Pregnancy and Birth in Ireland

 

 

 

 

 

 

 

 

 

Ireland has the lowest maternal mortality in the developed Western world with only 1 maternal death per 100,000 live births. This is a striking comparison to the United States’ rate of 11 maternal deaths per 100,000 births. What factors might impact the maternal mortality rate in Ireland, leading to more favorable maternal outcomes?

While infant and maternal safety are still the paramount concerns when discussing maternity care, this safety is not defined in any concrete way. The failure to define the concept results in women who cannot make fundamental choices pertaining to their births. With the increased medicalization of childbirth, women’s choices have been limited to little more than choosing a natural birth or an epidural, and (in Ireland) whether to use a public or private health care provider (Devane, 2007:93).

Devane states that even 20 years ago the “lack of control over the birth process” was a significant factor in the development of postpartum depression, which at the time was attributed to increasing technological interventions in birth (2007:94). Today, while technological interventions have increased, the use of such interventions is not the true exercise of choice but, as Devane argues, “a response by the individual woman to confusing and unsupportive circumstances where she is being asked to fit in with a pre-arranged system” (2007:94). The increased medicalization of childbirth has in some ways stripped women of their ability to make choices regarding birth, even when those choices would embrace a medicalized childbirth.

The framework surrounding pregnancy and childbirth in Ireland has changed in the last 5 years, following an increase in midwife- and maternally-led care. Following the increased safety of birth that developed in the 20th century in developed nations, maternity care in Ireland has undergone some fundamental changes. Maternity care, once only dealing with the safety of mother and child, is now beginning to encompass ideas of maternal choice, and informed choice in lieu of solely provider-directed choice (Devane, 2007:93).

The impetus for change in the birth system of Ireland came after a 1996 conference held by practicing midwives, childbirth groups and academics. This conference, titled “Mother and Child 2000” strove to communicate the possibility that, “perhaps by the year 2000, [they] would begin to see the realities of woman-centered care established in Ireland to the benefit of both women and midwives” (Devane, 2007:94).

In the years following the conference, there have been significant changes in Irish maternity services and policy structure. In 2004 a midwifery-led pilot program was instituted in two hospital units. As pilot programs they were under considerable scrutiny, especially in terms of safety. The midwife-led units were examined within obstetric care units before the units were considered for stand-alone care. The recent changes involving midwifery-led care have made a dramatic impact, both in terms of local policy revision, and the organization of women and midwives who press for the examination of existing policies and laws in place regarding childbirth.