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The percentage of 'perfect' births in first-time mothers is less than 1% - study

The study looked at over 8,000 pregnancies in women who hadn’t given birth before.

THE RATE OF “practically perfect” births among Irish women is estimated to be less than 1%, according to a study published in the Irish Medical Journal today.

The study looked at over 18,000 instances of labour at the National Maternity Hospital over a 2-year period. It found that the number of “practically perfect” births in women who hadn’t given birth before to be at 0.8%.

The authors defined  a “practically perfect” birth as a delivery after 37 weeks, a spontaneous labour without intervention, an intact perineum and a positive neonatal outcome.

The study poses the questions whether the unrealistic expectations of labour in first time mothers can present challenges to physicians and midwives.

These were the exclusion criteria in the study: delivery in under 37 weeks; induced/pre-labour Caesarean section; artificial rupture of membranes; Oxytocin; fetal blood sample; emergency Caesarean section/forceps delivery/ventouse delivery; perineal outcome: first degree tear +/- sutures, second degree tear +/- sutures, 3rd degree tear, episiotomy +/- sphincter damage, labial tears; neonatal outcome: apgars of <9 at 1 or 5 minutes.

Breakdown

shutterstock_694046602 (1) Shutterstock / HII_Tokyo Shutterstock / HII_Tokyo / HII_Tokyo

Among 18,698 there were 8,292 nulliparous women, or women who hadn’t given birth before. 7,616 of these women delivered after 37 weeks.

Of these, 4,171 went into spontaneous labour, while 2,753 were induced. 692 had a Caesarean section as a primary procedure. 2,111 women were noted to have an artificial rupture of membranes in labour and 857 received oxytocin. After excluding these, there were 1,203 remaining. 172 women had a fetal blood sample taken, leaving 1,031.

Of the 1,031 women who had a spontaneous labour without any of the interventions mentioned above, 57 had an emergency Caesarean section, 86 had a ventouse delivery, 33 had a forceps delivery, 2 were spontaneous breech deliveries and 5 were born before arrival to hospital.

That excluded a total of 183 leaving 848 “practically perfect” births.

Limitations of the study

The study included those who received epidurals during their labour. Neither antenatal nor postnatal complications were included; this is a potential limitation to the study.

This study objectively defined a practically perfect birth resulting in stringent exclusion criteria. No input from the mothers themselves was accounted which is both a limitation and an area for future research.

The authors conclude the study by asking whether imparting this information to first-time mothers evoke fear of labour or provide realistic expectations of what to expect.

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72 Comments
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    Mute Carina Clarke
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    May 10th 2018, 5:55 PM

    Considering the first thing they will do is hook you up to a bag of oxytocin the first chance they get because of chronic bed and midwife shortages, Im not surprised the figure is that low.

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    Mute Susannah O'Brien
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    May 10th 2018, 7:46 PM

    @Carina Clarke: I don’t actually believe that to be true at all. My first was a 12 hour labor, oxytocin was never even discussed. I had 2 of the loveliest midwives attending to me, and they were encouraging me all the way to stay away from interventions. My birth plan did not include pain relief, and they really helped me to stick to it. There is a lot of rot being spread around about midwives and doctors, all for the sake of getting the 8th through. It’s not nice. We have excellent doctors and midwives in this country.

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    Mute Eamonn Dunne
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    May 10th 2018, 8:40 PM

    @Susannah O’Brien: FFS. Leave the 8th comments for the referendum articles

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    Mute Elise
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    May 10th 2018, 8:45 PM

    @Susannah O’Brien: You should consider yourself lucky, many women are not. Many of us have had forced procedures such as c-sections, episiotomies, membrane ruptures, etc.

    I do agree that we have some wonderful doctors and midwives but the system really needs to be overhauled and the 8th removed in order to allow all women have the chance to experience what you did.

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    Mute Grainne Gillespie
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    May 11th 2018, 1:08 AM

    @Carina Clarke: Oxytocin is given to snakes which have eggs stuck inside them as well despite it not being that effective on them.

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    Mute epo eire
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    May 10th 2018, 6:05 PM

    What are the comparitive figures for other countries? In ireland, when a woman goes into labour they are very rarely left to carry on without intervention. They are given a time limit and every intervention going til baby is out. Its a cattle mart.

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    Mute Caren Dempsey
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    May 10th 2018, 8:55 PM

    @epo eire: 100% agree. Had my first child at the NMH and from the word go it was about bed management and nothing else. I was made to feel like an idiot for writing a birth plan that asked for no artificial rupture of membranes. Doctor snorted with laughter and said “but everybody gets that done, what’s the issue?” Ended up on oxytocin, epidural, major blood loss and a mass of stitches, all hopes for natural birth gone out the window and was never encouraged in the first place. This was only 3 years ago. Have to say my second time around, in the Rotunda, was world’s apart. They were amazing and totally on-board with my hopes for a natural birth

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    Mute Boyne Sharky
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    May 11th 2018, 7:15 AM

    @epo eire: Women themselves differ, it’s easy to look back upon this with the benefit of hindsight but at the time, no matter what information is available, the medical staff can’t predict what’s going to happen. My wife and sister in law were delivering at around the same time, many years ago. One had significant problems while the other never even got to the delivery suite.

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    Mute Rachel O' Meara
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    May 10th 2018, 6:14 PM

    Went in on my first with notions I was going to go au naturale after being induced, jayyyyzus the reality was some shock, got the epidural and sailed through the rest of the labour. Afterwards what should have been a happy time was ruined by incompetent staff which resulted in my baby’s life being put on the line. I knew there was something seriously wrong with my baby within the first 24 hrs but none of the nurses would believe me. The day we were due to be checked out a pediatric doctor was sent round to examined her to give us the all clear to go home, before he started he took one look at me and my big eyes red from crying and asked what was wrong, I told him I knew something was wrong with her, turns out she was fighting a life threatening infection and had two holes in her heart.

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    Mute Deborah Blacoe
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    May 10th 2018, 7:13 PM

    @Rachel O’ Meara: I hear you. I’m glad the paediatrician took note of your instincts. I had problems on my first. Went in to hospital to report it. Was sent home and told I was imagining things. Long story short, my new born baby had to be given Intravenous antibiotics immediately after birth so that they could cover their asses from negligence. But hey, we are only the mothers………

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    Mute Rachel O' Meara
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    May 10th 2018, 7:26 PM

    @Deborah Blacoe: Omg! You poor thing, it’s horrible not to be believed isn’t it?! I was made to feel like I nearly wanted something to be wrong, overheard one absolute wagon of a nurse say “first time mothers” while she rolled her eyes to another nurse, they both had a good giggle, I was fuming! That doctor was the first person with a heart I encountered while I was there, he was a foreign guy and said no one should ever discount a mothers instinct, you were right there is something wrong. Felt terrible I really didn’t want to be right I just wanted my baby to be ok. She’s a strapping teenager now full of life and more importantly healthy as a horse. Hope your little ones health is the same. x

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    Mute Deborah Blacoe
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    May 10th 2018, 7:44 PM

    @Rachel O’ Meara: I’m glad all turned out well for you. Yes, my daughter grew up fine and healthy. It’s just that every time I think of that tiny newborn being pumped full of antibiotics because of their incompetence I get very angry. Totally unnecessary. A mother’s instinct about her newborn baby is very, very strong at the time of birth. The bond between mother and baby is so wonderful. I remember going up to the neonatal unit and she was crying loudly with a ‘team’ of doctors around her. As I entered the room, someone said “here’s the mother”. I gently leaned over my baby and said “no need to cry”. She immediately stopped. We were SO close. She instinctively knew me. Instinct. But doctors do not give enough credit for it…..

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    Mute Rachel O' Meara
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    May 10th 2018, 8:04 PM

    @Deborah Blacoe: That’s great to hear that everything turned out ok afterwards. I completely agree a mother just knows, her instinct is spot on. Pity more medical professionals don’t listen to them.

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    Mute Missyb211
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    May 10th 2018, 8:33 PM

    @Rachel O’ Meara: All these bad experiences are the tip of the iceberg. I as a first time mother was ignored also. I could feel the eyes rolling. Fast forward a good few years and I have damage to my eosogphagus and voice box and other ailments. Furthernire the medication I was put on for 10 years( at too high a dose) caused gallbladder dysfunction and gallstones! Before HH diagnosis a gp ignored my symptoms including choking when I ate food and a constant cough. When I tried to insist on some action I was told I was suffering from Psychosis! Lol. yeah right, make us feel like hypochondriacs and tell us we are psychotic rather than simply listening and taking us seriously. No respect.

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    Mute Deborah Blacoe
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    May 10th 2018, 9:08 PM

    @Missyb211: it’s very easy to write off women as ‘nervy’ or hypochondriac. I have seen it done to friends and relatives who turned out to be very ill. And again, delays in diagnosis caused further damage. HH is a very serious and life threatening condition – I hope you are now receiving the treatment you should have been having all along. I wish you well.

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    Mute Frankie Beahan
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    May 10th 2018, 6:05 PM

    I believe the definition of a ‘perfect birth’ has been misinterpreted. What is described as perfect is what all maternity education 0.8% of women experienced a normal birth. Birth in itself is a normal physiological process which women have been experiencing for as long as we know. This clearly shows the extreme medicalisation of birth in Irish maternity services and is a perfect statistical example of the cascade of interventions that accompany pregnant women into the delivery ward.

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    Mute Susannah O'Brien
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    May 10th 2018, 7:51 PM

    @Frankie Beahan: I’ve had 4, and they were all pretty much perfect. The first lasted 12 hours, 2 pushes and she was out. The rest of them were very fast, 2-3 hours, and 1 or 2 pushed. No interventions, no drama. There is a lot of bad press going around the interned about midwives and doctors. It’s all for the sake of getting the 8th through. Not very nice in my opinion. We have excellent maternity staff in this country.

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    Mute Carol Oates
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    May 10th 2018, 8:18 PM

    @Susannah O’Brien: Good for you. However, people who had a negative experience are just as entitled to share their story. Personally, pregnancy, labour, and giving birth psychologically scared me for life. I wasn’t treated with much dignity. I had facts withheld, I was coerced, threatened, had someone midway through a failed procedure tell the other medics that he wasn’t supposed to be doing it. Consent was an afterthought. That wasn’t very nice in my opinion. I’m absolutely sure there are amazing midwives and doctors in Ireland. Unfortunately, my experience wasn’t wonderful.

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    Mute Anne Marie Devlin
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    May 10th 2018, 8:30 PM

    @Frankie Beahan: before the extreme medicalization of birth – which really got under way post ww2, maternal mortality rates were about 45 in 1000. They have been in steep decline since and are now about 3.3 in 1000. As a species we are extremely ill-equipped physically to give birth in comparison to other mammals. Our anatomy is not as flexible. It doesn’t expand or contract as much as other mammals which is why childbirth was a major cause of death in women before the 20th century and it still is in developing countries.

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    Mute Susannah O'Brien
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    May 10th 2018, 8:41 PM

    @Carol Oates: I loved every minute of all 4 pregnancies and births. The last one wasn’t as easy because I had a bad dose of asthma for the 6 weeks leading up to the birth, but overall I have never experienced anything as negative as what you describe. I had 2 in the Rotunda and 2 in Holles st. I think the best defense against a bad experience is to be as informed as possible. Have a birth plan and familiarize yourself with all the possible outcomes. Also, pelvic floor exercises are actually a huge part of birth prep, and nobody takes them seriously. You are of course entitled to share your story too, and i’m sorry you had such a bad experience. But I do think these really bad stories are in the minority.

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    Mute Sorcha Ní Shúilleabháin
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    May 10th 2018, 6:47 PM

    Recently had my baby 10 weeks early by emergency C-section due to severe pregnancy-induced pre-eclampsia. Was very grateful for all of the interference!

    I spent 10 days in hospital post-natally and having seen many women come and go during that time it’s apparent that lifestyle choices are contributing to the medicalisation of labour. Lack of physical fitness, obesity, diabetes, smoking, older maternal age etc. are going to result in a greater need for intervention.

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    Mute Sorcha Ní Shúilleabháin
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    May 10th 2018, 9:39 PM

    @Donald Trump: Thank you!

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    Mute Seán J. Troy
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    May 10th 2018, 9:11 PM

    When you hear the intactness of the perineum as being one of the major criteria of a successful birth, it makes me cringe as a man.

    Our idyllic view of childbirth is unrealistic, childbirth is a fairly heroic task. Fair play to the women who go through it, I definitely couldn’t.

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    Mute Dave Doyle
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    May 10th 2018, 6:27 PM

    My mother said I was a perfect birth, but it all went down hill from there

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    Mute Oiche Fairy
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    May 10th 2018, 6:37 PM

    Considering you’re automatically given oxytocin through a drip and have your waters artificially broken shortly after arriving in hospital, it’s very, very hard to have a ‘perfect birth.

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    Mute Karen NíDhochartaigh
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    May 10th 2018, 8:56 PM

    @Oiche Fairy: what hospital did you attend?? That so was not the case for me. No drugs or any assistance here.

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    Mute Oiche Fairy
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    May 10th 2018, 9:44 PM

    @Karen NíDhochartaigh: The first time it was in Holles St. and the second time the Lourdes hospital in Drogheda. Granted, the first time I had been in labour for a really long time so maybe they just wanted to get the baby out quickly but there was no hurry the second time which was a really quick labour lasting only 14 hours from start to baby.

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    Mute Lesley Harpur O Connell
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    May 10th 2018, 10:17 PM

    @Oiche Fairy: quick …lasting 14 hours !…

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    Mute daveyt
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    May 10th 2018, 6:10 PM

    Is it not 10.23%? 848/8292 x 100/1

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    Mute Hapax
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    May 11th 2018, 11:15 AM

    @daveyt: they forgot to include miscarriages too.

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    Mute Clinton Baptiste
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    May 10th 2018, 6:05 PM

    “The authors conclude the study by asking whether imparting this information to first-time mothers evoke fear of labour or provide realistic expectations of what to expect”.
    Are they for real , do people still believe that the stork drops babies off in a napkin ?

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    Mute Clinton Baptiste
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    May 10th 2018, 6:09 PM

    @Clinton Baptiste: Wow , first comment censored after 6 minutes .

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    Mute Declan McArdle
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    May 10th 2018, 6:27 PM

    @Clinton Baptiste: re-post it for the craic.

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    Mute Clinton Baptiste
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    May 10th 2018, 6:34 PM

    @Declan McArdle: I can’t ,I’m scared .

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    Mute Tracy Donegan
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    May 10th 2018, 8:42 PM

    It’s very difficult to give birth in NMH without intervention and that’s not because women need the intervention but because of how birth is managed at that hospital. Let’s look at the lack of evidence for ARM, high syntocinon rates and episiotomies at NMH. This article makes it sound like it’s the mother’s fault…let’s look closer at how birth is managed at NMH instead and compare it to the outcomes by the DOMINO scheme at NMH.

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    Mute Caren Dempsey
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    May 10th 2018, 9:05 PM

    @Tracy Donegan: Absolutely. I know firsthand how intervention-driven the NMH is; it’s about nothing more than bed management. I felt like I was on a conveyor belt and treated with derision for even having birth preferences, never mind the audacity to ask for no ARM. Doc looked at me as if I had two heads. I was bullied & coerced at the most vulnerable time-ended in oxytocin, epidural, awful tearing…& I would have considered myself well informed & prepared beforehand! I’d never step foot in there again. Second time round was Rotunda and was blown away by the difference. Offered a hypnobirthing class, midwife suggested aromatherapy oils and battery candles for the delivery etc, they were totally on-board with my hopes for a natural birth and just made the whole experience so much easier

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    Mute Tracy Donegan
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    May 10th 2018, 11:59 PM

    @Caren Dempsey: I’m so sorry you had that experience. There are some wonderful midwives in Holles St but unless parents bring written preferences (or state their preferences on admission) they have to follow Active Management. Midwives who want to practice real midwifery in the obstetric unit find it very challenging to provide evidence based care.

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    Mute leanne nueva
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    May 11th 2018, 2:28 PM

    @Caren Dempsey: holles street for me, might’ve had more if I’d had the rotunda experience 1st!

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    Mute bings
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    May 10th 2018, 8:12 PM

    Can someone please explain what is a perfect so I can compare it to the births I had. Why has everyting got to be “perfect” In my opinion there is no such thing as “perfect”

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    Mute Elvis Polkasalad
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    May 10th 2018, 8:24 PM

    @bings: Perfect

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    Mute Elvis Polkasalad
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    May 10th 2018, 6:09 PM

    All mine came out without a struggle , BEST thing that will ever happen to you,

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    Mute Chucky Arlaw
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    May 10th 2018, 6:12 PM

    @Elvis Polkasalad: there’s no way you’re a woman… Although going on your past comments I’m not surprised you consider another woman’s uterus to be your property so yeah your comment makes sense

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    Mute Thought Criminal
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    May 10th 2018, 6:22 PM

    @Chucky Arlaw: Wouldn’t the “mine” be referring to the children, rather than the “uterus” as you say?

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    Mute Elvis Polkasalad
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    May 10th 2018, 6:27 PM

    @Chucky Arlaw: i take it your not a dad then, No i am not a woman but as it took me and the very lucky lady to produce my children , she does not get all the say in what happens , makes sense doesnt it ,

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    Mute Elvis Polkasalad
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    May 10th 2018, 6:30 PM

    @Thought Criminal: Give him a minute, it will drop eventualy

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    Mute Marie McCormack
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    May 10th 2018, 8:05 PM

    @Elvis Polkasalad: yeah she must be sooooo lucky to have specifically your children

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    Mute Elvis Polkasalad
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    May 10th 2018, 8:13 PM

    @Marie McCormack: you either have it or you dont , I have ,i,m a nice man really , she,s gone and i,m single , might be your lucky night , Fancy driving my motor?

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    Mute Eamonn Dunne
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    May 10th 2018, 8:34 PM

    @Elvis Polkasalad: can you ask someone to show you where the apostrophe is?

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    Mute Elvis Polkasalad
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    May 10th 2018, 8:40 PM

    @Eamonn Dunne: jesus thats a coincidence i am only out of it , its the mince , goes straight thru me

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    Mute Elvis Polkasalad
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    May 10th 2018, 8:42 PM

    @Elvis Polkasalad: but serously , lifes , to, ,,,,,

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    Mute Fiona Fitzgerald
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    May 10th 2018, 6:21 PM

    This is all for one hospital. No mention of home births?

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    Mute Elvis Polkasalad
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    May 10th 2018, 7:03 PM

    Did i miss something or did he get sacked , {micheal]

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    Mute Matthew Henry
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    May 10th 2018, 7:45 PM

    @Elvis Polkasalad: id say once the overseas money lang got for trolling was stopped he ffed off ..

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    Mute Elvis Polkasalad
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    May 10th 2018, 8:07 PM

    @Matthew Henry: I was sitting in my doctors surgery in tallaght the other day ,and over the intercom in the packed waiting room all as i hear is Micheal langs name being called ,i looked around to see who the fook could it be , up gets this old bald guy about 70 with glasses and hovels into the doctors, i thought to myself ,he fits what i would of thought he looks like , that was on tuesday , has he been on since then,

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    Mute Matthew Henry
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    May 10th 2018, 8:55 PM

    @Elvis Polkasalad: i dont think so…ask paul ..he knows everything..a good legal brain is what we need to solve the mystery..

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    Mute Elvis Polkasalad
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    May 10th 2018, 9:53 PM

    @Matthew Henry: lol ,paul he doesnt know were he is himself ,never mind anyone else, , if brains were made of dynamite he wouldnt have enough to blow his nose , i know i cant spell propoorly

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    Mute Caz 17
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    May 11th 2018, 8:55 AM

    @Elvis Polkasalad: thanks for a much needed laugh. He’s some tulip our tony, FIONA, langer. And many many more aliases. He’s either reformed as someone else or he’s dead but he’s not takin a break.

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    Mute Butterfly
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    May 11th 2018, 12:11 AM

    After having a stillbirth then healthy twins, why not receive intervention medics etc as long as the baby is born healthy and the mother is well too.

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    Mute Hussy
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    May 10th 2018, 10:40 PM

    Given the obesity problem, average maternal age for having a baby and diseases associated with both these factors the risk of having complications at birth increases thus the need for intervention

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    Mute Charles McCarthy
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    May 10th 2018, 7:51 PM

    Wouldn’t be for me personally. All a bit much to be honest.

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    Mute David McCreery
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    May 11th 2018, 7:46 AM

    So 800 out of 8000 were perfect. About 1% it says , have I missed something here.

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    Mute Dani O'Hara
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    May 11th 2018, 2:38 PM

    I had emcs on my first baby after a failure to progress. Second baby tried for a vbac but they weren’t giving me a chance so the booked me in for section ( had great pregnancy and nothubg was wrong) for out then that i was progressing in m y first and they just wanted to hurry things along so ended up in section ( baby and mammy were fine) now I’ll never get to have a normal birth.

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