Writing -- Birthing guru has advice for Ireland

The following interview with Sheila Kitzinger appeared in the WOW! supplement of the Evening Echo, one of Ireland's leading daily regional newspapers, on 31 March 2004.

Sheila Kitzinger has acquired a variety of labels over the years: "the world's foremost birth educator", "high priestess of the childbirth movement", "Birth Mother of the nation" and "the scourge of reactionary obstetricians" to name but a few. Author of 24 books translated into 20 languages and countless articles and papers, Sheila is respected worldwide as a social anthropologist of birth and as a leading authority on women's experiences of pregnancy, childbirth and motherhood. "She speaks for women, with women and through women, challenging many of the beliefs and practices of obstetrics for the last half a century," said Niamh Ruiseal of the Homebirth Association of Ireland.

Last weekend Sheila was in Dublin as keynote speaker at the Homebirth Association of Ireland's annual conference, where she delivered an address called "Birth, Spirit and Social Values".

Sheila says: "I study birth in different cultures, and different models of birth: the social model, the medical model and of course how they contrast. I look at birth through history, and in different cultures today.

"One of the most common themes in social childbirth is that women come together to support each other. Birth takes place on female territory, and this knits together families in the community, so it's a very important form of social cohesion." Sheila believes that the support and status afforded to women during childbirth is intrinsically linked to the core values of a given society: values like friendship, sharing, community and women's support for one another. "It's an important part of women's identity both as transmitters of life and as healers in the society," she said.

Sheila contrasts the social model of maternity care with that of routine obstetric intervention - the system of "active management" so ubiquitous in Ireland today - and ask what that reveals about our true values as a society. "I don't think you can isolate social values from the culture of birth. If you look at the culture of birth in any society you can see very clearly what is considered important, what dominates. We live in a society which is dominated by technocracy, and birth is dominated by technocracy too."

She describes the Irish maternity care system with words like rigid, paternalistic and authoritarian. "Women don't have any real choices," Sheila said, "Ireland has a very, very low home birth rate. Women are nervous about what they see as a way-out alternative because they are not aware of the evidence for the safety of homebirth.

"There is so much lip-service paid to choice and to how women have all these options, when in fact they often don't, because you can't make real choices unless you have information and can weigh up the pros and cons."

In an ideal world a maternity care system should encourage collaboration between midwives and obstetricians to meet women's needs in relation to childbirth while ensuring the overall wellbeing of the mother and child. "Midwives and obstetricians can work together," said Sheila. "Obstetricians are the experts in pathology, while midwives are the experts in keeping birth normal.

"Birth is a psychosexual process. I don't mean by that that it's orgasms all the way, but that hormones are released into the bloodstream, the woman instinctively responds to the power in her uterus and she knows what to do. She needs to be protected in a setting where she can really get in touch with the messages that her body's giving her."

Sheila believes that most medical intervention in childbirth is questionable. "All of the research evidence shows that a great deal of intervention is not only unnecessary, but dangerous!" she said. "Of course there are problems sometimes, and I'm very grateful for the fact that we have experts in pathology, the obstetricians, who know how to tackle such problems, but most women can give birth spontaneously if they are in an environment in which they feel they can trust their bodies."

When it comes to the key issues that need to be addressed to ensure a more equitable maternity care system here in Ireland Sheila is characteristically forthright. "I would like to see the opening up of midwife-run units in which midwives offer one-to-one care, from the basis of which they can go out and do homebirths as well. The core thing is continuity of care, and continuity of carer."

Midwifery-led birthing centres offer an alternative tier of maternity care that lies in the critical middle ground between homebirth, which is sometimes viewed as radical, and the hospital labour ward, which by its very nature tends to be interventionist. According to Sheila such centres in the UK have led to a rediscovery of the role of the midwife, and their introduction here could play a fundamental role in transforming Ireland's medical birthing culture.