Thursday, 28 March 2013

What do 'Human Rights in Childbirth' look like?

When you think of ‘Human Rights in Childbirth’ – what do you see?

Do you see a certain kind of birth?

Do you see a certain image?

Do you think that it is not about you?

Human Rights in childbirth means that a pregnant woman’s basic rights and freedoms are the same as any other person.  A woman cannot have these rights removed simply for being pregnant or based on where she lives, sexual orientation, nationality, religion, or any other status.  Women can expect appropriate care. ‘Appropriate care’ means that the psychological and physical welfare of a woman is protected. Women shall be treated humanely. Women shall receive care based on the best evidence available rather than based on routine hospital policies - which do not treat women on an individual basis and are sometimes shown to do more harm than good. Appropriate care means a woman is respected in making decisions which will affect her and her baby.

Human Rights in childbirth affects all women, in all types of care.  And these rights must be protected equally.

Unfortunately, at times, these rights can be denied. This is often called a ‘breach’ or ‘violation’ of human rights. Some women who have given birth instinctively feel they have been denied their rights, that something just didn’t feel right. Others may not be sure.

What does a human rights violation look like?

Sometimes, women say they picture a human rights abuse in extremes. AIMSI hear women say all the time “my birth wasn’t that bad compared to others”. In reality, a breach of rights can look a lot more subtle.  Some examples of Human Rights breaches in childbirth are: having an examination or procedure done without your permission, cutting you without asking, or breaking your waters without giving you the full information. Breaches can also be how you were treated. Were you listened to? Were your choices respected? How were you treated? Were you cared for and treated  in a  dignified and respected manner? Were you given information on important decisions during your labour and birth? Sometimes, seeking your permission can be implied. For example: “I am just going to give you some help” as they are cutting you. This is not consent and is a breach of your rights. 

Any denial of a woman’s rights is not OK.

What does Human Rights in Childbirth look like?

The right to choose your hospital.

The right to choose your care provider, doctor or midwife.

The right to choose who supports you in labour – birth partner(s)

The right to choose the type of care for your birth: public, semi private, private consultant led,  midwife led (MLU, DOMINO) in hospital, or home birth.

The right to be an active member in decision making during your pregnancy, labour and birth.

The right to be given all the necessary information – benefits and risks – of a test, treatment, or procedure to help you make a decision. Benefits and risks means that any possible side-effects are explained to you, both for and against. You should also be given the opportunity to discuss 'doing nothing' - asking for more time before making a decision and if there any alternative suggestions you can try.

The right to give your consent, the right to more time, and the right to refuse.

The right to have your concerns and preferences respected.

The right to be treated in a dignified and compassionate manner.

The right to have enough staff to look after you.

The right to privacy.

The right to have pain relief, or not.

The right to have maternity care which is based on best evidence available.

The right to a second medical opinion.

The right to make decisions on the care of your baby.

The right to equality – all women are treated the same.


A recent decision by the European Court of Human Rights found that it is a basic right for women to decide the terms on which she becomes a parent. That means women have the right to decide where and how she gives birth. If you feel your rights were denied, AIMS Ireland would like to support you. AIMS Ireland will help you in a complaint. We also have legal experts who can talk to you and provide you with advice. Additionally, our legal experts can assist in a legal complaint to the European Court of Human Rights. AIMS Ireland wants to hear from you if you feel your human rights were breached in any way during your pregnancy, labour and birth. We are interested in collecting stories from women with a view to publishing them. Your voice matters and your story  will help gain awareness and protect women’s rights.

If you would like more information on any of the issues here please contact us at

Monday, 25 March 2013

Realise Your Rights - The Birth of AIMSI

In March 2007, a group of women came together with a common goal: to help other women who had been neglected, coerced, disrespected - and sometimes abused - in their maternity care to realise they are not alone. The Association for Improvements in the Maternity Services Ireland (AIMSI) believed that women were not being supported and respected in their childbirth choices and set out to campaign and lobby to change the culture of birth in Ireland. For the past 6 years, AIMSI has put in thousands of volunteer hours providing support, writing letters, researching evidence-based care in childbirth, participating at committee level to improve maternity services and making certain that the respect of women in childbirth is a right, not a privilege.

There is a long history in Ireland of women and their bodies being the domain of the State. Looking back through the annals of time, there are countless stories of women being told they must give up their babies because they were seen as 'unfit mothers' or that they must be committed to an institution, such as a Magdalene Laundry, often for no other reason other than they were not compliant with the sociocultural 'rules' of the State. Even some things that seem unrelated, such as the State obliging women to leave paid employment after marriage or making it legally impossible for a woman to petition for divorce from an abusive spouse, set the tone for many women to accept that they had very little to no autonomy or self-determination in relation to their bodies and their lives.

In recent years, thanks to the tireless work of activists and advocacy groups, like AIMSI, Ireland has moved on from the explicit discrimination of women, but these cultural attitudes are very hard to shift after years of indoctrination and justification. Recently an article in The Journal described the "grotesque and violent" treatment of women at the hands of surgeon, Dr. Michael Neary. It is widely known that Dr. Neary removed the wombs of at least 129 women and that many of these women are still waiting for compensation for this brutal and unnecessary surgery.  The most poignant comment in The Journal article is that of one of Neary's victims when she says:
“Even when the story broke years later, I was still convinced I needed it. I told people, ‘I wouldn’t be one of them’. I believed he totally saved my life. I did actually think he was a good man who knew what he was doing, and that he was doing it for the right reasons.”
This is what many women who attend a hospital birth and who undergo surgical interventions, from an episiotomy to Caesarean section, often are told - that the interventions a woman has been subject to are necessary and have saved her from pain and suffering or even from death. Women who have given birth in Irish maternity hospitals often tell dark stories of being threatened into complying with treatment (usually with the "dead baby card") or of being refused extra time in labour, all for the sake of medically managing their labour. The policy of Active Management of Labour (AML) was devised in the 1970s in the National Maternity Hospital in Dublin and is now practiced and taught internationally. The basic policy of AML includes that:
  • each labouring woman will fit into a standardised method of care whereby she will dilate at 1cm/hour
  • a woman will have a maximum of 12 hours to labour (including latent labour)
  • a woman will undergo routine amniotomy or 'breaking of the waters' by a midwife/doctor
  • the administration of synthetic oxytocin (Syntocinon®/Pitocin®) will be used to augment, or speed up, labour
  • a medical decision will be made regarding surgical intervention - episiotomy, forceps, ventouse, c-section - in the case of prolonged labour (+12 hours)
  • the 3rd stage of labour - delivery of the placenta - will be managed using a uterotonic drug, such as Syntometrine®
On the surface, AML sounds as if it is a method of protecting women from facing complications due to a painful and prolonged labour and birth - but in reality it is an inconsistent and unreliable method of controlling birth that solely focuses on the management of labour and has little regard for the woman who is actively labouring. The consequence of a medicalised birth, such as AML, is that women have begun to lose trust in their ability to manage their own labours. The talk of risk and intervention by midwives and doctors leads women to believe that there are inherent dangers in childbirth. Research that is used to support claims about the risks in childbirth are methodologically weak at best and spurious at worst. Of course, as in any medical emergency, there are instances where surgical intervention is necessary for the health and well being of the patient. But how does this explain the increasing rates of intervention in maternity care, such as a steep rise in inductions, epidurals, episiotomies and c-sections? Or even more telling, how can stark regional variations in these interventions across Ireland be explained?

These are the questions that AIMSI vigorously investigates on behalf of all women who are involved in the Irish maternity services. Our mission is not to deny that some births will necessitate medical intervention - it is to ask for the validity and respect of the woman's voice when making informed decisions in her maternity care, whether it involves an emergency or not. While the vast majority of births are non-emergencies and require no intervention, the following statistics in maternity care contradict this and demand closer scrutiny:
  • the sharp rise in inductions of labour (approximately 1 in 3 pregnancies are induced in Ireland) 
  • the increased use of epidural for pain relief (this occurs for approximately 70% of first time births in Ireland, and at slightly lower rates for subsequent births) 
  • the inconsistency in rates of episotomy (from less than 2% to more than 27% across maternity units in Ireland)
  • the broad variations in c-section rates in Irish hospitals (anywhere from 22% to 43%)
It is simply implausible to say that these increased rates of intervention have saved lives. All scientific research is governed by the phrase: correlation does not imply causation. Therefore, it is almost impossible to determine the validity of interventions in childbirth after the fact. The glaring omission in AML is the risk that the above interventions all carry. The misperception of these interventions being "almost risk free" means that there is very little chance of accurately assessing the risk to the mother versus the risk to the unborn baby. This is further confounded by Draft HSE National Guidelines on Consent which state that a pregnant woman's right to refuse treatment must be balanced with the right to life of the unborn.

Many women will report to friends and family that if it weren't for a given intervention, her baby may not have been born healthy or alive. This is the power that a policy such as AML has over women who are pregnant, labouring or giving birth. The control of her labour and delivery by the 'experts' means that she should be grateful that they have intervened. Like the quote from one of Dr. Neary's victims above - a woman is expected not to ask questions and to accept that she and her birthing baby "needed" the intervention(s). AML has not only ensured that women's labour is managed, it has also perpetuated a myth that all interventions are being done "for the right reasons". Even the doctors who originally invented AML were very open about the primary reason for controlling labour, and it was not to simply reduce c-sections or to nobly save lives - it was invented to reduce the number of hours each woman would require the care of the obstetric team. It is aptly summed up in this article by Dr. Marsden Wagner. He in turn quotes from an article by Marc Keirse called A final comment - managing the uterus, the woman or whom? that appeared in the journal, Birth in 1993:
 "It would appear that there are a large number of situations in which augmentation of labor is not directed at correcting a perceived abnormality in a woman's labor, but at shortening the labor commitment of her care givers"
It is a fallacy of logic to take a result, such as a healthy baby, and to attribute a number of interventions as the cause of that baby being healthy. Likewise, it is difficult to gather reliable and accurate statistics on the number of births that require no intervention because the standard of care in Ireland includes routine intervention, whether it is needed or not. One only has to flip through the partograms in any birth unit or to talk to a student midwife to get a clear picture of how rare it is to have a birth that is intervention-free. The strongest argument for the revision of AML is that it was originally introduced as a method of reducing c-sections and "the labor commitment of caregivers", but the rapid increase in c-sections and other interventions across Ireland (and internationally, since we exported AML) show that it has patently failed in this outcome. The paucity of reliable statistical data coupled with the lack of a national policy in maternity services makes for an ad hoc system of care. It is impossible to have consistent, evidence-based research policies and standards of care in pregnancy, labour and childbirth when each unit is operating as its own self-regulated medical outpost.

AIMS Ireland are trying to change these unsupported policies one woman at a time. Education, information and support are integral to bolstering women's confidence in their ability to birth and in their choices of how and where they wish to birth. Until the veil has been lifted on the dearth of evidence that supports AML and the risk of many of these interventions is highlighted and shared with birthing mothers, then improvements in the maternity services will be slow to positively change.

AIMS Ireland urges women to realise their rights in their choices on how and where to birth:
  • the right to an informed second opinion
  • the right to informed choice in the case of routine procedures such as electronic fetal monitoring (EFM), amniotomy, induction, movement in labour and position for birth
  • the right to informed refusal in the case of the procedures listed above and other routine interventions, such as pain relief (epidural, pethidine, gas and air), valsalva maneuver - or 'purple pushing' - and episiotomy
  • the right to choose between a home birth or hospital birth (in spite of restrictions that the HSE are attempting to place on this choice)
NB. Many women attend antenatal classes at the hospital where they are planning to give birth. While the antenatal educators arguably have the good intention of providing information on labour and birth to pregnant women, they are bound by the policies - ie. AML - of the hospital that employs them, so the information is skewed towards how a woman should behave or is allowed to behave during labour and birth. There is no mention of the 'domino effect' of one intervention often leading to the next - referred to as the 'cascade of intervention'. It is recommended to go to these classes with a critically analytical mind so that you are prepared for the policies of the hospital where you are going to labour and birth, and most importantly - you are prepared to ask questions and to exert your rights to informed consent and informed refusal.


Look out for a follow up blog post that will look at the reliance on technology in maternity services and a more detailed explanation on the 'cascade of intervention'.

More information on birth statistics in Ireland can be found here.

If you have any queries or would like more information or if you have been affected by your birth experience, please contact AIMS Ireland: or

Sunday, 24 March 2013

Submission from Association of Maternity Services Ireland (AIMSI) to the National Steering Committee for Home Births

Submission from Association of Maternity Services Ireland (AIMSI) to the National Steering Committee for Home BirthsDear All,

We have serious difficulties with both the proposed Memorandum of Understanding (MOU) and and the proposed "Agreement"  between midwives and the HSE from a human rights perspective and we write to bring these to the attention of the NSCHB.

AIMSI represents the views of several thousand women who have contacted AIMSI (and the Home Birth Association) over the duration of this Committee's life span. We are the only stakeholders on this Committee who have actively sought to canvass the opinion and views of the service users of a Home Birth Service that will be defined by the new MOU and Agreement that, we understand, this Committee plan to sign off on on 26th March 2013.

1. AIMSI recognizes a women's fundamental right to choose where she gives birth. This is a human right that finds expression in international best practice, such as NICE (UK) and ACOG(USA), which clearly define a woman’s choice as final, regardless of recommendations.

The proposed MOU does not have any provisions that recognize and safeguard a woman's preferences, and the NSCHB has made no effort to accommodate women who want to exercise their choice as to  place of birth. The official response to such women appears to be the exercise of coercion. During the lifetime of this Committee, suggestions, both implied and overt, verbal and in writing, have been made about how a woman who is reluctant to transfer to hospital in home birth might be coerced into doing so, either by the attending midwife or midwives, and/or involving "other stakeholders", included the Garda Siochana, which, as draft NSCHB guidelines were in breach of both the Constitution and European law. In practice, at least one mother has also been threatened with the seeking of a court order against her, making her unborn child being a ward of court at birth should she not agree to a hospital birth.. Indeed, the recent response to Mother A by the HSE suggests that court orders are becoming part of the official approach in Ireland to pregnant women who attempt to exercise their autonomy.

However, what may not be realized is that women who have experienced these tactics of coercion in Ireland are sharing their stories on social media to audiences of tens of thousands. Some pregnant women who read them have concluded that it is better NOT to engage with the HSE at all that their and their baby's best interests will be served by not availing of antenatal care and by birthing unassisted, without professional assistance of any kind.

This is surely not what NSCHB intends by way of outcomes to its intended sign off on the MOU and Agreement, yet, unless these documents are revised in such a way as to ensure that a woman's fundamental right to choose where she gives birth is upheld, an increase in the number of unassisted births, with their attendant risks, seems inevitable.

While the HSE recognizes the right to informed choice in medical treatment and health, maternal choice is recognized only if it reflects the prevailing model of obstetric care, apparently: the official approach does not seem to recognize women's right to make birth choices which reflect a midwifery model of care.For example, there appears to be no problem with c- sections on maternal request, despite the risks that this procedure carries.

2. But denying women their constitutional and human rights to autonomy, self determination, bodily integrity, etc leaves the State exposed to legal challenge. Both the MOU and the Agreement are in breach of Article 8 of the European Convention on Human Rights, which enshrines the fundamental right to bodily integrity. The MOU is also in in breach with the decision taken by the European Court of Human Rights in Ternovsky vs Hungary (2010), which found in favour of the right to choose the circumstances of becoming a parent. Here in Ireland, the Constitution enshrines the rights to autonomy, self determination, and bodily integrity, and the right to refuse medical treatment, yet the proposed MOU clearly breaches Article 8 of the ECHR.

3. For many women, one of the reasons they want to birth at home is because their previous experience of care in an obstetric setting left them with significant post traumatic stress. Ironically, these women may now find themselves in Tables 1 or 2 of the MOU, thereby preventing them exercising home birth choices in subsequent pregnancies, and forcing them back into the very same model of care that traumatized them in the first place..  Outlawing choice in this way runs the risk of further traumatizing women emotionally, which in turn will have knock on effects for already overstretched mental health and GP services.

4. AIMSI is particularly concerned, inter alia, about making mandatory a requirement that two midwives be present at every birth. The NSCHB's insistence on a second midwife who has signed the Agreement will severely curtail the home birth service in many areas of the country. This will lead to severe geographic inequities in service provision and will deny women their constitutional and human rights in childbirth.

This requirement is not evidence based: there is no good evidence to show improved outcomes for mother or baby when two midwives assist at a home birth. While this may have become practice in some parts of the country, due to local preferences,  imposing  this in the Greater Dublin area, where there are simply not enough midwives that meet the stringent criterion wrongly laid down by the NSCHB for the second midwives will potentially eliminate the choice of home birth services provided by SECMs in the region. NSCHB's unreasonable insistence that second midwives are required to have three years' prior experience in a Maternity Hospital will significantly reduce the pool of midwives available to act as second midwives: This requirement is also not evidence-based and appears to runs contrary to ABA's guidelines.

The requirement to have a second midwife will leave women in a very vulnerable position. Should a second midwife not be available at the last minute, women will be forced to transfer to hospital in the height of labour, an unsafe and traumatic scenario. The inevitable result will be more babies born before arrival in hospital. Birthing in the back of a car or on the side of a road with one midwife or a paramedic team with minimal training in the management of childbirth is infinitely less safe for mother and baby than birthing at home with one SECM. Another issue that has been raised is that women should be able to chose whether or not they wish to have a second midwife, whom they may not know, in attendance at their home birth. Many women specifically choose home birth so that they will have continuity of care from a known and trusted midwife.

5. Our presence on this committee was to bring the perspective of the service user to the table so that this could be factored into the new instruments (MOU and Midwife's Agreement) that will define the home birth services that these women and their families will have available to them. AIMSI has repeatedly been denied that opportunity, however. The MOU was drawn up in September 2008 under severe time pressure, at the behest of the then Minister of Health, Mary Harney. It was always AIMSI's understanding that the MOU was an interim document and that issues, such as VBAC at home, would be revisited and re-assessed. This review process excluded all such issues from consideration, leaving large groups of women excluded from the State's home birth services.

The only two groups that have not been consulted in the drafting of these key documents are the service users and the service providers (as in SECMs), even though both groups are theoretically represented on this HSE National Steering Committee. Consultation means more than engineering a fait accompli, it means parity of esteem, with each participant an equal partner in the drafting process. This has never applied to the NSCHB, however, where some delegates have always been "more equal" than others. AIMSI has been persistently denied the opportunity to consult these documents during drafting; and once drafted, the organization was informed that no changes were permitted; with repeated requests for the most recent versions falling on deaf ears.  Two days before these documents are scheduled for final approval, AIMSI has still not seen the final drafts.

In conclusion, AIMSI cannot reasonably be expected to sign off on any document that will radically affect the provision of the State home birth services without proper prior consultation and without being afforded the opportunity to input into these highly important contractual agreements. Until these issues are resolved, AIMSI will not be a signatory to any instrument seeking to restrict the provision of State home birth services that flies in the face of women's human rights in childbirth.

Yours faithfully

Krysia Lynch and the AIMSI National Executive

cc. Laverne McGuinness, National Director of Integrated Services, HSE
cc. Dr James Reilly, Minister of Health,


Update 11am Monday 25th March: AIMSI has received a letter from a woman to Patient Focus, the other consumer representative on NSCHB. Please see below - posted with permissions.

Dear Sheila O' Connor and Patient Focus,

As a Mother and pregnant Mother,  I strongly object to the MOU and how it will be  implemented as categorical exclusion rules. This means my maternity system is and will continue to treat me as a sheep in a herd. It denies me individual assessment for care options, it denies me an equal input into my care options, it denies my Midwife autonomy work in her professional it denies me evidence best practice.

If you vote for the MOU to go through, you will part-take in an ongoing battle of women's oppression and you will be in support of denying Women their Human Rights.
You will NOT represent me.

This MOU is flawed, how it has been drafted is flawed, it's current implementation is flawed and it's news content is flawed. Given the recent statement via AIMS Ireland, I cannot and could never say that anyone voting in agreement with the MOU represents me.

Your deeply concerned about our birthing future
Annette Harkness

If you would like to send a similar letter, please consider the following recipients:

Sheila Sugrue - National Midwifery Lead, Ireland:    
Michael Turner - National Obstetric Lead, Ireland:
Sheila O'Connor - Patient Focus, Consumer Rep:
James Reilly - Minister for Health: 
Michael Shannon - Chair of NSCHB:  

AIMSI have been approached by a legal firm who are looking for women/a woman to make a complaint to the Committee on the Elimination of Discrimination Against Women (CEDAW). We are looking for women who are prepared to make a complaint to the CEDAW because of a threat that their right to autonomy will be violated or because their rights have been violated. please contact:

* Please see earlier blog posts on draft HSE guidelines for consent in pregnancy for further background.

Friday, 22 March 2013

HSE set to dismantle Cavan MLU? For a non-maternity surgical day ward.

The measuring tapes are out and it would appear the Cavan MLU's days are numbered as a two room unit, according to several sources contacting Birth Matters Cavan and AIMS Ireland over the past 24 hours.

 If reports are correct, Cavan are transforming one of the two MLU birthing suites, the MLU ante-natal room and waiting rooms,the offices of the ADON for women's & children's services, the clinical midwifery managers and one of the OB consultants, and the early pregnancy unit) into a day ward for non-maternity surgical services. It would seem the remaining MLU birthing room and MLU office will be sandwiched between rooms being converted into the surgical day ward.

This will have immediate impact on the ability to provide MLU services to the full number of booking capacity MLU women - if a woman is already using the birth room there is nowhere for ante-natal checks or room for another woman to labour.

The Midwife Led Units (MLUs) were created as a pilot scheme in Cavan and Drogheda. They offer women normal birth practice and offer a unique gold standard of care within a hospital setting. AIMSI and many organizations have hoped that the MLUs would be rolled out nationally. The MLUs have been proven to provide women with safe midwifery led care, have high satisfaction ratings, and are cost effective. You can read more about the MLUs in the Mid-U study seen on this link HERE

This is not the first attempt to cease or reduce services in the Cavan MLU. In December 2011, the HSE made moves to close the unit based on 'uptake'; fewer bookings from women. So why the low uptake?

This Facebook post from December 2011 shows the low down:

AIMSI have been informed that the rationale for closing Cavan MLU is that it is functioning below capacity. How could this be so? We know that MLU in OLOL is fully booked, we know that women WANT midwifery led care (see recent study out of the Coombe showing a 42% preference for ML care. Is there something particular going on in Cavan. AIMSI have had many reports of women saying that they were (a) not informed of MLU option by their GP (b) that they wee dissuaded from care at the Cavan MLU by both their GP AND staff at the CLU, even thought they fit the criteria for low risk care.Women must be made aware of the fact that they can SELF REFER if this is the case.

In the past the women could refer themselves to the MLU, now they have to go through the Consultants. The feedback we have had from women is the Consultants and GPs are not referring women, even if they meet criteria, for the MLUs. Women have also told us bookings are left 'too late' if they indicate they want the MLU; women must be booked in by 20wks as per policy of the MLU but some women who indicated MLU preference, won't get an appointment til 24wks - too late for the Consultant to 'sign off' for MLU. AIMSI have also heard from women whom were told MLU care is risky.

Over the next few days, we will probably see a variety of excuses from the HSE as to why they are dismantling the MLU. AIMSI wants to preempt these before they begin.

This is NOT about money. The Mid-U report clearly states that for the same woman, having the same birth, the MLU costs  €400 less than the woman in CLU. For the SAME birth. Though, maybe it is...the obstetricians will certainly be getting more bookings.

This is NOT about safety. Midwife led care has been proven to be a safe option. The Mid-Ustudy shows us that midwifery- led care as practiced in these units, is as safe as consultant-led care but uses less intervention in pregnancy and childbirth.

This is NOT about women's preferences. Various research in Ireland has shown that women have high satisfaction ratings using midwife led care and women want access to MLUs nationwide. 85% of women using the MLUs would 'recommend it' to a friend.

So what is the REAL issue here?
Who benefits?
Is this another attempt by GPs and Consultants to prevent women from accessing midwife led care?

Looks like the Consultants are finally getting their way.

What can you do?

Join the Defend Cavan's MLU - facebook page:!/pages/Defend-Cavan-MLU/322709951092529

Contact your local TDs
Contact AIMS Ireland at


BIRTH MATTERS: "Measurements of the unit were taken yesterday. Our main concern was that we would be kept informed if any changes were to be made. I have received clarification from Cavan that the entire footprint of the hospital is being surveyed to try to accommodate a day surgery facility. A representative has explicitly stated that the MLU is NOT closing. I woukd interpret this as meaning som...e facilities will be rearranged. I understand that his is a highly emotive issue, and under present cost cutting measures across the country, it appears that no service is sacred, but we need to stay focused & calm & make sure our information is accurate if we are to be taken seriously at regional level. Thank you all for rallying round as usual. It is a huge comfort to know that there are vigilant people out there who value their services & are willing to fight for them......No immediate plans at present. Whole hospital survey underway. I have been led to believe that it would be a case of moving/ rearranging facilities rather than removing them."

AIMSI response:

This is good news if services to the MLU in Cavan are to remain fully operational with the current level of services; antenatal waiting room, booking room, 2 birth rooms. We look forward to being further updated on this issue. The MLUs are about 10yrs old and still in immacculate condition. The 2 birth suites are beautifully designed with state of the art facilities, including private ensuite toilets/showers and birth pools. 

Wonder how they plan on rearranging and moving them?

                                                           Birth Suite in Cavan MLU

Thursday, 21 March 2013

AIMSI's PQs via Clare Daly: High Court Caesarean Case and MOU for Homebirth

AIMS Ireland sent in the following PQs following the High Court Case in Waterford. Clare also asked a PQ in relation to the MOU and Homebirth restrictions in Ireland.


DÁIL QUESTION addressed to the Minister for Health (Dr. James Reilly)

by Deputy Clare Daly

for ORAL ANSWER on 20/03/2013

To ask the Minister for Health the circumstances in which a hospital went to the High Court to seek an order for a woman to have a Caesarean section on 10 March 2013; the nationality of the woman involved; the basis of that decision; and if he will make a statement on the matter.

Clare Daly T.D.


Following a request for information by officials from my Department, the HSE has confirmed that on Friday 8 March 2013 Patient A attended the ante-natal Clinic in Waterford Regional Hospital. The patient was 13 days overdue. Serious concerns arose following a clinical review at the clinic. The patient was advised that an immediate admission to the hospital for a caesarean section was needed. It was deemed that there was a substantial risk to the health and wellbeing of both the baby and the mother. I am advised that, at this point, the mother refused to be admitted to hospital.

As the risks were deemed unacceptably high, an application was made by the HSE to the High Court seeking an order – Notice of Motion - to allow the hospital (or its doctors or staff) to administer all appropriate medical treatment for the mother to safeguard her health and that of her unborn child. The court order included a request that the patient be compelled to undergo a caesarean section if necessary. As per the patient’s entitlement legal representation was organised for the patient by the hospital. The patient’s legal representation costs will be covered by the hospital.

An initial Notice of Motion was issued on Friday nightrequesting the patient to return to the hospital for further review. The mother consented to stay in the hospital. A second consultant obstetrician spoke to the mother and outlined the serious concerns and the risks for both the baby and the mother. The mother again refused to undergo a caesarean section

On Saturday 9 March the patient consented to a caesarean section which was carried out immediately. Therefore a further Court ruling was no longer required. I wish the patient a speedy recovery.

I am unable to advise the Deputy of the nationality of the woman involved on the grounds that this could potentially lead to the identification of the patient.


addressed to the Minister for Health (Dr. James Reilly)

by Deputy Clare Daly

for WRITTEN ANSWER on 20/03/2013

* To ask the Minister for Health his views on whether the Memorandum of Understanding between midwives attending home births and the Health Service Executive sufficiently safeguards a woman's right to give birth how and when she wishes by the care provider of her choice; and, if not, his plans, if any, to revise it..

Clare Daly T.D.


Currently in Ireland there is a National Domiciliary Midwifery service available to eligible expectant mothers who wish to avail of a home birth service under the care of a self employed community midwife (SECM). This service is provided by the SECM on behalf of the Health Service Executive who signs the Memorandum of Understanding (MOU) with the Health Services Executive (HSE). As the HSE has responsibility for this matter it has been referred to them for direct reply to the Deputy.

Wednesday, 20 March 2013

Seeking women/woman for an Irish CEDAW complaint on human rights abuses in Irish Birth

AIMSI have been approached by a legal firm who are looking for women/a woman to make a complaint to the Committee on the Elimination of Discrimination Against Women (CEDAW). We We are looking for women who are prepared to make a complaint to the CEDAW because of a threat that their right to autonomy will be violated or because their rights have been violated, who, with legal backup, are willing to make a complaint about their treatment to the UN.

If anyone is interested or would like to discuss this with us and the legal experts, please contact us at or

Tuesday, 19 March 2013

If in doubt, blame it on 'safety'; HSE closures in the Northeast

The past month there have been whispers of HSE plans to closure ante-natal clincs in Navan and Dundalk. In true HSE style, these closures look set to be implemented under the radar, without informing women, they will just suddenly cease to exist.

In an interview on LMFM radio, Alan Finan, clinical director for women and children's services in the Northeast has confirmed closures of clinics citing reasons for "ultimately about patient safety" LINK

Patient Safety?! That old reliable.

Of course, closures of clinics will have the direct opposite effect as an extra 60+ women will be booked into already full to capacity clinics in OLOL Drogheda. Women will be required to travel long distances for care, heavily pregnant on public transport, or will decide to forgo ante-natal care due to logistical problems.

Please see our letter to local TDs on this issue:

I wish to express the shock and anger of AIMSI's and Families for Safe Maternity Services in OLOL members regarding the closure of antenatal clinics in Dundalk and Navan. Members are well aware of the potential negative impact of these closures on all current and future pregnant women throughout Co Louth and Meath and we wish to ask a Parliamentary question on this matter. We wish to know why this decision was made in the first place and when will this decision be reversed, knowing the negative effect these closures will have on the growing numbers of women who are not in a position to travel to Drogheda for basic antenatal check-ups. These clinics were set up so that pregnant women could attend local antenatal clinics as lack of transport and caring for other children prevent many women from attending these essential medical check-ups during pregnancy.

 While all pregnant women in the Dundalk and Navan areas will be affected, disadvantaged women in particular will be more affected as attendance may not be a priority for these women and particularly when attending clinics involves bus journeys, financial costs and many hours away from home. Disadvantaged women are at higher risk of adverse birth outcomes for themselves and their children. However, disadvantaged women are an easy target as most will be unaware that antenatal services are no longer available until it directly affects them. These women are less likely to read local papers, listen to local radio and are also less likely to attend antenatal services, even when they are available locally. When services become difficult to access for these women, I fear that their attendance at antenatal clinics will decline even further. Closing local antenatal clinics will disproportionately affect disadvantaged women who are already at greater risk of complications and adverse outcomes. If the health service exists to protect health, what is the rationale for closing local basic antenatal clinics?

 While disadvantaged women will be most affected, many of our members are aware of the growing numbers of middle class women who are struggling financially. Recently some women have said that they were unable to bring their children to school as they did not have enough money for petrol and it was too far to walk. How are these women who are already struggling going to be able to afford transport to centralised antenatal clinics?

 Lack of local access to essential antenatal services breaches the HSE’s own service plans and all the Health Service research on women’s services over the past decade. We are aware of this because some of our members are also members of “Birth Matters”,a consumer group set up for parents to work with staff to improve local maternity services. Maternity services consumer groups were part of the Kinder recommendations for the on-going improvement of maternity services in response to parents needs. Parents identified their needs and some progress was made in developing local support structures for women. The Kinder report recommended community based and midwifery led services and recognised the importance of providing antenatal and postnatal services locally so that more women could attend. The HSEs own research also highlights that women need local access to services in recognition that potential barriers like childcare, lack of transport, cost of transport, work commitments are factored in when planning services. In this context, it beggars belief that decisions were made to stop these services and ask all pregnant women in County Louth and County Meath to attend Drogheda Hospital which is already experiencing very busy antenatal clinics. Closing antenatal clinics has huge implications for many women who don’t have transport and I fear that many women will not attend clinics in Drogheda. Closure of antenatal clinics contradicts all the Kinder recommendations aimed at improving health outcomes.

Woman's story: UCHG denies D&C for inevitable miscarriage, forcing woman to travel abroad for care

AIMSI has been contacted by this woman and she asked us to share her story.
She attended U C HG for a missed miscarriage and despite her loss confirmed, was left for several weeks without treatment. She eventually travelled abroad to Spain for care.

This is her experience in her words:

At the end of December I had a missed period so I made a pregnancy test from the Pharmacy and it was positive. At the end of January I went to my GP to have a confirmation. He made a urine test and it was positive. I was 9 weeks pregnant then. Urine tests are not very trustable (the confirmation should be done through a vaginal scan or at least through a blood test) and I told my GP I was a little concerned because I wasn’t having the symptoms I used to when I was pregnant with my first son (continuous heartburning, sacrum pain…). He reassured me by telling me that every pregnancy is different and I trusted him.

Two weeks later I had a small bleeding. I went to my GP, he unsuccessfully tried to hear the baby’s heartbeat, but as it was still very early in the pregnancy (11 weeks) this wasn’t concluding. He sent me to the hospital (University Hospital Galway) with a letter, and told me I would probably have a scan done at the moment. I went to the UHG then, but I didn’t have any scan done. I had a vaginal exploration instead; the doctor found a little tear in my cervix, she told me this was very common at this stage of pregnancy and nothing to be worried about. She also found the cervix was closed so was not worried about a threatened miscarriage. Nevertheless she booked me for a scan in two weeks. As I didn’t want to wait for so long and still had a weird feeling about it, I booked a scan in a private clinic.

I went to the private scan a week later (I was 12 weeks +6 days pregnant then). The doctor didn’t make a vaginal scan but an abdominal scan instead. He told me there was a pregnancy sac in the womb, but that it was empty. There was no heartbeat and he couldn’t see any embryo. He told me to go to the hospital on Monday (it was a Saturday then) to show them the scan report; he told me I would probably have a scan done at the moment, and he recommended me to carry a bag with my stuff since I would probably be booked to have a D&C done. Of course I was very sad and distressed with the news. No woman is prepared to hear this, even if she had a weird feeling about her pregnancy.

So I went to the hospital on Monday with my husband. They made us wait for five hours. I finally saw a doctor, and showed her the scan report and pictures. I had no scan done at the moment. The doctor told me that they needed a second scan done a week apart from the first one I was showing her, so that they could be sure the dates (last period and all that) were not wrong and the pregnancy had really stopped. She told me to go back to the hospital the following Friday (the 22nd February, which was the date I had the scan booked when I got there due to the small bleeding) to have the scan done and that then the doctor would recommend the best option to follow: D&C or tablets to stimulate womb contractions.

Since I knew the dates were right I did not expect anything in this sense, so I spent the saddest week of my life, saying goodbye to my supposed “empty nest”, disappointed with my body -which I thought was not working properly getting rid off it- and trying to mind my 2-year-old son at the same time with my ruined mood.

On Friday I went back to the hospital with my husband, hoping they will finally help me and give me the proper care. I finally had a vaginal scan done. The doctor found a 4 or 5-weeks dead embryo inside the sac. I was wrecked. I wasn’t expecting to see anything since I had been told my sac was empty, so when I saw my little tiny baby there, dead, I was destroyed. I was then almost 14 weeks pregnant, and the embryo stopped growing when it was 4 or 5 weeks. That means I have had a dead embryo inside my womb for more than two months. So besides the deepest sadness in my whole life I was also feeling a great fear. I knew well that I was in risk of infection. Septicaemia following missed miscarriage is not rare, and can be very serious. I already knew Savita’s story. The doctor expressed her condolences for my loss and then asked me how I would like to proceed next. I told her how distressed I was, how deeply sad and scared about the possibility of infection I felt, how difficult it was for me to mind my 2-year-old son with all this going on, and that I wanted to put and end to this nightmare. Then she told me that, since the embryo was smaller than 7mm, they could not help me in any way; that the only thing that could be done was to have another scan done a week apart to be sure the embryo was not growing. Honestly I did not understand anything. I had two scans done a week apart, there was no heartbeat present in any of them, the doctor had just told me my baby was dead, she offered me her condolences, and then she told me she needed to get sure the baby was not growing???? This was extremely shocking to me. Was she expecting it to resuscitate? She told us to wait in a separate room so another doctor would come and talk to us.

So we sat down in the separate individual room and waited. We waited for more than one hour. During that time I was feeling really scared since it had became clear to me that, if any complication raised, these people would let me die, just as they did with Savita, because although the embryo was dead its size was under 7mm. I was not feeling a human being anymore since I was not being treated as a human being. They were just leaving me to my fate; they denied me any assistance, which I believe is the worst thing a human being can do to another one.

Two different doctors came one after the other to talk to us and, as I had feared, none of them wanted to help me in any way.

I went back home destroyed but not willing to be in this hospital’s hands any longer. So I phoned my doctor in Spain (the one who took care of me when I was pregnant with my first baby); I told her the whole story and my situation, and she told to go to her clinic on Monday and that she will perform the D&C then. So we bought the tickets to go to Spain on Sunday. As soon as I spoke to my doctor I started bleeding (my body finally felt safe enough to start working!) and kept bleeding for the whole week-end. We made the trip to Spain on Sunday, a sixteen-hour trip by car, plane, train and taxi. I was bleeding all the way. I didn’t have the chance to see my doctor since as soon as we got to sleep I began feeling the contractions, so we went to emergencies of the nearest hospital. And there I had my miscarriage; doctors helped me with a short aspiration and then made sure nothing was left inside my womb.

That’s the story of my nightmare. I’ve been in hell for several weeks. Now I believe that when a woman gets pregnant in Ireland she just loses her human rights. Doctors here just don’t know the proper way to monitor a pregnancy. The first time I was in my GP’s to get the pregnancy confirmation, the day he congratulated me, my embryo had been already dead for one month. This would certainly not happen in a country where the proper care for pregnancy is taken. We live in the XXI century. Other ways to confirm pregnancy are available, much more trustable ways than a urine test! No one in a country that takes proper care of pregnant women would understand that I had no scan done when I was in the hospital with a bleeding. I just certainly cannot understand how a dead embryo can be more important than the emotional and physical health of the woman, or even her life. This is surely a dangerous country for pregnant women, and I will never ever try to get pregnant again while I’m living here. We’ll try to leave the country, indeed.


Death of Savita in UCHG

HSE says pregnant women don't have same rights

The Draft National Consent Policy - open 2nd link - page 34 - section 7.8.1 'Refusal of Treatment in Pregnancy'

"The Consent of a pregnant woman is reqired for all health and social care interventions. However, because of the constitutional provisions on the right to life of the 'unborn', there is legal uncertainty regarding whether a pregnant woman's right to refuse treatment extends to the refusal of treatment which puts the life of the foetus at serious risk. This matter can ultimately only be decided by the Courts. Thus, where a pregnant woman refuses treatment and this refusal may impact on the life of the foetus, it is essential that the consequences of the refusal are fully and clearly explained to the woman, and legal advice should be sought if she persists in the refusal"

Draft HSE guidelines here

No Country for Pregnant Women - Press Release

High Court forced Caesarean Section in Waterford here

 No Country for Pregnant Women

This past weekend, as the nation celebrated International Women’s Day and Mother’s Day, an Irish Maternity Hospital initiated an invasive procedure on a pregnant woman against her will. ‘Mother A’ was denied patient autonomy and the right to informed refusal when the drastic and unprecedented measure of an emergency High Court sitting was called in order to compel her to undergo a Caesarian section. The risk of uterine rupture was cited as one of the main reasons for the urgency in this case but this risk is widely reported as being 0.1% or 1/1000. This is what Dr. Michael Turner, Obstetrician at the c*e Hospital has called: “exaggerated, professional scaremongering...and it must stop”. (VBAC Conference, 2012)

State-sanctioned coercion of medical procedures on pregnant women or any other competent adult is not only unacceptable but it is also unlawful in other jurisdictions, such as the USA and the UK (Re AC [1990] & Re S [1998]). ‘Informed consent’ and ‘informed refusal’ abuses are common issues reported to AIMS Ireland by women.

Jene Kelly of AIMS Ireland states: “there is an overwhelming acceptance by the public and some maternity service providers in Ireland that a pregnant woman’s right to informed consent, or informed refusal, is not reliable and that women who exert their rights are selfish. It is this mentality that has allowed atrocities such as symphysiotomies, miscarriage misdiagnoses, unnecessary hysterectomies by Dr Neary and all the other reported assaults against women by our maternity system to continue to go unanswered in Ireland for so long. This is no country for pregnant women. ”

AIMS Ireland reports that women who are bullied into consenting do not fulfill the principles of informed consent and therefore are entitled to sue the doctors for assault. For example, a woman who was forced to have a caesarean section against her wishes in the UK sued the doctors (Ms S v St George's NHS Hospital Trust, 1998) and was awarded £36,000 damages. It is time that Irish women did the same. Threatening women, bringing women to the high court, removing women’s rights and choices - these bullyboy tactics do not promote trust between women and their care providers. How can you trust a system that doesn’t acknowledge your rights? Women are choosing to leave the system as a result.

Annette is one of these women. She is lobbying the HSE for a homebirth following a previous Caesarean section. The HSE currently does not recognize informed choice for homebirth for women who fall outside strict exclusion criteria in site of a European Court of Human Rights ruling recognizing a woman’s right to decide how and where she births. Annette does not meet criteria following her previous Caesarean, despite having subsequent successful vaginal births. Annette asks: “Is it HSE policy to use the High Court as a method of intimidation and coercion, when a patient tries to exercise her right to informed decision making, as laid out by the European Court of Human Rights (Ternovsky v Hungary, Under Article Eight)? We are humans, with great intellect. We are capable of informed discussion and decisions regarding our pregnancies and births in the best interests of ourselves, our babies and our families. I feel anger, disappointment and bewilderment. Today as a woman and mother, I grieve.”