Saturday 17 February 2018

'We gave birth on the road to hospital'

Dramatic DIY births without a doctor or midwife don't just happen on TV. For pregnant women living in rural areas with little maternity support, it's become a frightening reality.

Patricia Keane with her
son Ryan, who was born in the car en route to hospital in Limerick.
Patricia Keane with her son Ryan, who was born in the car en route to hospital in Limerick.

Sue Leonard

John and Patricia Keane from Kilbaha, Co Clare, are thrilled with their latest arrival. Born on February 5, little Ryan is thriving. But the couple are still reeling in shock because their third child was born on the roadside.

Patricia was booked into hospital in Limerick. She still had another week to go when she woke up with pains at 1.10am.

"I rang the hospital and we got ready to go," says Patricia. "The pains were coming every five minutes."

But as they were leaving for the 100km journey, Patricia became a little worried. "I thought, 'the last time I had this sort of pain, I was going into the labour ward for an epidural'," she says.

"The road to Kilrush is not the best. It was 22 miles of bumps. Between the pains and having to hang on to the car, there wasn't time to panic. But by the time we got to Kilrush, I thought, 'we are not going to make it'. The pains were really close together.

"When my waters broke, I could feel the baby moving into place. I was in a complete panic. I thought, 'I've never felt this before. I have always had an epidural'.

"I told my husband, and he drove even faster. I could hear him cursing beside me."

A part-time farmer, John Keane is used to delivering cattle.

"But he was panicking," says Patricia. "He was trying to ring 999, and 11811 for the number of the hospital. But we were in an area with no coverage. I said, 'pull in'. He opened the door, and literally caught the baby. I wrapped him in a towel and said, 'get to the hospital, fast'.

"We stopped at Ennis hospital. The maternity unit closed there 20 years ago, and the nurses weren't trained in midwifery. They cut the cord, but the placenta wasn't ready.

"The ambulance drive to Limerick was the worst part," says Patricia. "It was painful and uncomfortable. I was shivering and in shock."

The couple hadn't initially, rung for an ambulance, but if they had, they would have discovered that there wasn't one available. Staffing problems that day meant two other women in labour were denied an ambulance, and there's no local emergency care.

All this makes the Keanes angry.

"It would make me put off having another baby for a while," says Patricia.

Krysia Lynch of AIMS, a group lobbying for better maternity services, is appalled at the number of women forced to drive long distances in labour.

"The Government is committed to centralisation, and they don't seem to be doing anything about outreach and domiciliary care," she says. "There are midwifery-led units in Drogheda and Cavan, but we need them countrywide.

"There were once hundreds of local maternity hospitals, but they have all gone now. And more maternity hospitals are set to close.

"There is an appalling lack of choice for women in Ireland," she says. "In Britain, they can choose a consultant-led unit or from a wide range of domiciliary care. They can choose a birth centre too; there aren't any in Ireland."

Bridget Sheeran, an independent midwife working in Co Cork, did a study last year, asking women for their stories around birth.

"I interviewed six women, and each one said that distance was a problem," says Sheeran. "They worried about when they should leave home, they worried about traffic and speeding.

"There is a real fear around roadside birth," she says. "One woman held her baby's head in for the 40 minutes it took to get to hospital; the journey normally took an hour and a half.

"All this needs to be debated," she says. "There should be someone a woman in a rural area can call on, who can tell them how far advanced their labour is. At present, they get diverted to a long-term centre where there may not be someone with midwifery experience.

"Women don't want to arrive in hospital too early. They don't want to be told to go home or to walk the corridors. If you come from west Cork they tell you to stay in Cork with relatives or in a hotel. That's not woman-centred care. Doctors want a woman to be 4cm dilated, but she can't possibly tell when that will be."

"I wanted to raise awareness of the issue because I wanted to help other pregnant women. It breaks my heart that the situation is even worse today."

Co Wicklow mum-of-four Laura O'Shea is appalled that so many women are giving birth by the roadside. She hoped that, by now, the HSE would be giving women the services they need -- and are entitled to.

Laura's first two children, Eimhin and Elise, were born safely in Holles Street. But Conall, now five, was in a bit of a hurry to be born.

"We were living in Brittas Bay at the time," says Laura, who now lives in Arklow.

"My pains started on a Saturday. I rang my mother-in-law and she came round to mind the older children. I was telling her what to do, when my waters broke.

"By the time we got to Rathnew, I was in a blind panic. I got through to the Domino midwife and she talked it all through with me. My husband Barry looked so scared. He was driving as fast as he dared.

"The midwife said, 'tell me where you are and I'll get an ambulance'. But before I could tell her, the phone signal went.

"Barry was belting up the road and I could feel the baby's head. I took my seatbelt off to crouch, and asked Barry to pull over, but he said, 'put your seatbelt back on'. He was panicking, and drove faster."

Conall was born in the car, doing 80kmph at the Glen of the Downs. "He wasn't breathing and I panicked. I pulled him close to me and I said, 'please let him live' and then he breathed.

"We stopped at Loughlin-stown Hospital and an ambulance took us to Holles Street. They wouldn't let me hold the baby; that tore me apart. The ambulance guy was panicking that my placenta would come and he wouldn't know what to do."

When Laura became pregnant again, she asked the midwives what they planned to do. "I assumed that appropriate services would be provided," she says. "Maybe they'd send a midwife to escort me to hospital, but they kept saying, 'you'll be fine'.

"The only option, they said, was to take me in and induce me, but oxytocin can be dangerous for someone who delivers fast. The consultant agreed there was a high risk I'd not make the hospital and wrote to the HSE.

"We had a meeting with the manager of the HSE in Wicklow, the head of the Public Health Nurses and the head of the ambulance services.

"They offered to make an ambulance available, but said it would come with an emergency medical technician, who may not have delivered a baby before.

"I would be strapped in, unable to move, sit or turn on my side. When the head crowned, they would pull to the roadside and deliver the baby."

Traumatised, Laura was interviewed on the Pat Kenny radio show. And all hell let loose.

"The hospital offered me a long-term bed, but I had three other children at home. At one stage they offered childcare, but when I accepted that, the offer was withdrawn.

Eoin was born in May 2005, at home after a labour lasting an hour and a half. An independent midwife delivered the baby as a favour to Laura.

"I could have paid for an independent midwife, but I'd wanted what I was entitled to," says Laura. "The HSE is responsible for delivering appropriate maternity services. When I asked for my rights, I felt threatened.

"I wanted to raise awareness of the issue because I wanted to help other pregnant women. It breaks my heart that the situation is even worse today.

"I want another baby badly," says Laura, "but I don't think I could go through all that again. If I have another baby, I could not contemplate having it in this country."

What the HSE says...

According to the HSE, there is normally a 24-hour ambulance service in the Kilrush area. Six staff provide the service for West Clare, but there was a problem on February 4-5. Ambulance personnel were off sick, and no off-duty paramedics were available.

An ambulance was sent from Ennis to a mum in labour; it was called at 4.05am and arrived at 5am. By that time the baby had arrived, and a doctor was there. A third mother cancelled her ambulance when she realised that, if coming from Ennis, it would not arrive in time.

We contacted the HSE for Wicklow, who referred us to the hospitals for comment.

There are consultant-led clinics for antenatal care in Arklow, Wicklow, Greystones and Bray. Mums who live between Bray and Kilcoole can avail of the Community Midwives scheme.

There is a proposal to extend this scheme to women living in Wicklow and Arklow, and to allow them to have an early discharge home.

"But we have never envisaged these women being given the option of home birth, or somewhere to deliver in Wicklow," says Margaret Hanahoe, coordinator of the scheme. "They are, though, given the option of coming into hospital and being induced."

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