Holles Street a much loved institution with many Dublin parents and it has a very unique approach to labour and birth. There are two very different ‘styles’ of birth at NMH for healthy women and depending on which care option you’ve chosen you may not be aware of the other.

The Irish National Maternity hospital is making strides towards evidence based care with it’s award winning innovative ‘Labour Hopscotch’ created by a forward thinking Midwife Sinead Thompson.  Mobility in labour has been shown in study after study to shorten labour, reduce fetal distress and reduce the need for medication as well as improving mum’s feelings of control and satisfaction. This is a great example of supporting the physiology of birth but then on the public/semi-private/private side you have this opinion from a prominent former consultant and pregnancy book author.

“Squatting or kneeling on all fours confers no advantage, gravitational or otherwise. In fact these positions make it more difficult for medical staff to see what's going on and to help accordingly”

What I find most unsettling as a midwife myself is the love affair with routine amniotomy (breaking the waters) as a routine procedure for all women in labour. Despite the evidence recommending this outdated procedure be abandoned for healthy women in labour.  Read one mother’s recent frightening experience here. The year before AML became the usual approach at NMH a study was published detailing potential risks of ARM to the baby.

Within 9 to 12 minutes the fetus will often respond by violent and frequent movements and/or by alteration in fetal heart sounds as in the distress state.

The National Maternity Hospital’s perspective is that this will help avoid a prolonged labour. When you put it like that then it might make sense if it helps the small percentage of Mums who experience a prolonged labour (depending on your definition of prolonged…). If I was having a prolonged labour this might be something I might consider - but I’d also like to know the risks associated with this so I can make an informed decision - yet those risks are not discussed in the NMH antenatal classes nor when the amnihook is presented to you. If you choose to opt out of this unnecessary and potentially risky procedure parents are being told they have no choice but to have continuous monitoring. This goes against the HSE policy on monitoring your baby in labor as well as international recommendations around the world.

International guidelines suggest that labour is ‘stalled’ or prolonged when mum has been at 6cm for 4 hours.

With birth rates at between 9000 -  10,000 births …and only 9 delivery rooms the pressure is on. Unfortunately NMH is understaffed (as are most units) so they have to limit the length of time that a Mum labors - yet other hospitals have not adopted the same policies to manage staffing.

Readers may find some of the following quotes from NMH’s birth management guidelines thought provoking (and possibly distressing).

Quotes from the Active Management of Labour Manual

‘Duration of labour is also a matter of utmost practical importance to administrators because the delivery unit constitutes the bottleneck in a maternity service through which all women must pass. The result is that it is not possible to plan maternity hospital accommodation or to allocate professional staff unless the total number of hours women are in labour can be calculated in advance’


‘At NMH your care is not individualised….your care is standardised, routine care that every woman attending the obstetric clinic is 'offered’ - UNLESS she decides she would rather have individualised, evidence based care and has written birth preferences declining routine intervention.  But even then it is subject to review by staff who will determine if they find your birth preferences ‘appropriate’….  

'The main purpose of antenatal preparation - and should always be seen to be - to define a woman’s role in labour and to teach her how to fulfill it…’

'An expectant mother owes it to herself, her husband and her child, and to every other woman sharing the facilities of the same delivery unit, to be well briefed on the subject of a mother’s contribution to labour. The disruptive effect of one disorganised and frightened woman in a delivery unit extends far beyond her individual comfort and safety, and there should be no hesitation in telling her so’.

'Where necessary, it should be bluntly stated that midwives are not expected to submit themselves to the sometimes outrageous conduct of a perfectly healthy women who cannot be persuaded to cross a narrow corridor from an antenatal clinic to attend classes….’

‘Such women must learn how to behave with dignity and purpose during the most important event of their lives. Nor should midwives be held responsible for the degrading scenes that occasionally result from failure of a woman to fulfill her part of the compact….’.

There is no doubt that NMH has some amazing staff who strive to provide the best care they can under very difficult circumstances. There are some fabulous midwives and excellent obstetricians. And for any mums who arrive in to the labour ward with the waters already released and in active labour your experience will probably be very different.  But it your waters haven’t released be prepared that your birth preferences may not be accepted (at least not until 10 discussions have been had) as you try to focus on your labor.

If you have no birth preferences your Midwife is obliged to follow the hospitals birth plan for you (breaking waters, 2 hourly exams, Syntocinon drip etc). One colleague who works at NMH recently told me that she breathes a sigh of relief when parents have a birth plan because she gets to provide evidence based care and can support them in their choices rather than checking the boxes to prevent ‘bed blocking’.

To add to the confusion if parents are attending the community midwives the philosophy of care is very different as is the attitude to labour.  Birth is anticipated to proceed with minimal intervention. This is the healthiest approach for well mums and babies.

Download this helpful booklet - but remember this is for DOMINO moms only.

Without written birth preferences mums receive routine, 1 size fits all interventions designed to reduce time in labour due to the numbers of women giving birth in Holles Street.

If you attend NMH antenatal classes and ask questions that indicate you may be considering declining amniotomy - the reception may not be entirely positive.  Some GentleBirth parents have been laughed at and asked if their yoga teacher told them that they shouldn’t have their waters broken in labour….

Learn how this mom navigated her way at NMH.

 https://www.nice.org.uk/guidance/qs105/chapter/Quality-statement-5-Interventions-during-labour

How have your experiences been?

#nmh #holles street #informed decision making