43% of First Time Kilkenny Mums will have a Caesarean ..

SanFran07

Not great statistics out of the Dublin units either especially episiotomies ( 43.5% in NMH)....and induction for first time Mums in the Coombe (36.9%)


http://www.bump2babe.ie/

MLU rates are far more encouraging.

January

MLU rates may be far more encouraging but there are only two of them in the country and until such a time as there is more in the country they shouldn't be compared to hospital led care because, to be fair, that's all a lot of women have the option of using.

liliq

January wrote: »

MLU rates may be far more encouraging but there are only two of them in the country and until such a time as there is more in the country they shouldn't be compared to hospital led care because, to be fair, that's all a lot of women have the option of using.

Statistics like these may encourage more pregnant women to push for MLUs or a similar service to be made available in their area though. And although that will hardly happen in recessionary times, women pushing for these choices to be made available as a result of the stats can only be a good thing in the long run.

SanFran07

Although there are only 2 MLUs there are several Midwife Led services around the country - Wexford, Waterford, Cork, NMH and the Coombe.

Even comparing episiotomy rates between 2 hospitals - Wexford's rate is only 8%..... There are no National Guidelines in Ireland so polices and practice vary widely unfortunately.


Let's hope the HSE takes the advice of KPMG who recommended MLUs be set up nationwide. It's cheaper than consultant led care and women are more satisfied with their experiences. The majority of Irish women are low risk and should have access to evidence based care - even if it's not in an MLU.

cbyrd

You'd be surprised how little it takes to be excluded from the MLU's. I've had 3 very straightforward and uneventful births, but i'm excluded from the MLU cos i have an allergy to paracetamol. :rolleyes: Now of course i'm over 35 so that rules me out too. .

SanFran07

I hadn't heard about the paracetamol allergy - seeing as it's available in the CLU maybe they should have recommended you have a homebirth :rolleyes: You can always appeal an MLU decision - decisions have been reversed for other exclusion criteria.

The cut off age is 40 in the MLU.

January

I'd also be excluded from an MLU because of previous c section, I was excluded from the midwives in the Coombe because of it

Although, the only time the consultant came near me at the end of my vaginal birth on number two was to stitch my tear up

Lola92

I cant believe how high that rate for Cesarean Sections is...shocking.

I agree though, I think a lot more mothers would prefer having the option of a MLU or similar type of facilities.

SanFran07

January wrote: »

I'd also be excluded from an MLU because of previous c section, I was excluded from the midwives in the Coombe because of it

The Coombe Community Midwives do take on VBAC Mums but the Mums have to push for it. If anything comes up then you are reviewed by an Ob.

I agree the MLU criteria needs to be revised. Studies show Midwife led care outcomes just as good as CLUs for VBAC Mums. In the UK if a Mum opts to go to an MLU as long as the Midwives go through all the pros and cons with the Mum - the Mum makes the final decision not the consultant - even Mums considered high risk. This is what true informed consent is. In the UK VBAC Mums have the option of labouring in water and waterbirth too....:)

Cat Melodeon

Guess I slipped through the cracks! 1st time mum at St Luke's in Kilkenny, 35, induced but still managed to have a natural birth with only midwives in attendance. Can't fault my labour experience but had numerous battles with the antenatal doctors to avoid early induction and other interventions. I was pretty well informed, had a birth plan and was fairly confident in myself and my body's ability to get the job done. Whether that affected my outcome or it was just chance I don't know. It might have been down to the fact that it was a Saturday night in August with very few doctors about! Whatever, I feel I've proven myself now and hope to be left to my own devices on this pregnancy and birth.

GoerGirl

The first time mother stats are very concerning. ANd not just the high c-section rates either.

First time mothers that go into spontaneous labour at NMH have 50% ARM and 47% syntocinon! Add the 43% episiotomy rates....

Coombe ARM rates for first time mums in spontaneous labour is over 51% (!)

Instrumental birth rate for first time mothers 32/33% in Rotunda, Galway, Coombe, Portiuncula ....

Its just not acceptable!

Interesting that NMH has lowest section rates but yet the lowest success rate for VBAC. You would think as they are trying to keep section rates down by using more intervention in vaginal birth then the VBAC success rate would be better.

The MLU criteria is a joke - totally agree. In Ireland its not evidence based in many instances and is more about excluding women than finding a way to include women.

In Ireland a woman with BMI of 30 is excluded from midwife led care...in UK...women have home birth and midwife led care up to BMI 40+. I know a mum who was excluded as she turned 40 a month before her EDD.....:rolleyes:

Thanks for posting.

How Strange

What's ARM?

SanFran07

It's artificial rupture of membranes (breaking the waters) - rarely necessary but policy in H.Street on admission in labour and during labour in Coombe.

liliq

SanFran07 wrote: »

It's artificial rupture of membranes (breaking the waters) - rarely necessary but policy in H.Street on admission in labour and during labour in Coombe.

Sorry for off- topic, but it having membranes ruptured on admission in Holles st can be refused right?

embee

liliq wrote: »

Sorry for off- topic, but it having membranes ruptured on admission in Holles st can be refused right?

Of course, liliq. Any procedure has to be done only after consent is given by the woman. If you say you don't want it, they can't do it.

mariaf24

Are those generally elective or emergency c-sections? 43% is very alarming, i hope that is investigated further.

I agree that the mlu service criteria is far too strict...surely the purpose of such service is to offer a more natural approach to childbirth and pregnancy. By excluding so many women because of age, weight, allergies etc they are only damaging their own very purpose and placing more emphasis on the medicalisation of childbirth....

seamus

mariaf24 wrote: »

Are those generally elective or emergency c-sections? 43% is very alarming, i hope that is investigated further.

The statistics don't seem to mention whether a c-section is necessary or precautionary. They suggest that the vast majority of c-sections are elective.

However I know for example, one woman whose first child was born by emergency c-section, and the two children after that were then born by "elective" c-section as it was deemed necessary to avoid the same complications as the first child.

I imagine many of the "elective" c-sections are in a similar vein, where a c-section is advised by the consultant before the birth due to possible complications of a vaginal birth.

As such, they should be distinguishing "elective" c-sections from "medically advised" c-sections.

Hannibal Smith

January wrote: »

I'd also be excluded from an MLU because of previous c section, I was excluded from the midwives in the Coombe because of it

Although, the only time the consultant came near me at the end of my vaginal birth on number two was to stitch my tear up

Were you induced on the second one? Can you be induced once you've had a section? Were you treated any differently in the second one when it came to labour, or where you the same as everyone else?

January

Hannibal Smith wrote: »

Were you induced on the second one? Can you be induced once you've had a section? Were you treated any differently in the second one when it came to labour, or where you the same as everyone else?

Not induced no, although they did use ARM once I was in established labour. I had my emergency c section in the Rotunda and decided on the Coombe because I had heard stories of the Rotunda being a bit c section happy if the mother had been a previous c section...

I had gone into hospital the night before with pains, and although I wasn't in labour they kept me in to observe me because of the previous c section... I went into proper labour at around 4am the next morning and asked for pain relief (was just thinking gas and air) so they brought me to the labour ward, there were four beds, and for about 5 minutes I was the only one there! I don't think I was treated any differently, but I'm not sure about that,

I felt they never left me alone, kept poking and prodding me, taking my blood pressure and temperature etc... I hadn't slept since the morning before and when I got the epidural I thought they'd let me sleep for a little while, like they did in the Rotunda when I got my epidural! But no such thing, I wasn't given a minute to myself...

My consultant had discussed induction with me and told me that he wouldn't consider it and if I went too far overdue he would just book me in for the section.

Hannibal Smith

January wrote: »

Not induced no, although they did use ARM once I was in established labour. I had my emergency c section in the Rotunda and decided on the Coombe because I had heard stories of the Rotunda being a bit c section happy if the mother had been a previous c section...

I had gone into hospital the night before with pains, and although I wasn't in labour they kept me in to observe me because of the previous c section... I went into proper labour at around 4am the next morning and asked for pain relief (was just thinking gas and air) so they brought me to the labour ward, there were four beds, and for about 5 minutes I was the only one there! I don't think I was treated any differently, but I'm not sure about that,

I felt they never left me alone, kept poking and prodding me, taking my blood pressure and temperature etc... I hadn't slept since the morning before and when I got the epidural I thought they'd let me sleep for a little while, like they did in the Rotunda when I got my epidural! But no such thing, I wasn't given a minute to myself...

My consultant had discussed induction with me and told me that he wouldn't consider it and if I went too far overdue he would just book me in for the section.

That's what I'm concerned about....once you've had a section, they'll be a bit inclined to do another one. When I was in hosp the first time, the girl beside me had a section on her first and her next two normally and I think I remember her telling me, though I'm not too sure, that on the next baby, you're supposed to go into hospital as soon as your labour starts, so they can monitor you in case your section scar ruptures?

Now my recollection of things the days after the birth are all abit all over the place, so I wouldn't be surprised if I've got that completely wrong, but maybe that's why they were around you all the time?

Had you been induced at all on your first or was it an emergency section without any labour? Did you find the VBAC labour tough? I'm just wondering how worse the pain gets :D

January

I think it may have been to do with the risk of scar rupture, my scar was only 14 months old at the time too... they kept telling me to tell them if I felt any pain in the scar and at one point at the end of my labour, just before I felt like I needed to push (epidural wore off) I got an almighty stabbing pain but when I told them they quashed it and told me I was imagining it... didn't open my mouth again after that!

I was induced on number 1, my waters had broken 24 hours before hand, so they done ARM and then half an hour later hooked me up to the syntocin drip, I got the epidural at about 3pm (3 hours after drip went in) as the pains were becoming a bit unbearable and I was sectioned some time after 6 because of foetal distress (her heart beat was almost stopping with every contraction I was having).

I didn't find the VBAC tough at all, walk in the park compared to being induced on number 1, where the pains were coming almost on top of each other and I wasn't progressing either (only got to 3cm with the drip in over 6 hours whereas I went from 3cms to 10cms within 4 hours on number two). I was a bit reluctant to push and begged for a c section towards the end though but the great midwife just laughed and told me I was doing fine and was having the baby without c section.

Hannibal Smith

January wrote: »

I think it may have been to do with the risk of scar rupture, my scar was only 14 months old at the time too... they kept telling me to tell them if I felt any pain in the scar and at one point at the end of my labour, just before I felt like I needed to push (epidural wore off) I got an almighty stabbing pain but when I told them they quashed it and told me I was imagining it... didn't open my mouth again after that!

I was induced on number 1, my waters had broken 24 hours before hand, so they done ARM and then half an hour later hooked me up to the syntocin drip, I got the epidural at about 3pm (3 hours after drip went in) as the pains were becoming a bit unbearable and I was sectioned some time after 6 because of foetal distress (her heart beat was almost stopping with every contraction I was having).

I didn't find the VBAC tough at all, walk in the park compared to being induced on number 1, where the pains were coming almost on top of each other and I wasn't progressing either (only got to 3cm with the drip in over 6 hours whereas I went from 3cms to 10cms within 4 hours on number two). I was a bit reluctant to push and begged for a c section towards the end though but the great midwife just laughed and told me I was doing fine and was having the baby without c section.

omg that is brilliant to read (stabbing scar pain aside), I'm so glad you found it okay. It sounds exactly the same as me...waters were broken the day before...the next morning 8.30am I had the drip...by 1.30pm they decided fetal distress and I was brought down for the section. I was only 3cm at that stage.

The recovery after the second must have been a walk in the park was it?

SanFran07

An interesting take on what's going on in Kilkenny and Obs defending the practice. Same hospital that defended Neary's practices too.

http://www.kilkennypeople.ie/news/highest_percentage_of_caesarean_births_in_the_country_1_2730175


Nobody died - is that how we measure health in maternity services?


This article came out last month looking at 'tribal arrogance' amongst some obstetricians and Ireland was part of this paper.

http://www.smh.com.au/national/obstetricians-accused-of-tribal-arrogance-20110521-1exnn.html

metrovelvet

43% is disgraceful. That is nearly HALF of all women.

Smells like financial motivations to me.

Does anyone know if OBs are on a flat salary or or they get paid per procedure?

January

Hannibal Smith wrote: »

omg that is brilliant to read (stabbing scar pain aside), I'm so glad you found it okay. It sounds exactly the same as me...waters were broken the day before...the next morning 8.30am I had the drip...by 1.30pm they decided fetal distress and I was brought down for the section. I was only 3cm at that stage.

The recovery after the second must have been a walk in the park was it?

More or less! I had a slight tear (no episiotomy, although I don't think they do them as standard procedure in the Coombe? Just after looking at the stats and the rates for second and subsequent mothers who go into spontaneous labour is 1.8% for episiotomy... ) and that was a bit sore and looking after the newborn and the 14 month old at the time was tiring! But it was a piece of cake compared to the c section!

embee

SanFran07 wrote: »

An interesting take on what's going on in Kilkenny and Obs defending the practice. Same hospital that defended Neary's practices too.

http://www.kilkennypeople.ie/news/highest_percentage_of_caesarean_births_in_the_country_1_2730175


Nobody died - is that how we measure health in maternity services?


This article came out last month looking at 'tribal arrogance' amongst some obstetricians and Ireland was part of this paper.

http://www.smh.com.au/national/obstetricians-accused-of-tribal-arrogance-20110521-1exnn.html

Could we please endeavour not to villianise Obstetricians? That second article is so lobsided it's about to fall in on itself. It's all about the bad things doctors are purported to have done. Yes, some doctors have a questionable bedside manner but every birth I've attended thus far where a doctor has to be involved, the doctors are very very sure to gain consent from women. In fact, the presence of the doctor in the delivery suite is not necessary in a normal, low-risk labour and birth, but that doesn't mean that we should be villifying the medical profession. There are plenty of Obs out there who do fantastic work. They save the lives of babies and women alike... that article makes doctors sound like monsters and I think we all know that that just isn't the case.

metrovelvet wrote: »

43% is disgraceful. That is nearly HALF of all women.

Smells like financial motivations to me.

Does anyone know if OBs are on a flat salary or or they get paid per procedure?

http://www.dohc.ie/publications/pdf/salary_scales_jan10.pdf?direct=1

A comprehensive list of the pay scales of every HSE employee as at January 2010. As you will see, they are paid a flat salary and do not get paid per procedure. It's pretty dispicable to even suggest that, to be honest.

SanFran07

Embee I agree there are some fantastic Obs in Ireland and some not so fantastic ones. I don't believe this salary report includes consultant obstetricians' private practice income.

On the issue of consent I suggest you check out the AIMS Irelands survey on consent in maternity care. Consent is not always sought even in non-emergency situations.

embee

SanFran07 wrote: »

Embee I agree there are some fantastic Obs in Ireland and some not so fantastic ones. I don't believe this salary report includes consultant obstetricians' private practice income.

On the issue of consent I suggest you check out the AIMS Irelands survey on consent in maternity care. Consent is not always sought even in non-emergency situations.

SanFran,

With the greatest of respect, please do not talk to me as though I haven't a clue what I'm on about. I'm a student midwife, there is little currency in helpfully directing me to AIMS Ireland. Do you seriously think I haven't read any of the AIMS reports or findings? My point about consent is that, in my experience, I have never seen a woman having a procedure carried out without her consent. It is always expressly stated that she needs to consent to it (or not). I don't believe that procedures being carried out without consent is a widely spread situation, not by a long shot.

Of course, I'm only going on what I've seen. I'm a student midwife, not a qualified one, so I'm learning on the job. I would hope that in my practice I act as an advocate for womens wishes, no matter what my own beliefs are. We can all hold very strong views but as midwives we're there to be with the woman. Scaring women with all sorts of horror stories is not the sort of midwife that I want to be.

Orion

SanFran07 wrote: »

On the issue of consent I suggest you check out the AIMS Irelands survey on consent in maternity care.

Can someone point me in the direction of the number of births in Ireland in 2009? I think it was over 75000. Of that 75000, 367 people responded on a survey being held by a site which is already dissatisfied with maternity services. These basic premises already prejudice the independance and reliability of this survey and any other survey on that site. I do not doubt the sincerity of the operators of the site but their 'surveys' are compromised by this.

I have some serious reservations about your approach to this topic. Can you point to a single, objectively reported, case in Ireland where consent was not sought for a medical procedure during pregnancy? The Kilkenny People article does not imply that. Without some actual proof (not tabloid articles) I will insist that you desist with your scaremongering on this issue and in this forum. This forum is here to support pregnant women - not to scare them.

You may consider this a mod warning.

Cunning Stunt

My sister had her first baby in Kilkenny hospital.
She was a bit overdue and they said she should be induced. They brought her down, tried to bring on the labour - she was in pain but still no sign of the baby coming -- back up to the ward with her.
Back down again later for another attempt to induce - waters broke but still no baby.
Back up to the ward.
Back down again for inducing again. This all happened over the course of around 48 hours and eventually when her boyfriend protested that she couldn't take any more pain, they did a caesarean.
Not a great experience for her first birth.

metrovelvet

embee wrote: »

/pdf/salary_scales_jan10.pdf?direct=1[/url]

A comprehensive list of the pay scales of every HSE employee as at January 2010. As you will see, they are paid a flat salary and do not get paid per procedure. It's pretty dispicable to even suggest that, to be honest.

A 43% C section rate is what is pretty despicable.

Health providors are not above criticism.

The scales you provide do not show private earnings, of which they piggy back off public hospitals.