Being a Doula in Irelandby Tracy Donegan, CD(DONA)
As Ireland's only DONA approved birth doula trainer, I thought I would share my experiences of the Irish birth scene and give you a little flavor of the life of a doula in Ireland.
I began the first doula service in Ireland four years ago, and we continue to be faced with strong opposition from doctors and midwives. This situation is very frustrating for a DONA approved birth doula trainer, as most doulas cannot attend hospital births unless they are the designated birth partner - making the mom choose between her partner and her doula. Some of the less-busy hospitals are slightly more accommodating, but we are always aware that we could be asked to leave a birthing room at any moment without any justification.
Preparing for Birth in Ireland
Of course, the US favourite, What to Expect When You're Expecting, is very popular with Irish moms-to-be. There are two Irish pregnancy books. One of these is my own, The Better Birth Book: Taking the Mystery (and Fear) Out of Childbirth. My second book is due out this summer and is a guide to cesarean birth and VBAC in Ireland. Another popular book in Ireland is The Irish Pregnancy Book, written by Peter Boylan, a former Chief of Obstetrics. This book is extremely medicalized and recommends episiotomies, birthing on the bed, rupturing the membranes routinely, Pitocin and immediate cord clamping.
Childbirth classes are provided free by the hospital and by several independent providers. I teach an antenatal class called GentleBirth, which incorporates birth hypnosis, active birth and informed decision-making. I have also created a positive birth preparation program as a home study class.
Birth in Ireland
Similar to the United States, arond 98 percent of babies are born in the hospital. Homebirth services are very limited and are provided by a few self-employed midwives and a couple of hospital homebirth programs.
Approximately 75,000 babies are born in reeland every year. Around 26,000 babies are born in the capital city of Dublin, but there are only 30 birthing suites available. You can imagine what that means for moms who want to labour in their own time! A natural, unmedicated birth in uncommon unless the mother arrives at the hospital in advanced labour.
There are two Midwife Led Unites (onsite birth centers) in Ireland. There are curently no stand-alone units, but this is something I would like to establish when I finish my midwifery degree in two years. Doulas are generally accepted as additional birth partners within these units as the care is much more focused on mother-friendly practices.
The active management of labour protocol began at our National Maternity Hospital in Dublin and is still very common in Ireland (waters are broken on admission and if mom is not following the one centimetre per hour dilation rule, she is augmented with Pitocin). Approximately 40 percent of first-time moms attending our National Maternity Hospital are augmented. There are roughly 8,000 births in this hospital, but there is only one shower in the labour ward and no bath. So, being at home with a labouring mom can really help her stay comfortable and in control of her own environment.
Maternity care is free to European citizens. About 40 percent of healthy moms will choose private obstetric care and will pay approximately $6,000 to their doctor, who may or may not attend the birth. All of the care during labour is provided by midwives.
Evidence-based practices are very limited and not all the staff appreciate those parents who do their homework and express particular birth preferences, such as delayed cord clamping. Informed choice is almost non-existent.
Although most moms give birth in a private room, they will sometimes labour in a ward with 12 or more other women.
Water birth is only available at a homebirth with a self-employed community midwife. Two of our largest hospitals have beautiful pools but refuse to even let moms labour in them. I organized a water birth study day in July 2009 with a UK expert on water birth for students, midwives and doulas. None of the staff from the two hospitals that have birth pools attended.
Ireland's cesarean rate is approximately 25 percent to 30 percent in some places and is increasing. VBAC rates vary widely depending on the hospital and can be anywhere from 6 percent to about 70 percent. Episiotomy rates are still high and range from 10 percent to 40 percent in places.
Unlike in the United States, all healthy babies room in with their moms in the hospital. Even so, postnatal care leaves a lot to be desired. Often, post-cesarean moms are unable to reach their crying babies or are too medicated to take care of a newborn; and the shortage of night staff makes this situation even worse. Moms get little privacy after birth, and a woman can sometimes share a postnatal ward with up to eight other moms and babies.
Breastfeeding rates leaving the hospital are very low (around 35 percent) and artificial feeding is the norm. Although we have quite a few Baby-Friendly hospitals, breastfeeding rates remain low.
Ireland's Birthing Future
There are several active doulas in Ireland, but in some areas there are no doula services available. It is my hope that as more mothers demand that doula care be an option available to them in hospitals, we will see an increase in the accessibility of doula services and more options available to birthing women.