centuries etc.. even though back then the mortality rate in childbirth was 50%, but that's beside the point. They only get the dr. to intervene when the fetal heart tones are down and a stat c-section is needed. Of course, I may be biased because i'm married to an OB, but you would not believe how many times he has sat on the sidelines quietly watching a woman labor for way too long with a midwife (because the woman feels it's natural) only to produce a limp baby with a cone head from being jammed in the birth canal. There was actually one scary time when a baby came out more or less dead and needed reviving.

When I have my baby in a few months I want every single piece of monitoring equipment hooked up to me because i've heard too many horror stories of what can go wrong. But just like you ladies, I certainly do not want to be talked down to or rushed if it's not necessary. I definitely get how a lot of woman want the "birthing center" feel though, my only experience with childbirth in ireland was when my sister gave birth at the rotunda, her opinion - "it was mortifying and the nurses were rude"!

SanFran07

Lily10 wrote: »

When I have my baby in a few months I want every single piece of monitoring equipment hooked up to me because i've heard too many horror stories of what can go wrong. But just like you ladies, I certainly do not want to be talked down to or rushed if it's not necessary. I definitely get how a lot of woman want the "birthing center" feel though, my only experience with childbirth in ireland was when my sister gave birth at the rotunda, her opinion - "it was mortifying and the nurses were rude"!

Being married to an OB means he'll be well versed in the evidence against continuous monitoring for any low risk Mum......continuous monitoring has very little predictive value in how well a baby is doing (it's somewhere around a 98% false reading rate...). Intermittant monitoring is the international standard of practice (ACOG guidelines agree).

Did you watch the US OBEM show last week? The one Mum who was actively trying to have a natural birth was labeled 'insane' by her nurse/midwife....so it's a little unfair to tar all Midwives/obstetric nurses with the same brush.

mumtoe&e

Lily10 wrote: »

I notice everyone is praising the midwives, not sure what they're like in ireland but here in the US, they're a little over the top. The leave the mother hanging in pain for days, telling her to do it naturally and that their body is made for this, woman have been doing this on their own for centuries etc.. even though back then the mortality rate in childbirth was 50%, but that's beside the point. They only get the dr. to intervene when the fetal heart tones are down and a stat c-section is needed. Of course, I may be biased because i'm married to an OB, but you would not believe how many times he has sat on the sidelines quietly watching a woman labor for way too long with a midwife (because the woman feels it's natural) only to produce a limp baby with a cone head from being jammed in the birth canal. There was actually one scary time when a baby came out more or less dead and needed reviving.

When I have my baby in a few months I want every single piece of monitoring equipment hooked up to me because i've heard too many horror stories of what can go wrong. But just like you ladies, I certainly do not want to be talked down to or rushed if it's not necessary. I definitely get how a lot of woman want the "birthing center" feel though, my only experience with childbirth in ireland was when my sister gave birth at the rotunda, her opinion - "it was mortifying and the nurses were rude"!

The most ridiculous reply to a thread that I have ever read!
"when I have my baby in a few months I want every single piece of monitoring equipment hooked up to me because i've heard too many horror stories" - the best of luck with that - sounds as though you are going to have a beautiful birth experience (not)

You so obviously have absolutely no idea what midwifery in Ireland is like - as women here most definitely are not left in pain for days, or even hours for that matter, without pain relief!

"only to produce a limp baby with a cone head from being jammed in the birth canal" - you have such a way with words!

You say your husband is an obs - well by the sounds of your reply you seriously need to educate yourself regarding birth and labour! your reply is actually frightening!!!!!

Das Kitty

Can we take it down a notch or two please?

lynski

I am not surprised at lily10's reply because I have a friend who is married to an ob and her attitude was the more or less the same. He could not understand why women did not take every bit of intervention and pain relief in labour and why they did not just trust the doctors to know what was best for them. She had 2 elective sections due to complications, but the idea of a natural birth, if she had not been ill, was not even discussed. He knew best and that was that.
He practically laughed at the idea of hypno-birthing when i tried to talk to him about it.
There are no women left in labour for days here, AFAIK, I believe 24 hrs might be the longest time, but the woman would be driving that, not the midwives. They no more want to watch a woman in unnecessary pain then she wants to be in it.