It was great to be invited to several events over this week in support of all the wonderful midwives who work so hard to support women during their journey to pregnancy birth and beyond in Ireland. The big day was the Essence of Midwifery conference at The Coombe. As usual they put on a great show and there were some great speakers and posters with the focus being on caesarean section and choice within it.

Maternity Strategy 2016

1. That the maternity strategy has been launched a 100 days and nothing has yet been implemented. With a government now voted in, when is the action going to start in ensuring that women have access to along side midwifery led units?  The overview of the Strategy was given by Deputy Chief Nurse and Midwife Susan Kent

Caesarean Section Rate

2. That the c section rate in the North of Ireland was 36% but investment in evidenced based research, support, care pathways, informing women of their choices and in trusting women was able to reduce it to 25%. (Dr Niamh McCabe and Margaret Rogan Consultant Midwife.) There are four main reasons for c section (1) compromised baby, (2) “failure to progress”, (3) breech presentation and (4) previous caesarean section. Niamh and Margaret highlighted this last issue and the lack of informed choice surrounding VBAC in Northern Ireland that was a major factor in maintaining the high caesarean rate.

Risks of Elective Repeat Caesareans

3. .Women are rarely told the risks of Elective Repeat Caesarean Section (ERCS), instead the risks of VBAC are the primary focus of discussion. Niamh discussed some of the risks including placenta acretia and hysterectomy. Niamh pointed out that she hardly ever used to see placenta acretia when she started out in her practise and now she sees about one a month.

4. Women hoping for a VBAC are absolutely encouraged to use the water pool for labour and birth and also CTG as Niamh argued that it is almost impossible to have a uterine rupture without an abnormal CTG . However, if its a woman’s choice then she doesn’t have to have it and there are other signs that can be looked for. Niamh said that the rate of uterine rupture has increased over the years as more and more women are having c-births.

5. The increased risk of a fetal death with a VBAC is about the same risk as when you had the caesarean birth the first time round. The increased risk is perceived because in general  if you had a normal birth the first time round then the chances of your second baby dying is much less than your first.

6. You are three times more likely to die with a ERCS than with a VBAC

7. The risk of a VBAC is about the same as of an IOL

Michel Odent

8.Birth is a series of involuntary processes hindered by the interference of the neocortex

9. Melatonin and oxytocin work together to promote surges and birth. Light in the blue spectrum inhibits the production of melatonin. The most common spectrum used in delivery suite lights is blue spectrum. The light emanating from mobile phones is also in the blue end of the spectrum. Mobiles and apps are not good for connecting with your inner self and increasing oxytocin levels. Michel Odent.

Decision Making in Midwifery and Obstetrics

10. When we make decisions around pregnancy labour and birth we tend to believe that the more information we have the better decisions we will make, however what we need is sufficient information to reduce our uncertainty enough to make a decision.

Also decisions are often based on heuristic pattern recognition. Once we see a pattern it is difficult to erase it from our minds so even though what we are seeing is marginally different from the pattern we know, we will recognise it as the same. Situations that are similar to ones we recognise can fool us into making quick decisions based on faulty recognition. On the other hand we like using patterns to make decisions because it enables us to make decisions more quickly. Until we recognise a pattern we have to work things out from first principles, and that takes time which most HCPs dont have.   Prof Maskery.

Top 5 things I enjoyed

1. The company of being with midwives and women

2. The Japanese water blessing offered in honour of the day

3. The student midwife discourse “keep it going keep it going keep it going keep it going keep it going . . . keep it going keep it going” “Exactly how long is a breath?”

4.  The poster presentations. My favourite was the poster looking at caring for same sex couples

5. The food (lunch and the lovely dinner)

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