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

SanFran07

Yes these are very different motivators to the usually suggested causes (more high risk Mothers, obese Mothers, older mothers etc - which are also factors).

What I took from this report is that Kilkenny Mums are most likely built like the rest of us........but Kilkenny obstetricians seem to be more risk conscious.

This article by Mike Turner from the Coombe agrees with Farah but not on the topic of litigation.

http://www.irishhealth.com/article.html?id=17255

Hannibal Smith

Maybe they are more risk conscious, but I don't think it's for sinister reasons. The initial survey is based on statistics only, not reasons behind them, so it's difficult to say, without looking deeper into it, why women in Kilkenny experience higher caesarians the first time round. The MLUs select women with low risk healthy pregnancies. So it's kind of a safe bet that the women are going to go into spontaneous labour isn't it?

GoerGirl

Hannibal Smith wrote: »

The MLUs select women with low risk healthy pregnancies. So it's kind of a safe bet that the women are going to go into spontaneous labour isn't it?

This is a very valid point - however - there has been international research which shows that low risk women in consultant led care suffer more adverse affects than low risk women in midwife led care. The research also indicates this is not only with "low risk" women but also women with moderate risk factors

One could argue, that the exact same low risk first time mother is more likely to have intervention simply down to the fact that midwife led care is not available to her.

The majority of mothers in Ireland will not have access to midwifery led care - be it by lack of facility or by choice.

To further add to the problem, maternity care in Ireland is not standardised. Policy varies from unit to unit, and often within a unit, varies from care provider to care provider. So, potentially, a low risk first time mother's risk of intervention can rise simply based on the a) choosing consultant led over midwife led b) the unit she accesses maternity care in and c) the consultant she is under

Ayla

GoerGirl wrote: »

To further add to the problem, maternity care in Ireland is not standardised. Policy varies from unit to unit, and often within a unit, varies from care provider to care provider. So, potentially, a low risk first time mother's risk of intervention can rise simply based on the a) choosing consultant led over midwife led b) the unit she accesses maternity care in and c) the consultant she is under

+1!

In my case, even the GPs within the same surgery had different policies/procedures, so I had a different care between my 1st and 2nd preg b/c I was with different GPs. :rolleyes:

Hannibal Smith

GoerGirl wrote: »

This is a very valid point - however - there has been international research which shows that low risk women in consultant led care suffer more adverse affects than low risk women in midwife led care. The research also indicates this is not only with "low risk" women but also women with moderate risk factors

One could argue, that the exact same low risk first time mother is more likely to have intervention simply down to the fact that midwife led care is not available to her.

The majority of mothers in Ireland will not have access to midwifery led care - be it by lack of facility or by choice.

To further add to the problem, maternity care in Ireland is not standardised. Policy varies from unit to unit, and often within a unit, varies from care provider to care provider. So, potentially, a low risk first time mother's risk of intervention can rise simply based on the a) choosing consultant led over midwife led b) the unit she accesses maternity care in and c) the consultant she is under

That paints a picture of maternity hospital = bad, mlu = good

What happens if a baby goes into fetal distress at an mlu? Or if a baby just isn't moving? I know for example for serious problems in a pregnancy in the Mount Carmel in Dublin, the mother will be sent to Holles Street, so it's a bit unfair to say that Holles Street have X amount of caesareans/labour interventions, if other hospitals are sending problems there?

SanFran07

Hannibal Smith wrote: »

Maybe they are more risk conscious, but I don't think it's for sinister reasons. The initial survey is based on statistics only, not reasons behind them, so it's difficult to say, without looking deeper into it, why women in Kilkenny experience higher caesarians the first time round. The MLUs select women with low risk healthy pregnancies. So it's kind of a safe bet that the women are going to go into spontaneous labour isn't it?

I agree that there is no conspiracy theory here. But when the overriding reason for doing a caesarean is based on fear of being sued rather than a clinical need then we need to change the culture of fear around birth - for women and their caregivers.

Not every woman who starts in the MLU stays there. Any deviation from normal means an obstetric review and can mean the Mum leaves Midwife led care. The MLU has more spontaneous births for the same reason H.Street has the lowest caesarean rate in the country - induction of labour doesn't happen until 14 days (compared to 10 - 12 days in other units).

SanFran07

Hannibal Smith wrote: »

That paints a picture of maternity hospital = bad, mlu = good

What happens if a baby goes into fetal distress at an mlu? Or if a baby just isn't moving? I know for example for serious problems in a pregnancy in the Mount Carmel in Dublin, the mother will be sent to Holles Street, so it's a bit unfair to say that Holles Street have X amount of caesareans/labour interventions, if other hospitals are sending problems there?

It paints the picture of obstetric led care = more routine interventions vs less routine intervention in MLUs. For some Mums more intervention is associated with safety and they prefer Obstetric led care - but thats about the perception of more being better rather than the evidence.

If there are any deviations from a normal birth a consultant goes to the MLU
and a plan of care is discussed. In some cases a Mum moves next door to the main
labour ward and her care continues there.

H.Street's routine interventions are policy for every Mother - not just Mums who need assistance. Considering the numbers that they are dealing with their caesarean rates are low but episiotomy rates etc are unacceptably high.

Hannibal Smith

SanFran07 wrote: »

I agree that there is no conspiracy theory here. But when the overriding reason for doing a caesarean is based on fear of being sued rather than a clinical need then we need to change the culture of fear around birth - for women and their caregivers.

Not every woman who starts in the MLU stays there. Any deviation from normal means an obstetric review and can mean the Mum leaves Midwife led care. The MLU has more spontaneous births for the same reason H.Street has the lowest caesarean rate in the country - induction of labour doesn't happen until 14 days (compared to 10 - 12 days in other units).

Coming from a legal background, as I do, I disagree. Medical negligence cases are lengthy and really are a waste of hospital funds. Personally speaking I'd prefer the hospital devote their funds to equipment etc, rather than litigation. Hospitals have been around a lot longer than the MLUs and I'm sure when the MLUs have more experience under their belts, they'll have to introduce policies which may not be in the best interests of the mother, but to protect themselves. How many news stories have there been against maternity hospitals because of still births, or injuries to mother and baby because the hospital didn't intervene early enough? So they're a bit damned if they do and damned if they don't.

The national maternity hospital as far as I can see from the statistics in your first post, comes off fantastically well. I remember posts before in this forum about how bad the three main dublin maternity hospitals were for intervening in a birth to keep the hospital beds free. Considering the large volume of pregnancies and labours the NMH deal with and the many different complexities in a lot of the pregnancies, I'm impressed by that chart.

It's important for Kilkenny mothers to be aware of what they're facing, but there must be a reason for it, rather than the doctor wanting you in and out as quickly as possible and it's important for the mothers to be to have faith and trust in their caregiver, instead of being suspicious of their motives.

It's unfair that MLUs are being compared to Maternity Hospitals if they are only taking the 'good' patients . Cold statistics can be used to prove any point convincingly, but given the narrow spectrum of patients that are under their care, it doesn't seem like an accurate comparison to me.

Hannibal Smith

SanFran07 wrote: »

It paints the picture of obstetric led care = more routine interventions vs less routine intervention in MLUs. For some Mums more intervention is associated with safety and they prefer Obstetric led care - but thats about the perception of more being better rather than the evidence.

If there are any deviations from a normal birth a consultant goes to the MLU
and a plan of care is discussed. In some cases a Mum moves next door to the main
labour ward and her care continues there.

H.Street's routine interventions are policy for every Mother - not just Mums who need assistance. Considering the numbers that they are dealing with their caesarean rates are low but episiotomy rates etc are unacceptably high.

But the statistics say for the MLU in Cavan 100% spontaneous births, and in MLU OLOL 100%...with 0% interventions?

January

/8

Hannibal Smith wrote: »

That paints a picture of maternity hospital = bad, mlu = good

What happens if a baby goes into fetal distress at an mlu? Or if a baby just isn't moving? I know for example for serious problems in a pregnancy in the Mount Carmel in Dublin, the mother will be sent to Holles Street, so it's a bit unfair to say that Holles Street have X amount of caesareans/labour interventions, if other hospitals are sending problems there?

Women are only sent from Mount Carmel to Holles Street if they present in labour before 33 weeks as MC have no NICU only a SCBU, otherwise they're kept in MC...

SanFran07 wrote: »

I agree that there is no conspiracy theory here. But when the overriding reason for doing a caesarean is based on fear of being sued rather than a clinical need then we need to change the culture of fear around birth - for women and their caregivers.

Not every woman who starts in the MLU stays there. Any deviation from normal means an obstetric review and can mean the Mum leaves Midwife led care. The MLU has more spontaneous births for the same reason H.Street has the lowest caesarean rate in the country - induction of labour doesn't happen until 14 days (compared to 10 - 12 days in other units).

SanFran07 wrote: »

It paints the picture of obstetric led care = more routine interventions vs less routine intervention in MLUs. For some Mums more intervention is associated with safety and they prefer Obstetric led care - but thats about the perception of more being better rather than the evidence.

If there are any deviations from a normal birth a consultant goes to the MLU
and a plan of care is discussed. In some cases a Mum moves next door to the main
labour ward and her care continues there.

H.Street's routine interventions are policy for every Mother - not just Mums who need assistance. Considering the numbers that they are dealing with their caesarean rates are low but episiotomy rates etc are unacceptably high.

What for instance would happen when Alukura House opens? Isn't that supposed to be out of the way of a maternity hospital? God forbid if a real emergency happened, would they make it on time to the maternity hospital to save mother and babies life?

SanFran07

Hannibal Smith wrote: »

Coming from a legal background, as I do, I disagree. Medical negligence cases are lengthy and really are a waste of hospital funds. Personally speaking I'd prefer the hospital devote their funds to equipment etc, rather than litigation. Hospitals have been around a lot longer than the MLUs and I'm sure when the MLUs have more experience under their belts, they'll have to introduce policies which may not be in the best interests of the mother, but to protect themselves. How many news stories have there been against maternity hospitals because of still births, or injuries to mother and baby because the hospital didn't intervene early enough? So they're a bit damned if they do and damned if they don't.

The national maternity hospital as far as I can see from the statistics in your first post, comes off fantastically well. I remember posts before in this forum about how bad the three main dublin maternity hospitals were for intervening in a birth to keep the hospital beds free. Considering the large volume of pregnancies and labours the NMH deal with and the many different complexities in a lot of the pregnancies, I'm impressed by that chart.

It's important for Kilkenny mothers to be aware of what they're facing, but there must be a reason for it, rather than the doctor wanting you in and out as quickly as possible and it's important for the mothers to be to have faith and trust in their caregiver, instead of being suspicious of their motives.

It's unfair that MLUs are being compared to Maternity Hospitals if they are only taking the 'good' patients . Cold statistics can be used to prove any point convincingly, but given the narrow spectrum of patients that are under their care, it doesn't seem like an accurate comparison to me.

NMH's caesarean rate is impressive and they do have some excellent policies in place to reduce caesareans (induction policy, breech birth, ECVs and guidelines for VBAC) where they don't fare so well is in normal birth - less than 4% of women attending NMH have completely spontaneous births. Their labours are interrupted in some way by speeding up their labour with routine breaking of the waters, routine use of the drip, episiotomy etc...these are hardly statistics to be shouting from the rooftops. There is no evidence to show these routine procedures offer ANY benefits to Mums or babies.....

Let's take away MLU as a bricks and mortar facility (a birth center within a hospital) which is relatively new in Ireland and look at Midwife Led Care which has been around long before hospitals.

This report published recently compares the different models of care - Socioeconomic Value of the Midwife A systematic review, meta-analysis, meta-synthesis and economic analysis of midwife-led models of care (and it includes different risk levels - not just low risk Mums.

http://www.rcm.org.uk/valueofthemidwife/


Based on the evidence contained in this review, the majority of women will benefit from midwife-led models of care, including models that have and do not have an antenatal component, without any adverse consequences for them or their infants. The clear benefit and absence of evidence of harm provides grounds for midwife-led models of care becoming the dominant model of care for childbearing women.

Kilkenny Mums should also have faith and trust in a system that gives them a better opportunity than a 1 in 2 chance of having a normal birth.

It's no secret that maternity services are incredibly underfunded and understaffed - one regional unit has often has 2 Midwives on the labour ward at night with 4 or 5 women in labour....another regional unit recently had 30 women and babies under the care of 1 Midwife on the post natal ward on the nightshift....litigation is not going to decrease any time soon.

Hannibal Smith

SanFran07 wrote: »

NMH's caesarean rate is impressive and they do have some excellent policies in place to reduce caesareans (induction policy, breech birth, ECVs and guidelines for VBAC) where they don't fare so well is in normal birth - less than 4% of women attending NMH have completely spontaneous births. Their labours are interrupted in some way by speeding up their labour with routine breaking of the waters, routine use of the drip, episiotomy etc...these are hardly statistics to be shouting from the rooftops. There is no evidence to show these routine procedures offer ANY benefits to Mums or babies.....

Let's take away MLU as a bricks and mortar facility (a birth center within a hospital) which is relatively new in Ireland and look at Midwife Led Care which has been around long before hospitals.

This report published recently compares the different models of care - Socioeconomic Value of the Midwife A systematic review, meta-analysis, meta-synthesis and economic analysis of midwife-led models of care (and it includes different risk levels - not just low risk Mums.

http://www.rcm.org.uk/valueofthemidwife/


Based on the evidence contained in this review, the majority of women will benefit from midwife-led models of care, including models that have and do not have an antenatal component, without any adverse consequences for them or their infants. The clear benefit and absence of evidence of harm provides grounds for midwife-led models of care becoming the dominant model of care for childbearing women.

Kilkenny Mums should also have faith and trust in a system that gives them a better opportunity than a 1 in 2 chance of having a normal birth.

It's no secret that maternity services are incredibly underfunded and understaffed - one regional unit has often has 2 Midwives on the labour ward at night with 4 or 5 women in labour....another regional unit recently had 30 women and babies under the care of 1 Midwife on the post natal ward on the nightshift....litigation is not going to decrease any time soon.

Am I missing something? It says in the link you first quoted in this thread that spontaneous births in Holles Street are 64%? That's not less than 4%? It says the amount of labour inductions are 25%. So either the link you posted initially is completely off the mark, or there's something not right with your 4%? Given what you're saying about this new 4%, and the fact that interventions do actually happen in MLUs, I'm not entirely sure that first link is all that accurate at all.

Also, the need for interventions, am I right in assuming that more interventions are necessary when epidurals etc are introduced, because the labour moves slower? So what are they to do? Leave the baby where it is?

What happens if 4/5 women present at the MLU's at the same time in labour?

I can't go to a midwife led unit. Because of the problems I had in my last pregnancy, I have to go to a hospital, I guess I should look forward to a lousy birthing experience and a poor level of care then?

GoerGirl

Hannibal Smith wrote: »

Am I missing something? It says in the link you first quoted in this thread that spontaneous births in Holles Street are 64%? That's not less than 4%? It says the amount of labour inductions are 25%. So either the link you posted initially is completely off the mark, or there's something not right with your 4%? Given what you're saying about this new 4%, and the fact that interventions do actually happen in MLUs, I'm not entirely sure that first link is all that accurate at all.

I think the 4% that SanFran quotes is in relation to their rate of "normal birth"

If you scroll down the full stats for each hospital you will see 4 stats which are not usually correlated to determine patient safety (usually its induction rates, c-section rates, etc) but are very important to take note of:

1. percentage of women who present to the hospital in spontaneous labour who have ARM (breaking waters)

2. percentage of women who present to the hospital in spontaneous labour who have syntocinon

3. percentage of women who present to the hospital who have a "normal birth"

4. percentage of women who will have an episiotomy


NMH rates for first time mothers is that 50% of first time mums who present to the hospital in spontaneous labour will have ARM, 47% of first time mums who present themselves in spontaneous labour will have syntocinon (oxytocin), 43% of first time mothers have an episiotomy, and only 4.2% of first time mums will have a "normal birth"

Coombe's rate for "normal birth" for first time mums is 5.8% and Rotunda is 10.9%

Its very telling that nearly half of first time mums presenting in spontaneous labour will have their labour's sped up either by ARM or syntocinon. Midwife led care does not generally follow this practice - therefore "normal birth" rates will instantly be higher.


First time mother's stats are incredibly important as a first birth experience will have future implications of subsequent pregnancies.


I cannot avail of midwife led care either. Purely observational, but I have seen the standard of care decrease from my first and last baby. There is a much stronger focus on time and routine policy now than there was several years back. However, there are great things happening in some hospitals and there is no reason why a woman must think she can expect poor care. This is why information is so important - the more information you read the better equipped you are to make informed choices to back up your birth preferences.

Hannibal Smith

GoerGirl wrote: »

I think the 4% that SanFran quotes is in relation to their rate of "normal birth"

If you scroll down the full stats for each hospital you will see 4 stats which are not usually correlated to determine patient safety (usually its induction rates, c-section rates, etc) but are very important to take note of:

1. percentage of women who present to the hospital in spontaneous labour who have ARM (breaking waters)

2. percentage of women who present to the hospital in spontaneous labour who have syntocinon

3. percentage of women who present to the hospital who have a "normal birth"

4. percentage of women who will have an episiotomy


NMH rates for first time mothers is that 50% of first time mums who present to the hospital in spontaneous labour will have ARM, 47% of first time mums who present themselves in spontaneous labour will have syntocinon (oxytocin), 43% of first time mothers have an episiotomy, and only 4.2% of first time mums will have a "normal birth"

Coombe's rate for "normal birth" for first time mums is 5.8% and Rotunda is 10.9%

Its very telling that nearly half of first time mums presenting in spontaneous labour will have their labour's sped up either by ARM or syntocinon. Midwife led care does not generally follow this practice - therefore "normal birth" rates will instantly be higher.


First time mother's stats are incredibly important as a first birth experience will have future implications of subsequent pregnancies.


I cannot avail of midwife led care either. Purely observational, but I have seen the standard of care decrease from my first and last baby. There is a much stronger focus on time and routine policy now than there was several years back. However, there are great things happening in some hospitals and there is no reason why a woman must think she can expect poor care. This is why information is so important - the more information you read the better equipped you are to make informed choices to back up your birth preferences.

But you don't know why they've had their membranes ruptured...you've no idea what condition the women were in, whether there was meconium in the amniotic fluid...there are a wealth of reasons why these women's waters were broken, and if the MLUs are selective in who they take under their care, and the hospitals are left with everyone else that's not an even comparison.

For example...the MLU in Cavan, dealt with 90 women, the NMH dealt with 9,161...how on earth is that a fair comparison? If you have a higher volume of people coming through your door of course there is a need for uniformity and policies. The MLUs are doing imposing policies straight off the bat because they're only selecting low risk women, low risk women some of whom San Fran herself said have presented problems, some of whom have not gone to plan and who have needed some sort of intervention. You go to Bewelys at 11am on a Tuesday when no one else is there, you'll get a more personalised service than you would if you went lunch time on a bank holiday friday, that's the way things go.

I had a baby in Holles Street in 2009 and I couldn't fault them labour/delivery wise. They gave me every chance they could to bring my son into the world myself. I had 3 gels, waters broken and finally oxytocin, I had 2 midwives with me a student nurse and an obstetrician, all of whom were fantastic, but nothing worked and eventually fetal distress wasdiagnosed. The Obstetrician even got a second opinion before making the decision and sending me down for a section. He couldn't have been nicer and more calming. So when you look at cold hard facts then can be quite daunting, and there are people who have had bad experiences, but there are others, like me who had fantastic care.

If people are going to promote MLUs then by all means go ahead, for those who are selected for them they seem like fantastic services, but I don't see the need in promoting them by trouncing all over hospital care. It's not fair on the midwives and obstetricians who work there who do amazing work and offer such great care to their patients.

SanFran07

Hannibal Smith wrote: »

But you don't know why they've had their membranes ruptured...you've no idea what condition the women were in, whether there was meconium in the amniotic fluid...there are a wealth of reasons why these women's waters were broken, and if the MLUs are selective in who they take under their care, and the hospitals are left with everyone else that's not an even comparison.

It's NMH's policy to rupture the membranes whether you need it or not. They tell you this in the antenatal classes and if you choose not to have it then you're expected to have your preference 'signed off' by a Doctor....

The reasons given by NMH are:
1 - to speed up the labour
2 - to check for meconium (it's safer and easier to check the baby's heart rate).

Neither of these routine practices are recommended by international best practice. This is substandard care but funnily enough these practices are not routine with the Community Midwives - that are part of NMH.

Hannibal Smith wrote: »

If people are going to promote MLUs then by all means go ahead, for those who are selected for them they seem like fantastic services, but I don't see the need in promoting them by trouncing all over hospital care. It's not fair on the midwives and obstetricians who work there who do amazing work and offer such great care to their patients.

I agree 100% with you that MLUs are extremely selective on who they take on - a Mum who has had a previous caesarean can't go to Cavan or Drogheda MLU but someone who smokes can...... BTW the Midwives don't make the rules the Obstetricians do.

When the Coombe opens it's full MLU service I've no doubt that that their policies will be equally as restrictive (although the Coombe is ok with VBAC Mums attending their Midwives clinic which is a positive first step but it wasn't offered to the Mums they had to insist on it). MLUs are in their infancy here and hopefully in the future they will be open to a much wider range of Mums to be.

In the UK the Mother makes the decision on whether she wants obstetric led or MLU care in consultation with her Midwife and Doctor - Mum makes the final decision....that's what true informed consent is all about. It's not unusual for 16 year olds, VBAC Mums, Mums with high BMIs to choose Midwife Led Care.

I don't agree with you that I am 'trouncing on' Midwives or obstetricians as there are fantastic staff in Irish maternity services. As I said in my earlier posts NMH has some great polices in place around breech, VBAC and induction. But I have no problem challenging non evidence based, one size fits all policies and the lack of informed consent that goes along with them.

If you were having heart surgery and one hospital offers the most up to date surgical techniques with the best outcomes and the hospital across town is still following procedures that are no longer considered best practice - where would you go for your surgery.

As someone who is in the legal field don't you find this a bit bizarre?

Hannibal Smith

SanFran07 wrote: »

It's NMH's policy to rupture the membranes whether you need it or not. They tell you this in the antenatal classes and if you choose not to have it then you're expected to have your preference 'signed off' by a Doctor....

The reasons given by NMH are:
1 - to speed up the labour
2 - to check for meconium (it's safer and easier to check the baby's heart rate).

Neither of these routine practices are recommended by international best practice. This is substandard care but funnily enough these practices are not routine with the Community Midwives - that are part of NMH.





I agree 100% with you that MLUs are extremely selective on who they take on - a Mum who has had a previous caesarean can't go to Cavan or Drogheda MLU but someone who smokes can...... BTW the Midwives don't make the rules the Obstetricians do.

When the Coombe opens it's full MLU service I've no doubt that that their policies will be equally as restrictive (although the Coombe is ok with VBAC Mums attending their Midwives clinic which is a positive first step but it wasn't offered to the Mums they had to insist on it). MLUs are in their infancy here and hopefully in the future they will be open to a much wider range of Mums to be.

In the UK the Mother makes the decision on whether she wants obstetric led or MLU care in consultation with her Midwife and Doctor - Mum makes the final decision....that's what true informed consent is all about. It's not unusual for 16 year olds, VBAC Mums, Mums with high BMIs to choose Midwife Led Care.

I don't agree with you that I am 'trouncing on' Midwives or obstetricians as there are fantastic staff in Irish maternity services. As I said in my earlier posts NMH has some great polices in place around breech, VBAC and induction. But I have no problem challenging non evidence based, one size fits all policies and the lack of informed consent that goes along with them.

If you were having heart surgery and one hospital offers the most up to date surgical techniques with the best outcomes and the hospital across town is still following procedures that are no longer considered best practice - where would you go for your surgery.

As someone who is in the legal field don't you find this a bit bizarre?

What has the legal field got to do with chosing a hospital? Whether you one hospital is using new practises and another is using procedures which are no longer considered best practise, it doesn't mean that either of them are experiencing anything but good outcomes. Heart stents are now being done on heart patients by going through the wrist, instead of the groin, my father had one which went through the groin, it was fine, had another one which went through the wrist, he ended up in intensive care for two nights. Yet the wrist way is considered best practise.

Of all the women who received 'outdated' care in hospital care, how many of them had healthy babies? Is that not the outcome they're looking for? Whether you push your baby out all by yourself, or whether your labour was intervened with, is a healthy baby not what you were looking for?

MLUs have a small number of patients, if they had the same volume as Maternity Hospitals you can be sure they'd be introducing policies left right and centre, they'd have to, that's the practicalities of business.

You keep saying you've no problem tackling non evidence based practise, but if that practise is to check for meconium, it's not exactly the most sinister of intentions is it?

By all means women should have a choice in what kind of birth they want, but it should be done on the basis of a level playing field and objective information, if MLUs are great in their own right, promote them as such, without bringing down hospitals or their staff. And I don't see how posting your issues with maternity care here can further your protests. Should you not be tackling the HSE directly instead of doing it here? Why should we be used to fight your campaign for you?

Babyblessed

Hannibal Smith wrote: »

What has the legal field got to do with chosing a hospital? Whether you one hospital is using new practises and another is using procedures which are no longer considered best practise, it doesn't mean that either of them are experiencing anything but good outcomes. Heart stents are now being done on heart patients by going through the wrist, instead of the groin, my father had one which went through the groin, it was fine, had another one which went through the wrist, he ended up in intensive care for two nights. Yet the wrist way is considered best practise.

Of all the women who received 'outdated' care in hospital care, how many of them had healthy babies? Is that not the outcome they're looking for? Whether you push your baby out all by yourself, or whether your labour was intervened with, is a healthy baby not what you were looking for?

MLUs have a small number of patients, if they had the same volume as Maternity Hospitals you can be sure they'd be introducing policies left right and centre, they'd have to, that's the practicalities of business.

You keep saying you've no problem tackling non evidence based practise, but if that practise is to check for meconium, it's not exactly the most sinister of intentions is it?

By all means women should have a choice in what kind of birth they want, but it should be done on the basis of a level playing field and objective information, if MLUs are great in their own right, promote them as such, without bringing down hospitals or their staff. And I don't see how posting your issues with maternity care here can further your protests. Should you not be tackling the HSE directly instead of doing it here? Why should we be used to fight your campaign for you?

Why is the 'healthy baby' argument always rolled out???
I chose home birth because I wanted a healthy experience for my child, myself and my family. Yes we all want a 'healthy' baby thats obvious but some studies (currently being researched) are suggesting a link between anti-social behaviour and either epidural or syntocinon. Other parents will talk about feeling they needed to seek a cranial osteopaths assistance following the vacuum or forceps extraction of their child.

We really dont know what affect all the interventions have on the baby into the future. What we do know is that the 'feel good' hormones elicited in NORMAL birth have a positive effect on infant/maternal bonding and breastfeeding.

Health isnt just the physical, its social, emotional and psychological too.

GoerGirl

Hannibal Smith wrote: »

You keep saying you've no problem tackling non evidence based practise, but if that practise is to check for meconium, it's not exactly the most sinister of intentions is it?

THere are other ways to check for meconium.

Routinely speeding up labour by ARM and oxytocin puts mum and baby at a much more elevated increase risk of not tolerating labour = fetal distress. We know this is routine policy in many units - they are happy enough to disclose this. With rates of 50% it is obviously being used as routine rather than medical indication.

Other reasons to avoid ARM other than just increased risk of distress is cord prolapse, strep b - with the waters gone, if strep b is an issue, the baby is in at more risk as they will have increased contact with strep b without protection of the membranes.

If mums are happy to have routine AML (Active Management of Labour) this is one thing - but many either are uninformed of the risk/benefits or have no choice of this policy.

Hannibal Smith wrote: »

By all means women should have a choice in what kind of birth they want, but it should be done on the basis of a level playing field and objective information, if MLUs are great in their own right, promote them as such, without bringing down hospitals or their staff. And I don't see how posting your issues with maternity care here can further your protests. Should you not be tackling the HSE directly instead of doing it here? Why should we be used to fight your campaign for you?

Midwife led care is much more inclusive and has higher admissions in other countries than in Ireland - freestanding units and MLUs are inclusive of women who would be conidered "moderate" or "high" risk in Ireland and the evidence is conclusive; Midwife led care has less adverse affects on labour than consultant led care. So this is not as simple as a case of lower case loads, smaller admissions, or "low risk" women.

Consultant led care should be available for women who need or choose it. As should home birth and midwife led care in freestanding units and MLU. However it is not and the majority of us have to make due with no choice.

The evidence does show us that for women who do not "need" it there are increased risks under consultant led care and AML. Pointing this out is not "bringing down" hospitals or staff nor putting one against the other. The evidence speaks for itself: are we meant to simply ignore it? In no other realm of health care would patients be expected to ignore evidenced based practice, so why is maternity care different?

GoerGirl

On the "healthy baby" card

If routine intervention puts increased stress on a baby, increases the risk of fetal distress, increases the risk of caesarean section, increases the risk of adverse outcomes in mothers...is this really to be considered "healthy" ?

Cat Melodeon

Hannibal Smith wrote: »

And I don't see how posting your issues with maternity care here can further your protests. Should you not be tackling the HSE directly instead of doing it here? Why should we be used to fight your campaign for you?

I for one am delighted that threads are started on the parenting forum which serve to highlight both the positive and negative aspects of maternity services and other issues in Ireland. This information is not forthcoming from my own care providers nor does it receive a lot of attention in the media. I do not take any of the information I find on the internet as fact, but it is often a good starting point for further research and for becoming equipped to ask the right questions from the appropriate sources, be those sources GPs, consultants, midwives etc.

I do not feel I am being used by anyone to fight their fight for them. I know SanFran07 is extremely involved in raising awareness around maternity services in Ireland and does so in a number of different roles. Although I have never met her, her posts on here and on other sites as well as some of her media contributions have certainly affected how informed I am about how things 'should be' and helped equip me to advocate for myself when I was effectively being bullied during my own care.

Information is one of the most powerful tools individuals have in securing the best possible care and outcomes for themselves. Advocacy is all about giving people a voice where previously they felt unheard. It is not just about official protest, it is about empowerment. You may not feel the need to challenge or to advocate Hannibal, and may be perfectly satisfied with how things are, but not everyone feels the same as you, some of us feel threatened or scared or angry and want more. SanFran07 might be one of the more vocal posters, but it is not for her own personal gains, we all stand to benefit from it.

D rog

Babyblessed wrote: »

Yes we all want a 'healthy' baby thats obvious but some studies (currently being researched) are suggesting a link between anti-social behaviour and either epidural or syntocinon. Other parents will talk about feeling they needed to seek a cranial osteopaths assistance following the vacuum or forceps extraction of their child.

Do you have an impartial link for this study please?
I did find a study regarding immediate bonding sheep. But I can't find anything longer term and related to human studies. All I could find was Michael Odent and some natural birth websites.

Hannibal Smith

Cat Melodeon wrote: »

I for one am delighted that threads are started on the parenting forum which serve to highlight both the positive and negative aspects of maternity services and other issues in Ireland. This information is not forthcoming from my own care providers nor does it receive a lot of attention in the media. I do not take any of the information I find on the internet as fact, but it is often a good starting point for further research and for becoming equipped to ask the right questions from the appropriate sources, be those sources GPs, consultants, midwives etc.

I do not feel I am being used by anyone to fight their fight for them. I know SanFran07 is extremely involved in raising awareness around maternity services in Ireland and does so in a number of different roles. Although I have never met her, her posts on here and on other sites as well as some of her media contributions have certainly affected how informed I am about how things 'should be' and helped equip me to advocate for myself when I was effectively being bullied during my own care.

Information is one of the most powerful tools individuals have in securing the best possible care and outcomes for themselves. Advocacy is all about giving people a voice where previously they felt unheard. It is not just about official protest, it is about empowerment. You may not feel the need to challenge or to advocate Hannibal, and may be perfectly satisfied with how things are, but not everyone feels the same as you, some of us feel threatened or scared or angry and want more. SanFran07 might be one of the more vocal posters, but it is not for her own personal gains, we all stand to benefit from it.

I don't believe it's about giving people a voice. I believe it's about promoting a business.

Hannibal Smith

Babyblessed wrote: »

Why is the 'healthy baby' argument always rolled out???
I chose home birth because I wanted a healthy experience for my child, myself and my family. Yes we all want a 'healthy' baby thats obvious but some studies (currently being researched) are suggesting a link between anti-social behaviour and either epidural or syntocinon. Other parents will talk about feeling they needed to seek a cranial osteopaths assistance following the vacuum or forceps extraction of their child.

We really dont know what affect all the interventions have on the baby into the future. What we do know is that the 'feel good' hormones elicited in NORMAL birth have a positive effect on infant/maternal bonding and breastfeeding.

Health isnt just the physical, its social, emotional and psychological too.

What healthy baby argument? Where did I say if you chose a home birth you don't want a health baby?

The point I was making was that an accurate or fair comparison cannot be made between the MLUs and the maternity hospitals because of the stark difference in the number of women involved and because the MLUs only select low risk pregnancies.

Hannibal Smith

GoerGirl wrote: »

THere are other ways to check for meconium.

Routinely speeding up labour by ARM and oxytocin puts mum and baby at a much more elevated increase risk of not tolerating labour = fetal distress. We know this is routine policy in many units - they are happy enough to disclose this. With rates of 50% it is obviously being used as routine rather than medical indication.

Other reasons to avoid ARM other than just increased risk of distress is cord prolapse, strep b - with the waters gone, if strep b is an issue, the baby is in at more risk as they will have increased contact with strep b without protection of the membranes.

If mums are happy to have routine AML (Active Management of Labour) this is one thing - but many either are uninformed of the risk/benefits or have no choice of this policy.




Midwife led care is much more inclusive and has higher admissions in other countries than in Ireland - freestanding units and MLUs are inclusive of women who would be conidered "moderate" or "high" risk in Ireland and the evidence is conclusive; Midwife led care has less adverse affects on labour than consultant led care. So this is not as simple as a case of lower case loads, smaller admissions, or "low risk" women.

Consultant led care should be available for women who need or choose it. As should home birth and midwife led care in freestanding units and MLU. However it is not and the majority of us have to make due with no choice.

The evidence does show us that for women who do not "need" it there are increased risks under consultant led care and AML. Pointing this out is not "bringing down" hospitals or staff nor putting one against the other. The evidence speaks for itself: are we meant to simply ignore it? In no other realm of health care would patients be expected to ignore evidenced based practice, so why is maternity care different?

The comparison wasnt being made in the opening post between MLUs in other countries, so I can't make any comment on what you say on that score.

My point was that breaking the waters, wasn't being done for sinister reasons.

What about birth plans? Are these not used?

GoerGirl

Hannibal Smith wrote: »

The comparison wasnt being made in the opening post between MLUs in other countries, so I can't make any comment on what you say on that score.

My point was that breaking the waters, wasn't being done for sinister reasons.

What about birth plans? Are these not used?

Hi there,

I am not sure I understand; in what way are you wondering about birth plans?

I hear you when you say that breaking the waters is not done for sinister reasons - in fact, I feel that by in large, the majority of care providers are genuinely trying to help. Despite this, we cannot ignore the fact that breaking the waters as routine has been shown to do more harm than good - so while not "sinister" it is still unproductive and can instantly change the pattern of the labour for the worse.

GoerGirl

D rog wrote: »

Do you have an impartial link for this study please?
I did find a study regarding immediate bonding sheep. But I can't find anything longer term and related to human studies. All I could find was Michael Odent and some natural birth websites.

If I recall, there were research articles in relation to investigations for a link between oxytocin and autism - it was published in the Harvard magazine and also picked up by Michael Odent. From what I recall, further studies - including one out of TCD, debunked the autism link. I would have to look it up but could find links for you if you are interested?

There are currently investigations on research correlating oxytocin and child behavioral issues - ADHD mainly

D rog

I was curious personally as to whether there was any solid real statistics around this. So there is no confirmed research, just ongoing research some of which was debunked? Any released research I'd be interested in links if you have them?

I'm not keen on Michael Odent so didn't want to read anything by him to be honest.

GoerGirl

D rog wrote: »

I was curious personally as to whether there was any solid real statistics around this. So there is no confirmed research, just ongoing research some of which was debunked? Any released research I'd be interested in links if you have them?

I'm not keen on Michael Odent so didn't want to read anything by him to be honest.

Hi there, no problem. Here is what I can find so far. My background is mental health so most of the links are related to this area rather than a "maternity" setting.

Articles speculating link of oxytocin to autism:

1. Oxytocin, Pitocin and Autism: Researchers wrestle with links

http://www.psychiatrictimes.com/autism/content/article/10168/57071

2. Harvard Magazine: Beyond the Genome: http://harvardmagazine.com/2008/01/beyond-the-genome.html


3. Harvard Magazine: A Spectrum of Disorders: http://harvardmagazine.com/2008/01/a-spectrum-of-disorders-html


Articles which counter the speculation after the discovery of a genetic link:


4. ‘Irish Researchers Discover New Autism Genes as Part of Major International Research Project’ (It was UCD not TCD!!)

http://www.ucd.ie/news/2010/06JUN10/100610_autism.html


5. Harvard Magazine: Autism Update

http://harvardmagazine.com/extras/autism-update

New Research: Oxytocin and ADHD link (?)

New Risk for ADHD Identified - Use of Pitocin During Labor
http://www.suite101.com/content/new-risk-for-adhd-identified---use-of-pitocin-during-labor-a369228


From what I can see - there is nothing to suggest that oxytocin can be directly correlated with autism as the discovery of the genetic link is substantial.

There continues to be arguments in some fields for further research to investigate if oxytocin somehow mutates brain chemistry of infants, I have no further information on this at the moment.

I hope this helps?

Hannibal Smith

GoerGirl wrote: »

THere are other ways to check for meconium.

Sorry to drag this thread up again, but I've been searching online (given that I've no access to medical books ) and I can't find any other way of checking for meconium during labour? I have found plenty of information on them being able to trace whether you've taken drugs or alcohol during your pregnancy though What other ways are there of doing it?

Apparently there's another reason for breaking the waters, in case, during labour, your baby goes into distress and they need to attach the monitor to the baby's scalp, they can't do that if your waters are intact.

Cat Melodeon

Hannibal Smith wrote: »

Sorry to drag this thread up again, but I've been searching online (given that I've no access to medical books ) and I can't find any other way of checking for meconium during labour? I have found plenty of information on them being able to trace whether you've taken drugs or alcohol during your pregnancy though What other ways are there of doing it?

Apparently there's another reason for breaking the waters, in case, during labour, your baby goes into distress and they need to attach the monitor to the baby's scalp, they can't do that if your waters are intact.

I'm wondering why there is any need to check for meconium at all. I mean, I understand the problems it can cause, but is it necessary to routinely break waters just in case it is there even if labour is going normally and baby is doing fine? Genuine question, I don't have a medical background.

I think any situation where a baby is in distress, any mother would be happy to consent to ARM and monitoring. However those are not normal births. It is still difficult to see how at least 43% of births in Kilkenny become 'not normal'.