A year ago, in Ireland, Denise Livingstone went into premature labour and was turned away by her local hospital as its maternity unit had recently been closed. She had to travel an extra 30 miles on country roads, giving birth on the way. Tragically, her baby
girl, Bronagh Mary, later died, giving rise to a row about provision there. Ireland has gone down the path of centralisation with even greater vigour than Scotland and has ended up with some of the worst maternity services in Europe. In Ireland, 83% of smaller maternity
units were closed between 1976 and 2000. Pregnant women are required to register in big hospitals and home births are not covered by state health provision.
Ireland has a large rural population and women who are not permitted to give birth at home must travel long distances to hospital. Because of the high throughput of labour wards and for convenience, more than half of first-time mothers have births ”induced” by a synthetic hormone called syntocinon. This procedure frequently fails completely or
partially, and leads on to the use of forceps, vacuum pumps and emergency Caesarians, all of which increase the risk of complications.
Scientists do not quite understand what causes labour to begin. It is like the question of what makes an apple fall from a tree – there are a number of factors not all of which are easy to control. Therefore, it is difficult to prevent premature labour or to start labour when a baby is due. Almost a quarter of births in Ireland are now by Caesarian – double the WHO safety limit and the perinatal death rate in 1999 was 8.2 per 1000 compared to an EU average of 5.2 per 1000. In contrast, the Netherlands is the gold standard of maternity services. There, a third of babies are born at home under the care of independent midwives, who try to establish trust and confidence and allow the labour to unfold in
its own time. In the UK, artificial time limits are set – if this or that stage does not happen within a certain time-frame, machines will be introduced. In the Netherlands, more emphasis is placed on the human element, and it is recognised that women’s bodies are different and that faster is not always better when it comes to giving birth.
The Netherlands has a very good safety record and the lowest Caesarian rate
in Europe, at 10%. Importantly, women there also say that they take a feeling of ”great strength” from their experience of natural and nurtured birth. Centralising birth services in big hospitals does appear to lead to more intervention and a more machine-oriented approach.
Healthy babies and healthy mothers are, of course, the most important considerations in planning maternity provision. But not the only considerations – how women feel at the end of the process is important, too. Sometimes a woman can feel pretty much as if she has been in a near-fatal car crash, and that experience and its aftermath and effect on her mental health should be taken seriously. We now know that women who undergo emergency Caesarians are less likely to go on to have more babies, and it has emerged recently that they sometimes suffer from post traumatic stress disorder.
No-one who has seen a woman after having a Caesarian can honestly think it is the easy option. After a natural birth, women often seem well, whereas after a Caesarian they are often unable to walk and in tremendous pain from their wounds. As well, death rates for women are elevated. Local maternity services and a supported programme of home birth are better for women and babies, and they are what women are demanding. However, providing these services properly is a more expensive option. Scotland’s politicians should fight harder over the Barnett formula.
They have allowed Westminster to claim that the cost of providing services such as health and roads should be assessed on a per capita basis. The Wick case is an example of why providing a comparable level of service costs more for a scattered rural population
than for a dense, urban one. Opening Christmas cards showing the most famous
pregnant pin-up in history travelling against her will to a strange town, health providers and politicians should all spare a thought for the plight of Highland women.
The Scottish Herald
December 17th 2003