Can mum ever be the boss of her pregnancy?
The advancement of medicine and obstetrics saves many lives and is essential care in high risk cases, but Simone Kenny asks if medical intervention can sometimes cause unnecessary complicated outcomes?
Before my first pregnancy I had a huge fear around childbirth. I think most women do, and with images of exhausted, sweaty women in excruciating pain lying on a hospital bed as our main frame of reference, it's no wonder really.
And despite it being a natural and frequent occurrence, until you are thrust into the maternity world, giving birth seems like the most unnatural thing in the world.
For most first-time mums, pregnancy plus frequent hospital encounters equals very anxious ladies.
However, fear and childbirth do not go well together. Too much adrenalin, our 'fight or flight' hormone that is released during times of stress, fear or extreme pain, can impede labour. So the more relaxed you feel during labour, the better your birth experience.
This is probably why an increasing number of women are doing pregnancy yoga and hypnobirthing, which teaches relaxation and breathing techniques, among various other things.
According to Louise Ní Chríodáin, co-author of ebook Bump To Babe: "The interest in hypnobirthing amongst women seems to be growing, as they hear about its effectiveness from friends, family and even public figures like Kate Middleton and Jessica Alba (pictured right)."
To help allay my fears I tried to gain as much knowledge as I could, including practising yoga and learning the principals of hypnobirthing. Learning about the different stages of labour and how hormones can enhance or inhibit labour made me feel more relaxed and confident about giving birth naturally.
Of course I was still concerned about my baby and all the possible outcomes but, ultimately, I felt empowered and prepared for the birth.
Most women give birth in hospitals and, by association I assumed that the birthing process was a medical one that was controlled by doctors. But I soon discovered that medical intervention is only necessary should complications arise or if you choose it. Although once a rarity, medical intervention is very much the norm today.
So how has childbirth evolved from being an event exclusively assisted by other women that occurred at home, to one that now takes place in a hospital?
Jessica Alba and her children
A more technical approach to childbirth developed in the 1700s. According to the British Science Museum, prior to this women dealt with straightforward births, while male physicians were called when complications needed physical intervention.
Man-midwives became popular with the upper classes during the 1800s (wealthy families began calling for the invariably male doctor), and female midwives became associated with the poor.
Although the majority of births were still attended by midwives at home until the early 20th century, obstetricians began defining 'normal' childbirth standards, and the ideal environment to monitor, manage and intervene in childbirth was the hospital.
In Ireland, the Mother and Infant Care Scheme (Mics) was introduced in 1956 and resulted in maternity units being overseen by obstetricians, and so the medicalised birthing experience began.
Today, the measuring of foetal heart rate has become commonplace and pain relief, induction and Caesarean sections are often seen as a normal part of birth rather than an exception.
While there's no denying that the advancement of medicine and obstetrics saves many lives and is essential care in high risk pregnancies, can medical intervention cause unnecessary complicated outcomes in low risk pregnancies?
According to Margaret Hanahoe, co-author of Bump To Birth and assistant director of nursing and midwifery at the National Maternity Hospital: "There is no doubt that medicalisation has a huge impact on normal birth.
"For example, if you place continuous monitoring on every low risk baby you will increase the intervention rate. Epidural, meanwhile, will lead to continuous monitoring and because of lack of sensation in your pelvic area, can lead to an instrumental birth such as forceps or ventouse."
This was not the birth experience I wanted. My pregnancy was low risk so I trusted my body's ability to give birth naturally and didn't want any unnecessary medical intervention.
I also knew that, for me, a hospital environment wasn't conducive to a relaxed labour so I planned on labouring at home for as long as possible. Although I wasn't in the catchment area for midwifery-led care, maternity care is slowly moving away from a traditional hospital environment into clinics.
"There has been big changes over the last 15 years," says Hanahoe, who set up and developed Ireland's first community midwifery programme - the DOMINO (domiciliary in and out) at the NMH.
"Cavan and Drogheda commencing standalone units was a great development and the study that followed really supported midwifery-led low risk care in lreland," she says. "The Coombe have recently started a DOMINO service as have Cork University Hospital. Many clinics have opened over the last four years, which are run by midwives."
Despite my research, when it came to the birth I still felt very vulnerable and things got off to a bad start.
Unfortunately, when I was admitted to hospital in labour I received a dressing down in a public corridor - mid-contraction - for not coming in sooner, despite previous hospital advice; not a great start.
My birth plan was evidently also a source of irritation. I devised a birth plan so that my choices could be conveyed clearly at a time when I was at my most scared and vulnerable.
Verbal communication during painful contractions is not easy, so a birth plan allowed me to focus on my labour while the midwife, who I had only just met, got to know me.
After the midwife read my plan she actually laughed at my preference to birth without an epidural.
"We'll see about that," she said before telling me I didn't need to be a martyr. I felt that this was not respectful.
I stood firm and, thankfully, my care experience began to improve.
Three midwives and nine hours later I gave birth in hospital to a healthy baby boy, Étienne.
The midwife who eventually delivered my baby was hugely supportive and genuinely helped me to achieve the birth that I had wanted.
I gained huge confidence from the birth and my decision to stand firm on my choices, but my second pregnancy two years later provided a different medical hurdle.
Raised blood pressure during a routine check-up in my 39th week led to me being admitted and almost induced, despite several tests and foetal monitoring confirming the well-being of my baby and I.
Feeling frightened and vulnerable I had to make a case for my birth choice once again.
Where was the line between taking precautionary measures and ensuring a safe outcome, while also listening to the mother and allowing her to trust her instinct and have input in her own care?
The obstetrician was eager to get my labour underway artificially and was perplexed as to why I wasn't when I objected to a sweep, which can induce labour.
My baby was otherwise healthy and not in any distress so I wanted labour to occur naturally.
During normal, natural labour, mum and baby both release hormones, which work together to get labour established. Induction can interfere with this natural hormonal process, which can sometimes lead to a string of interventions.
"The best example of interventions causing complications is induction," says Hanahoe.
"Statistics show that in women who are induced on their first baby, the Caesarean section rate soars from 8pc to 30pc.
"The difficulty with this statistic is we are still not sure if it is the induction that causes the section or is it the reason for the induction that causes the section."
Opting not to be induced wasn't a decision I made lightly, but having weighed up all the evidence I felt I could achieve a better outcome if I was allowed to birth naturally.
I found the midwives really supportive of my choice and I eventually convinced the obstetrician too. I was discharged with blood pressure medication and an appointment for four days later.
Happily, three days later my waters broke spontaneously and, following a shorter but more intense natural labour, I gave birth to another healthy baby boy, Quinn.
For me, being allowed a say in my care and to birth in a way that I felt safe and relaxed led to the uncomplicated delivery of my two sons, but was clearly not without its challenges.
According to Hanahoe, the level of input women are afforded in their care can be determined by their location, but knowing what you want is key.
"Your options of care given will be limited by your geographical location and what services are available within your area.
"However, women can have choices even within those restrictions if they know what they want. If your request is safe and within reason there should be no problem with getting your choice in any service or location."
I would encourage every mum-to-be to research all the options available to them as well as all the possible outcomes.
Don't be afraid to question your caregiver if you're uncomfortable or unsure about a clinical decision, and stand firm on your choices once you're satisfied that baby is not in any distress.