Prince William and Kate Middleton (Duchess of Cambridge) welcomed their second child into the world this week. You may have seen something about it in the press. 😉 Everyone oohed and aahed over their baby girl, talked about how amazing Kate looked, and who made her dress, and even how early she left the hospital. But one thing that did not get much press is that Kate chose midwife-led maternity care. Although a team of doctors was at the hospital on-call, two midwives delivered the baby girl just two and a half hours after she arrived at the hospital, and Kate and baby Charlotte departed less than 12 hours later. It was clear that she had a low-key birth. From my perspective, it was a great example of the benefits of midwife-led maternity services that are definitely the norm in Europe.
My introduction into the Irish health system was fast and furious. A week before we departed for Ireland, I found out we were unexpectedly expecting our third child. We were completely surprised. I don’t know anyone who plans to get pregnant in the middle of an international move. We were literally about to board a plane to the other side of the world, and there really wasn’t anything else to do but figure it out once we got here. I had to navigate a completely different maternity and healthcare system in only a matter of weeks. In Ireland, as in the UK, you have your choice of public, semi-private, and private maternity care. I won’t go into the differences in this post, but we chose private care simply because it was the plan most similar to the US system, and we had private health insurance through Brad’s employer. As in the US, I selected an OB, and saw her at every appointment. The difference that I noticed right away was how my general practitioner and my OB treated pregnancy as a natural part of life, not a condition that needed to be ‘treated’. For the record, I was very happy with my choice of OB for my first two pregnancies in the US. My doctor was a very low-key, hands off, calm guy. I say this only to point out that I wasn’t resentful, or looking for differences between the systems to prove a point. No “ax to grind” here.
The approaches to pregnancy, labor, and delivery are just very different. There was not a focus on the lists and lists of things pregnant women should avoid. It was perfectly fine to exercise, eat seafood, even have a glass of wine occasionally. Part of this was that this was my third pregnancy in 4 years. I knew what to expect, and when to speak up when I had questions. But I really liked the hands-off approach. I felt less stress about doing all the “right things” vs “wrong things”. I am not a share-all-the-nitty-gritty-details-of-my-labor-on-the-internet kind of gal, but on the night Patrick was born, we checked into National Maternity Hospital around 11:30 pm. I was attended by a midwife the entire time. Not only did she not intervene, she also relied on my judgement. It felt like much more of an egalitarian relationship. When Isaac and Liesl were born, the delivery room was full of people. Probably 8-10. There were nurses and pediatric nurses, and an assistant or 2. So many people! Part of it was that the hospital had rounds of medical school students that observed the birth. (This didn’t bother me particularly. When I was about to have Isaac, my OB asked if I minded if a few Physician Assistant students observed the birth. I told him that I didn’t care if he sold tickets and popcorn, but the baby was about to be born RIGHT THEN. )
In contrast, when Patrick was born, it was just myself, Brad, and the midwife in the delivery room. I was amazed how much calmer the room was, and how it felt much less chaotic. Although my OB intended to be at the birth, things moved so quickly that she didn’t make it in time. But even if she has been there, it is unlikely that she would have delivered Patrick, as the midwife was fully capable. Patrick was born at 3:23 am, and we left the hospital about noon that day. I wasn’t forced to leave early, and could have stayed at least 2 nights for a regular delivery and 4-5 nights for a cesarean birth. But I asked to go home that day, as I was feeling fine, and would much MUCH rather sleep in my own bed and rest at home. Now, I swapped my Jenny Packham dress for yoga pants and a t-shirt, and I’m sure my hair was a wreck and my skin was blotchy, but the health care system was completely supportive of me going home when I wanted. The very next day, Judith, our local public health nurse, came by to check on Patrick and I. She’s also a registered midwife. She brought her own scale to weigh Patrick, and check him over. She came every day or every other day for the next 2-3 weeks. Patrick became jaundiced a few days after birth, and it took awhile to clear from his system. It was so nice not to have to take a newborn into the doctor’s office with all the sick people around. Judith just came to the house!
I spent a lot of time thinking about this over the past week, which is why I haven’t posted earlier. I didn’t write this post because I think that midwife-led care is the answer to all pregnancy conditions and situations. I fully understand that pregnancy can be a complicated and volatile situation for some women, and that other women prefer to make other choices. But I do wonder if there the standard of care was a low-intervention, midwife-led approach, would we have better maternal outcomes? I think there’s value in midwife-led maternity care and this is overlooked right now in the US. I also loved how in Ireland, you could opt to have a low-intervention birth at a hospital. I have written before about how the US can become a place of absolutes: hospital vs home birth! doctor vs midwife! But there doesn’t appear to be a clear middle ground. Here in Ireland, as in the US, a range of options is available, from midwife-assisted home birth to elective cesarean section, but I loved how midwife-led maternity care is the solid middle ground.