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21 st Century maternity care is in crises as ‘actively managed' hospital births create unnecessary suffering for mother and baby.

babiesIn the Republic of Ireland, efforts are increasing to centralise births to hospital wards in and around city centres. Womens groups, unhappy about this , argue that these proposals would put thousands of womens lives at risk. The Medicinal Manpower Forums , which is responsible for the decision, plans to reduce maternity services up to one half by relocating Dublin's two main labour wards to hospitals on the outskirts of the city. They also propose the closure of nine baby units around the country.

These closures evoke memories of the death of a baby girl born on the roadside in an ambulance in December last year. Her labouring mother was turned away from Monaghan General Hospital, whose maternity unit has been closed, with tragic consequences.

The Institute of Obstetricians and Gynaecologists has echoed calls by the National Birth Alliance for no closures after they were forced to withdraw their services from Monaghan and Dundalk Hospitals in the face of fierce local protests ; and no other maternity facilities have replaced these suspended obstetric services.

Removing services from rural and community settings to larger centralised units began in Ireland in 1976. The decisions were based on national figures of 2 000 annual births and the allocation of one labour ward bed per three women per twenty-four hour period to begin with. Therefore, all pregnant women, regardless of their general state of health, were required to register with consultant obstetricians in big hospitals. Between 1976 and 2000 , 83% of Irelands' smaller maternity units run by midwives and GPs were closed.

It is estimated that more than half all babies born in the Republic of Ireland hospitals this year will have ‘actively managed' births. Active management is tailored to meet the needs of the hospital not the woman. Centralising birth means more women and increased medical interventions. Invasive techniques such as induction to speed up labour leads to greater use of forceps, vacuums and caesareans. The caesarean rate in Ireland is almost 1 in 4; double the safety limit set by the World Health Organisation.

A major cause for concern on Irish maternity wards is the use of drugs to induce labour. A synthetic form of the naturally occurring hormone oxytocin, known as Syntocinon, is given intravenously to 50% of all first time mothers at The National Maternity Hospital in Dublin. Syntocinon is cited frequently in medical negligence cases as a contributory factor in foetal deaths during labour as well as infant brain damage. Dublin 's three main hospitals confirmed to the Irish Times that specific consent is not sought for interventions during labour and their routine procedure for induction is to ‘spike' the mothers' amniotic fluid with a hook (amniotomy) and introduce Syntocinon via a drip.

The National Institute of Clinical Excellence describes amniotomy in their childbirth report as not just a single intervention, but a complex set of interventions, which presents challenges for clinicians and mothers.

The Association of Radical Midwives takes a dim view of the procedure of breaking the amniotic membranes to release the fluids surrounding the baby in the womb by force, known as ARM or Artificial Rupture of Membranes. When intact, the fluid cushions the baby as it is expelled from the birth canal. This ‘caul' protects against infection and can be broken soon after birth. When membranes are forcibly broken more pain is created for the mother because the baby's skull has direct contact with the cervix. There are cases where ‘waters' break spontaneously or it becomes advantageous for the health of mother and child to break the membranes before birth, but generally they serve a natural purpose.

A 1999 report by The Economic and Social Research Institute revealed that Ireland has the highest perinatal death rate in the European Union. The average peri-natal death rate in Europe is approximately 5.2 per thousand. Irish babies, however, face an 8.2 per thousand risk of death . Roadside births that occur outside hospital carry even higher mortality rates of 68 per thousand, eight times higher than planned hospital birth and sixteen times higher than home birth. A national survey showed that for every woman who plans a home birth there is a mother who fails to reach hospital in time to deliver her baby due to the long distance travelled.

Post- natal care in Ireland is also among the lowest in Europe. Women are discharged at great haste from their hospital beds, within twenty-four hours if it is not their first child. Support services from community midwives have been run-down and breast-feeding rates are 30% lower than mainland Britain.

The Dutch Model

In contrast, standards for women and child health care in Holland are first rate. Here , 32% of births take place at home under the expert care of an independent midwife. Medical interventions are unheard of in successful home births. Time and nature go unmanaged and trust between mother and midwife is essential. If mother or child encounters difficulties during labour, they will be transferred to their local birthing facility, which on average is a fifteen-minute journey away. The Dutch caesarean rate of 10% is the lowest in Europe.

Post-natal care is also radically different for women in Holland. Every new mum is assigned one of 6 000 maternity assistants called a Kraamverzorgster . She stays with the mother and child for up to 8 hours a day for 8 days. Her duties include cooking, cleaning, caring for any other children and light household chores. This service costs about £1 000 and is provided by the State or health insurance. Dutch women report a feeling of “great strength” from their natural and nurtured birth experience rather than the distressing stories of “powerless” hospital births recalled by their European counterparts.

Eight Million Babies Die Every Year

Elsewhere in the world, three million women give birth every year without the help of a professional birth attendant with midwifery skills. In 2001, ISIS covered the persecution of Malaysian midwives, the Bidan, who practised midwifery for centuries until mechanistic models of medicine encouraged their government to fine and/or imprison these women caught attending a birth. Intolerance to traditional birthing methods puts women's lives at risk. In the majority of healthy pregnancies, labouring women need midwives, not machines.

Four million newborns die each year before they reach the first month or life and four million babies are stillborn. A report released by the charity Woman and Children First, The Institute of Child Health and Save the Children called State of the World's Newborns examines the link between healthcare in developing countries compared to Europe and USA. The risk of peri-natal death is thirty times higher in West Africa than in Europe or North America.

The report recommends simple practices for mother and child health; skilled attendance at birth, hygienic delivery environments, keeping babies warm and ensuring mothers receive basic health care throughout pregnancy and after birth.