Friday, 2 December 2016

Additional Information regarding Fact Check: Ireland's safety record on maternal health

AIMS Ireland were contacted with regards to the Journal.ie Factcheck on a leaflet used by anti-choice campaigners highlighting an excellent record of safety in Irish maternity services.

The Factcheck can be read here: http://www.thejournal.ie/yes-to-life-life-institute-8th-amendment-abortion-leaflet-facts-3058066-Nov2016/

AIMS Ireland had a brief exchange with Factcheck over twitter and requested to discuss further offline. Several days following the initial discussion, AIMS Ireland then privately sent in information which we feel is vitally important to assist in interpreting statistics provided by Factcheck as well as additional factors relevant in the discussion of the issue of safety.

We have not had a response from Factcheck (2 weeks) so are publishing the additional information provided to Factcheck into the public domain.

AIMS Ireland have been campaigning for improvements in the Irish maternity services, including the implementation of evidence based care practices and basic rights to informed consent, as well as  providing advocacy to thousands of women and other pregnant people since 2007. This issue continuously arises in support services, as well as academic circles and between care providers.



Hi Dan,

Thank you for the offer to engage with us following our brief Twitter chat. Apologies for the delay in getting back to you - we are a wholly voluntary-run organisation with no funding and thus no full-time staff.

AIMS Ireland is a maternity rights organisation which also provides advocacy to women within the continuum of maternity services.

With regards to the Factcheck on Ireland being one of the safest places to have a baby, we have some points that we feel would help clarify. We have been contacted by individuals confused and upset by the Factcheck, as presented.

With regards to WHO data, we feel it is relevant for the following to be quantified in order to assist in people’s understanding of the data.


Ireland is ranked joint 6th in WHO data.

This ranking is made up of a 31 year average
Joint 6th does not mean that we are 6th in the world – there are 26 Countries whom have MMRs lower than Ireland. Ireland at 8 per 100,000 shares this rate with Croatia, France and FYR Macedonia. However the following 26 Countries have rates lower.

Australia 6 Germany 6 Norway 5

Austria 4 Greece 3 Poland 3

Belarus 4 Iceland 3 Slovakia 6

Belgium 7 Italy 4 Spain 5

Canada 7 Japan 5 Sweden 4

Cyprus 7 Israel 5 Switzerland 5

Czech Rep 4 Kuwait 4 United Arab Emirates 6

Denmark 6 Montenegro 7

Finland 3 Netherlands 7


WHO statistics are global, which is problematic as it does not compare like with like; Western Countries (with access to basic hygiene, nutrition, antenatal care, technology, well trained health care providers, maternity units, etc) to Countries without the very basic of care.

Comparatively, looking at EU States, we rank 16th of 28 with the UK (9), Bulgaria (11), Estonia (9), Hungary (17), Latvia (18), Luxemborg (10) Malta (9) and Portugal (10) with higher rates.

For Western nations, with the availability of factors mentioned above, many (including AIMS Ireland) are of the opinion that maternal mortality alone should not be the sole indicator for measuring the safety and quality of our maternity services. Women have reacted strongly on this point, sharing stories of poor quality of care void of basic safety procedures. AIMS Ireland strongly recommends that any discussion of safety and quality must include morbidities; physical and psychological to mother and baby.

Maternal Morbidities MAMMI Study Ireland 2016

1/7 women in Ireland who die, die from suicide
¼ of maternal deaths have mental health issues and the State is not addressing this. There are 3 perinatal psychiatrists, all in Dublin, for the entire Irish population. Ireland also has no Mother-Baby units.
Ireland has the highest rates of postnatal depression in the OECD
4/10 women who give birth in Ireland are readmitted to hospital for their own health.
10% of maternal deaths in Ireland are due to maternal haemorrhage
Major Obstetric Haemorrhage (MOH) has increased from 1.5% to 4.1% in Ireland from 2001-2011
24% of MOH in Ireland are admitted to the UCU (near misses)
11.2% of MOH have hysterectomy
The National rate of MOH is 2.6 per 1000
Almost 2/3 of women report sexual health problems post birth. 1 in 5 women reported painful sex a year following birth.
Anal incontinence 12% of women who gave birth in Ireland


Also worthy of mention, the HSE directly cites the 8th Amendment in the National Consent Policy as a barrier to consent in continued pregnancy and childbirth. Informed consent/refusal is the cornerstone of medical ethics and evidenced best practice. A health system void of this most basic but core value is incapable of being considered in highest ranking.

While AIMS Ireland understands that the Factcheck was in relation to accessibility to abortion, all care within the maternity continuum are inherently linked and should be inclusive of the full data.

Regards,

Jene and Sinéad

** In addition, AIMS Ireland would like to reiterate that Ireland's ranking in WHO documentation is based on a 31 year average. However, Ireland has only participated in the Maternal Death Enqiry (MDE Ireland) surveilance system since 2009. Disparities between MDE statistics and methods of classification/collection of these statistics prior to 2009 (under-reporting in CSO figures) are widely disucssed and it should be noted that our statistical ranking from a 31 year average is based on recognised classification definitions only since 2009. Further, MDE Ireland's recent report continues to highlight challenges within the Irish system, particularly through regional units and coroner's reports, which contribute to under-reporting of maternal deaths in ireland.

Additional information on MDE Ireland ia available to read here: https://www.ucc.ie/en/mde/about/


AIMS Ireland Statement on the publication of Judge Maureen Harding-Clark’s report into the Surgical Symphysiotomy Ex Gratia Payment Scheme and media commentary on the same.

AIMS Ireland Statement on the publication of Judge Maureen Harding-Clark’s report into the Surgical Symphysiotomy Ex Gratia Payment Scheme and media commentary on the same.

The Association for Improvements in the Maternity Services (AIMS) Ireland  is outraged at the suggestion that the survivors of symphysiotomy have exaggerated, or been in some way dishonest, in their claims in what has been a long and difficult struggle for them, in the pursuit of justice.
We at AIMS Ireland know that women are very slow to expose themselves to legal proceedings, especially when they have been traumatised in the past. The fact of the matter here is that medical records are missing.

We are very disappointed that Judge Maureen Harding-Clark has made completely unfounded accusations of dishonesty against elderly women and their supporters, based on a lack of documentation and records.  At the same time, she fails to hold the hospitals and medics responsible for not keeping that documentation, as is their responsibility.

The claim that a woman’s medical record could prove or disprove that a procedure had taken place is laughable. Medical record keeping of the time was minimal to say the least. Many women’s medical records for a birth consist of a few lines, hardly comprehensive proof. All medical records prove is that a midwife or obstetrician wrote something once upon a time on a chart. Whether this is an accurate reflection of events is another story entirely. It is not uncommon to see issues with medical record keeping to this day.

Further, AIMS Ireland is at a loss to understand why, in an era where women not only had no access to abortion, but also had no access to contraception as well as no legal right to not be raped within marriage, women who had further pregnancies after symphysiotomy are deemed by the judge to not have been traumatised by the symphysiotomy. Women of the time had no say over whether they became pregnant or not regardless of their state of health and wellbeing, and as of course is still the case, they had no say over whether they remained pregnant or not. Becoming pregnant was not something a woman had any say whatsoever in. 

This report is a further violation of those women, who are and were entitled, in their latter years, to expect more of a state that claims, with little evidence, to be more enlightened.

Women who have experienced mistreatment know that it has happened. They are neither hysterical nor litigious as suggested by those who should know better. It is beyond belief, that those practicing medicine in today’s world, would turn to the ancient argument of the hysterical woman.

The biggest issue for AIMS Ireland today, is the establishment’s complete failure to hold a mirror to its practices both past and present.  It demonstrates to women today how little value is placed in their well-being.  It further illustrates that ‘the professionals’ in this country have rights over women’s bodies which would not be given in other jurisdictions.

In media commentary this week, the point has been made that symphysiotomy is still used in poorer countries where alternatives are lacking. The key point here is “where alternatives are lacking”.  This was not the case in Irish hospitals in 1965, with access to trained surgeons, surgical theatres and antibiotics.

There is no valid reason for the fact that though symphysiotomy was dropped and even banned as a procedure in other Western countries, it  continued to be used in Ireland as late as the 1980’s, no matter how frequent its use was.  Points have also been made regarding the life-saving potential of symphysiotomy in specific situations. No one is questioning that.   We are questioning the medical need to perform these procedures in Irish hospitals in the years in question, when evidence showed a caesarean section was a viable alternative.

We at AIMS Ireland find it appalling that women’s experiences, trauma and injuries at the hands of what was a highly patriarchal and religious-led maternity care system, could be so lightly dismissed, and their suffering labelled as in some way “normal”.

Women should not be suffering either emotionally or physically after childbirth in Ireland.

#ENDS

Tuesday, 8 November 2016

Statement from AIMSI on the publication of the MAMMI STUDY 
Stat
Dublin, Tuesday November 8th 2016
The Association for Improvements in the Maternity Services in Ireland (AIMSI) welcomes today’s publication of the MAMMI (Maternal health And Maternal Morbidity in Ireland) study.  AIMSI is keen to point out, however, that up until this point, the safety of the Irish maternity system has been measured purely by maternal mortality, which according to AIMSI Chair Krysia Lynch is “crude and uninformative”.
The study findings show alarming prevalence of life changing health issues - issues that make everyday life hugely challenging for Ireland’s mothers.  AIMSI is also concerned by the under-reporting of such issues illustrated in the findings, for example 70% of women reporting pelvic pain in pregnancy, but only 5.8% documented as having such issues in hospital records.
Speaking in Dublin following the publication of the study, AIMSI Chair, Krysia Lynch said, “Women enter our maternity services every day feeling well and leave feeling unwell with morbidities that are rarely discussed; pelvic floor problems, mental health problems, incontinence, scar breakdown and infection. Women need to be aware of these risks and how to minimise them.  The only way to do this is for women to be able to access high quality evidenced based information such as this study illustrates.”
"Women need to know that certain settings and care providers have greater associations with certain morbidities” she added,  “a fact which is rarely discussed in Ireland. In particular, given our soaring birth by caesarian rate, women need to be aware that birth by c-section carries morbidities for both mother and baby and women should factor them into any choices made about their birth setting, care provider and mode of birth".
AIMSI also notes commentary that suggests women are not reporting or discussing health issues because of inexperience, embarrassment and fear.  The Association would prefer if society could stop blaming women asks if we should be asking our health professionals if they are listening instead.

Friday, 4 November 2016

AIMS Ireland: Maternity Care based on medical best practice, NOT Constitutional Amendment.




Maternity : adjective,  
 
"of, relating to, or for the period in which a woman is pregnant or has just given birth to a child."
 
 
 
 
What is Maternity Care?
 
Maternity Care covers a wide base of health services to women and other pregnant people, responding to the needs of various eventualities in the Maternity Continuum which may occur from the moment a woman becomes pregnant, to birth and the postnatal period. This definition covers a wide range of services, including abortion. As a campaign and support organisation, AIMS Ireland further extends this definition to include women planning a pregnancy, (pregnancy prevention, fertility services, etc,) and we also supports women whom contact us years (sometimes decades) after a traumatic birth.
 
AIMS Ireland campaigns for the implementation of evidence based best medical practice. Any discussion on evidence based best practice cannot be had without the inclusion of bodily integrity, autonomy, informed decision making. Whatever your terminology of preference, this issue, the right to informed consent / informed refusal, is the very cornerstone of medical ethics and best care practice in all realms of health. This right is eroded in Ireland in maternal health; reproduction, abortion and in continued pregnancy, labour & childbirth due to the 8th Amendment of the Irish Constitution. A non-pregnant woman with full capacity is legally recognised to make decisions on her health care - the right to informed consent/refusal. However, the moment she becomes pregnant, her capacity is immediately diminished.

The State removes viable care options from her.
The State owns her decisions and body.
The HSE directly cites the Constitution as a barrier to consent in her health care should she decided to continue her pregnancy.
 
A health care system which fails to provide the full range of safe, accessible care options with scope for informed decision making is void of best care practice. Removal of choice is never best practice. As a Maternity Rights and Advocacy organisation, is futile to have a position on rights violations in continued pregnancy and birth under the 8th without also including abortion. And vice versa. The two are inherently linked as part of the maternity continuum and equally restricted by ramifications of the 8th Amendment.
 
 AIMS Ireland holds a position which supports full autonomy, to all women, in all aspects of her healthcare. As elected unanimously by our members. We support a position of maternal requested abortion and birthing autonomy. A maternity system based on full care options, medical best practice, and maternal autonomy. Not Constitutional Amendment.
 
Maternal Requested: What is it? Why does AIMS Ireland support it?
 
AIMS Irleand supports every woman to make an informed decision on her healthcare in her personal circumstances. It is never about the choice, or if you would make it for yourself. Its about supporting a woman's right to weigh the risks, for and against, the options being presented to her in order to make the best decision for her, in her current personal circumstances, taking on board her medical history. There are no absolutes in maternity care, its about balancing risks and making a decision you feel safest in *at that moment* with scope to revisit the issue if medical indication arises.
 
Maternal requested - the woman is the lead decisioin maker in HER healthcare based on HER personal circumstances.
 
Maternal requested abortion.
Maternal requested Caesarean.
Maternal requested Homebirth.
Maternal requested Foetal screening.
Maternal Requested.
 
AIMS Ireland work with pregnant women. We have supported thousands of women in the last decade. Women make good decisions. They are articulate, informed, and acutely aware of their circumstances and what they are capable of. To deny women agency over their decisions and body, to ask them to give their decisions away to strangers, is a gross violation of rights of half the Irish population. It also creates an unsafe medio-legal environment for service users and health care providers alike. The 8th Amendment fails to protect anyone, and in fact, actually creates more risk for all individuals within the maternity continuum. Women needing abortion. Women in happy healthy pregnancies, prevented from making decisions in pregnancy, labour and birth which they feel is best, safest, for themselves and their baby. Failure to provide a full continuum of services, failure to provide evidenced best practice.
 
 
AIMSIreland believe all maternity services should be publicly funded
 
With all its many flaws, which are very serious and at times dangerous, one of the most positive aspects about the Irish maternity system is that it is free to all who enter its doors, whether resident here or visiting at any time, and that the midwives are highly trained to 4 yr degree standard. Healthcare should  not be dependent on ability to pay nor should it differienciate duty to care by whom is worthy, or not, based on their personal circumstances, needs, choices, or medical history. Abortion should be a part of any evidenced safe maternity services in order to maintain a duty of care for all within the maternity continuum. The moment we begin selecting whom may or may not have duty to care, a medio-legal conflict is created with devastating direct consequences on the most vulnerable service users. As recent and past cases have shown.

Shiela Hodges.
Michelle Harte.
Savita Halappanavar.
Mother A.
Ms Y.
Mother B.
 
 
 
Repealing the 8th and Maternity Care
 

The 8th Amendment affects women's autonomy to birth. The HSE directly citing it as a barrier to consent in continued pregnancy and childbirth. AIMS Ireland have reiterated this issue since 2010, that the 8th Amendment has direct consequences on the rights of birthing women in Ireland. AIMS Ireland has supported many women whom have been threatened with High Court proceedings for their birth choices, most consent under duress of the threats, however recent court proceedings - HSE v Mother B - realises the extent of this issue to the public issues which we have witness for a decade.
 
Repealing the 8th and replacing it with similar legislation which gives equal rights to the foetus in some instances will result in no changes for pregnant women/people in happily continued pregnancy. With shared rights a pregnant women/person is automatically considered of reduced capacity in the ability to make an informed decision, consent to, or decline care options and interventions in continued pregnancy, labour, and childbirth.
 
The HSE directly cites the 8th as a barrier to consent in continued pregnancy and childbirth. Further, The Capacity Act legislation outlines the importance of Advanced Health Care Directives, as being legally binding to ensure patient wishes, but outlines that these directives can be overruled in the case of pregnancy.
 
Pregnant women/people should be the lead decision maker on their care - if, where, how, with whom they give birth. In no other realm of health is a person with full capacity's right to bodily autonomy diminished.
 
Bodily autonomy is the cornerstone of medical ethics. Removal of this right in the instance of pregnancy is discrimination. Removal of choice is never best practice.
 
The Repeal conversation must be opened to include continued pregnancy and the dangerous ramifications the 8th has on ALL aspects of maternity care in Ireland. The 8th Amendment effects EVERY pregnancy.
 
** Note: AIMS Ireland fully recognises that not all individuals who become pregnant identify themselves as women. We try to use inclusive language as much as possible. The use of "woman" is reflective of the majority of individuals seeking our support. However, we fully recognise that discussions surrounding maternity services and the 8th Amendment should be inclusive to all whom are affected.

Thursday, 3 November 2016

What people are missing - HSE v Mother B

There has been a lot of commentary in the last 24 hours in regards to the HSE v Mother B case questioning the decision VBAC3; Why would a woman question medical advice and take this case to the High Court.

What people are missing - it's not about the choice, or if you would make it for yourself. It's about supporting a woman's right to weigh risks for and against each care option and make the best decisions for her in her current circumstances taking on board her medical history. Informed choice. A cornerstone of medical ethics.

The unit in question refused to engage with this woman and instead decided threatening her & taking her to court was the best option. And they were backed by our National Health Service under Constitutional personhood law.

 The foetus, like many other cases, had its own legal representation against it's mother.

If we want to make it about "risk", if discussing the 3% chance of uterine rupture, we must discuss all the risks and that it's up to the woman to weigh them out. There are real and substantial risks in repeat Caesarean; most severe maternal morbidities in Ireland (the near misses) are involving repeat Caesarean section. There are no absolutes in maternity care, it's about balancing risk and making the decision you feel safest in *at that moment * with scope to revisit the issue if medical indication arises. As in this case. The woman requested a Caesarean when she no longer felt vbac was a safe option.

Women are not stupid. Women do not take risks. They make good decisions for themselves and their baby. They need to be supported, not violated and threatened.



Wednesday, 2 November 2016

7 POINTS ON THE HIGH COURT’S REFUSAL TO FORCE A WOMAN TO UNDERGO A C-SECTION AGAINST HER WILL

These points relate to the case of HSE vs B. The in-camera reporting of the case was lifted on 2nd November 2016, over a month after the original case was heard. The case relates to the HSE who took a heavily pregnant woman, Ms B to the High Court to seek an order for a forced sedation and c-section against the woman’s consent.
  1. This case is clear proof of what AIMS have been saying for years now; that the HSE coercively use the existence of the 8th amendment to the Irish Constitution against birthing women. The fact that they tried to prevent their defeat in this case being publicly reported is cause for ongoing concern about their continued desire to bring further cases of informed refusal to the High Court.
  2. That this woman had the support and strength to go and vindicate her right to informed refusal in the High Court whilst heavily pregnant makes her very unusual.  Ms. B deserves our very great thanks for publicising this practice by the HSE.
  3. Whilst a case with a formal judgement such as this is unusual, AIMS Ireland are aware of many cases in which heavily pregnant women have been threatened “with the guards coming to get them” if they don’t turn up for their scheduled induction. In fact a cohort of women reported such statements are regular commentary at antenatal classes at one particular hospital. AIMSI can also confirm that there are other women who felt they had no other option than to be coerced into a section they did not freely consent to.The fear of being taken to the High Court and being sedated for forced obstetric procedures is usually enough to ensure that women comply with whatever the HCP may be suggesting whether it is evidenced based or not.
  4. AIMS Ireland are aware of these situations in a variety of settings and geographic locations. It is not limited to large tertiary referral hospitals or to smaller units. It is endemic and a result of article 40. 3. 3 which informs the HSE National Consent Policy, enabling High Court Actions to be taken against pregnant women who exercise their right to informed refusal of medical treatment.
  5. The ruling makes clear that the 8th amendment can be, and is used against women in continued pregnancy and birth. It finds in this particular instance that the threat to the baby’s life is not great enough to warrant forcibly sedating and sectioning a woman, but it gives us no examples of when that threat might be great enough. This leaves the door open to the HSE to continue to interpret this “risk” as they please. It enables women to be forced into processes and procedures such as CEFM (Continuous Electronic Fetal Monitoring) which the evidence base acknowledges does not improve outcomes for mothers or babies.
  6. The judge’s comments on Ms. B having to bear the whole financial weight of any potential care baby B would have needed shines a light again on an issue that AIMS Ireland have repeatedly highlighted; that of babies who need lifelong care from injuries acquired at birth only being financially supported if someone is found to be ‘at fault’ for those injuries.AIMS Ireland have long argued that instead of the State Clinical Indemnity Scheme  paying out huge sums in compensation and families needing to pursue litigation, a care fund should be established, from which monies can be allocated for the lifelong care of any child injured at birth without the need to assign blame.
  7. Ms. B’s decision to request a c section despite having been vindicated in her right of refusal goes to prove AIMS Ireland’s position that women’s experiences of their care are differentiated entirely by whether their autonomy is respected or not, rather than what form their birth actually takes. It is clear that Ms. B did not want to avoid a section at all costs including her own health and the health of her baby, but instead to be supported by her healthcare providers in her decision to attempt a trial of labour as far as she felt was safe, with the most information and support she could obtain available to her. AIMS Ireland is delighted that Ms. B fought and won this right for herself, and by extension all other women in Ireland in her position.
Ultimately this case highlights supporting a woman's right to weigh risks for and against each care option and make the best decisions for her in her current circumstances taking on board her medical history. The unit refused to engage and instead decided threatening her & taking her to court was the best option. And they were backed by our National Health Service under Constitutional personhood law. The foetus, like many other cases, had its own legal representation against its mother.
If we want to make it about "risk", if discussing the 3% chance of uterine rupture, we must discuss all the risks and that it's up to the woman to weigh them out. There are real and substantial risks in repeat Caesarean; most severe maternal morbidities in Ireland (the near misses) are involving repeat Caesarean section. There are no absolutes in maternity care, it's about balancing risk and making the decision you feel safest in *at that moment * with scope to revisit the issue if medical indication arises. As in this case. The woman requested a Caesarean when she no longer felt vbac was a safe option. Women are not stupid. Women do not take risks. They make good decisions for themselves and their baby. They need to be supported, not violated and threatened.

AIMSI points: HSE v B

These points relate to the case of HSE vs B. The in-camera reporting of the case was lifted on 2nd November 2016, over a month after the original case was heard. The case relates to the HSE who took a heavily pregnant woman, Ms B to the High Court to seek an order for a forced sedation and c-section against the woman’s consent.
  1. This case is clear proof of what AIMS have been saying for years now; that the HSE coercively use the existence of the 8th amendment to the Irish Constitution against birthing women. The fact that they tried to prevent their defeat in this case being publicly reported is cause for ongoing concern about their continued desire to bring further cases of informed refusal to the High Court.
  2. That this woman had the support and strength to go and vindicate her right to informed refusal in the High Court whilst heavily pregnant makes her very unusual.  Ms. B deserves our very great thanks for publicising this practice by the HSE.
  3. Whilst a case with a formal judgement such as this is unusual, AIMS Ireland are aware of many cases in which heavily pregnant women have been threatened “with the guards coming to get them” if they don’t turn up for their scheduled induction. In fact a cohort of women reported such statements are regular commentary at antenatal classes at one particular hospital. AIMSI can also confirm that there are other women who felt they had no other option than to be coerced into a section they did not freely consent to.The fear of being taken to the High Court and being sedated for forced obstetric procedures is usually enough to ensure that women comply with whatever the HCP may be suggesting whether it is evidenced based or not.
  4. AIMS Ireland are aware of these situations in a variety of settings and geographic locations. It is not limited to large tertiary referral hospitals or to smaller units. It is endemic and a result of article 40. 3. 3 which informs the HSE National Consent Policy, enabling High Court Actions to be taken against pregnant women who exercise their right to informed refusal of medical treatment.
  5. The ruling makes clear that the 8th amendment can be, and is used against women in continued pregnancy and birth. It finds in this particular instance that the threat to the baby’s life is not great enough to warrant forcibly sedating and sectioning a woman, but it gives us no examples of when that threat might be great enough. This leaves the door open to the HSE to continue to interpret this “risk” as they please. It enables women to be forced into processes and procedures such as CEFM (Continuous Electronic Fetal Monitoring) which the evidence base acknowledges does not improve outcomes for mothers or babies.
  6. The judge’s comments on Ms. B having to bear the whole financial weight of any potential care baby B would have needed shines a light again on an issue that AIMS Ireland have repeatedly highlighted; that of babies who need lifelong care from injuries acquired at birth only being financially supported if someone is found to be ‘at fault’ for those injuries.AIMS Ireland have long argued that instead of the State Clinical Indemnity Scheme  paying out huge sums in compensation and families needing to pursue litigation, a care fund should be established, from which monies can be allocated for the lifelong care of any child injured at birth without the need to assign blame.
  7. Ms. B’s decision to request a c section despite having been vindicated in her right of refusal goes to prove AIMS Ireland’s position that women’s experiences of their care are differentiated entirely by whether their autonomy is respected or not, rather than what form their birth actually takes. It is clear that Ms. B did not want to avoid a section at all costs including her own health and the health of her baby, but instead to be supported by her healthcare providers in her decision to attempt a trial of labour as far as she felt was safe, with the most information and support she could obtain available to her. AIMS Ireland is delighted that Ms. B fought and won this right for herself, and by extension all other women in Ireland in her position.
  8. Ultimately this case highlights supporting a woman's right to weigh risks for and against each care option and make the best decisions for her in her current circumstances taking on board her medical history. The unit refused to engage and instead decided threatening her & taking her to court was the best option. And they were backed by our National Health Service under Constitutional personhood law. The foetus, like many other cases, had its own legal representation against its mother.
    If we want to make it about "risk", if discussing the 3% chance of uterine rupture, we must discuss all the risks and that it's up to the woman to weigh them out. There are real and substantial risks in repeat Caesarean; most severe maternal morbidities in Ireland (the near misses) are involving repeat Caesarean section. There are no absolutes in maternity care, it's about balancing risk and making the decision you feel safest in *at that moment * with scope to revisit the issue if medical indication arises. As in this case. The woman requested a Caesarean when she no longer felt vbac was a safe option. Women are not stupid. Women do not take risks. They make good decisions for themselves and their baby. They need to be supported, not violated and threatened.
AIMSI Press release:
http://aimsireland.ie/statement-from-aims-ireland-on-the-lifting-of-in-camera-status-in-the-case-of-mother-b-vs-hse-heard-in-the-high-court-dublin-on-30th-september-2016/

Irish Times reporting:
http://www.irishtimes.com/news/crime-and-law/in-camera-judgement-released-in-case-where-hse-sought-surgical-delivery-1.2852130