Monday, 22 April 2013

PQ Reply: HSE Draft Consent Guidelines breach Women's Human Rights


DÁIL QUESTION addressed to the Minister for Health (Dr. James Reilly)
by Deputy Clare Daly
for WRITTEN ANSWER on 16/04/2013

* To ask the Minister for Health with regard to the Draft National Consent Policy in relation to refusal of treatment in pregnancy, if the guideline which says that a woman's refusal of treatment which may impact on the life of the foetus must require a legal opinion to be sought and if this is not a serious breach of the woman's human rights regarding her own decision making with regard to giving birth.

Clare Daly T.D.

An adult with capacity can refuse all forms of treatment (including life-sustaining treatment) even where such a refusal may be considered unwise and/or conflict with prevailing medical advice and could lead to his/her death. The case [In the matter of a Ward of Court (withholding medical treatment) (No. 2) [1996] 2 IR 79] established that an adult with capacity has the right to refuse medical treatment to facilitate a natural death. A number of subsequent court cases have reinforced the rulings from the Ward of Court case, in particular JM v The Board of Management of St Vincent’s Hospital[2002] 1 IR 321 and Fitzpatrick v FK (No.2) [2008] IEHC 104. However, this situation becomes more complex in the case of pregnancy given that the rights of both parties (i.e. the mother and unborn) need to be considered. As the HSE's Consent Policy remains in draft form it would be inappropriate for me to comment on it at this stage. I expect the policy to be finalised shortly

Thursday, 4 April 2013

Women continue to raise concerns over early pregnancy concerns/miscarriage care in Galway

Since the death of Savita Halappanavar, AIMS Ireland has been contacted by concerned women regarding their care in early pregnancy and during miscarriage in Galway's UCGH. Many women prefer to remain anonymous, others ask to share their stories.

In March, AIMS Ireland shared the story of a woman who was left waiting three weeks during a miscarriage without care. As a result she travelled abroad for treatment.
Her story is available here: STORY

AIMS Ireland has been contacted by another woman today with regards to her treatment and delay for early pregnancy assessment despite bleeding and GP referral. This is her story in her own words.

I want to make you aware of a particularly unhappy situation in Galway University Hospital at present at their EPU.

The wait time for a scan at the early pregnancy unit is currently between a week and two weeks. They do not offer any scan services at weekends.

These scan appointments are following GP referral for bleeding and cramping.

I myself have been spotting, yet following a letter from my doctor, they offered me a scan date 2 weeks later. This is with a previous history of miscarriage. My symptoms worsened and I presented myself at the unit, to be offered an internal and a blood test, but a point blank refusal to scan me despite severe pain and heavy bleeding. The doctors that I dealt with at the EPU this time were actually very nice, but you could see that their hands were tied also. It is difficult to endure any kind of bleeding in pregnancy, but at least a scan gives you peace of mind either way, be it a good or bad outcome. Nobody should have to wait so long to learn of that outcome. I have been so stressed and anxious - difficulty eating/sleeping - as a result of this huge almost inhumane delay to be scanned. It is not good enough. Nobody should have to wait so long to learn of that outcome.

In the end, I resorted to a private scan as I needed to know. Luckily all is ok. But what about those for whom a private scan is not an option? Are we women in Galway not entitled to equivalent care as received in Cork or Limerick or Dublin?

If I broke a bone, would I have to wait two weeks for an X-ray? No. Why then, if a woman bleeds in early pregnancy, should she wait two weeks for an ultrasound?

If you have an experience you would like to share or if you would like support following an experience please contact us at

Wednesday, 3 April 2013

Guest Blog: Does your doctor love your baby more than you do?

Does your doctor love your baby more than you do?

Guest blog byCristen Pascucci,, USA

The gift of motherhood has been called divine.  To be given a baby—to nurture him in the womb, give birth to him, and bear responsibility for his every physical, emotional, and spiritual need even after that—is perhaps the greatest responsibility we are given as a species. 
The physical ability to create this life and release it into the world is what distinguishes women from men.  It’s what we do.  It is what makes our bodies different.  And it’s what often makes our lives very different; our responsibility as mothers is embedded in our chemistry, in our bones, and in our souls.  We never forget that we are mothers.
It is an odd thing to me, then, that so many women are expected to forget what we are during the very event that makes us mothers.  We sacrifice our bodies, time, energy, youth, and our own needs so that we may give to our babies while they are in the womb and after it.  Yet, at the life-changing event of their actual births, we are often expected to hand over the reigns to someone else.  Why is that?
A woman is not less deserving of respect at birth.  She is more deserving of respect as she undertakes her greatest responsibility in life.  We were not given the gift of life to be undermined by others as we bring it into the world.
Let’s examine the expectations of a mother giving birth.  Ideally, she will have a glowing, healthy baby, and she will come through birth healthy and ready to mother, as well.  She cannot wait for that first precious moment when she catches sight of her mysterious little roommate, and she longs to hold him close, to smell him, to protect and warm him, to nurse him from her body with the best food on the planet.  Her goal is the safest, smoothest birth possible so that she is physically capable of caring for her newborn and no complications are created for future births.  And, of course, because his birth is a major life event for them, she wants her memories to be good ones.
If she’s done her research, she’ll know that science firmly backs what she instinctively wants—the skin-to-skin contact regulates his temperature and heart rate, the proximity to his mother and the sound of her voice soothes him.  He cries less than if he is away from her.  The breastmilk he receives supplies him with perfect nutrients.  Science has not come close to duplicating that formula, nor can it reproduce the benefits of bonding that occur with it that are so beneficial to the brain and social development of our babies.
Perhaps her care providers have the same expectations; perhaps they don’t.  The truth of the matter is that even the best of care providers is under competing pressures: pressures of time, of cost, of administrative policies, of practices that are meant to keep the healthcare machine running at a certain pace and with certain outcomes as priorities.  Each of these pressures and priorities serves to push the optimal well-being of mom and baby just a little further down the list.
In the U.S., for example, we know that the single biggest factor (see here and here) as to whether or not a low-risk woman receives a Cesarean section is the practice patterns of the providers with whom she gives birth—not her individual circumstances.  The odds of a woman giving birth by surgery are as much as 15 times greater in one hospital over another.  In our case, scheduling constraints, legal liability, and insurance reimbursements are very real factors in the care we receive.
When other factors take precedent—when surgery, induction by drugs, or instrumental deliveries are used a little more frequently than is necessary for mom’s and baby’s sake—we end up with births that are more traumatic, more complicated, and more risky than they might have been.  We end up with babies whose systems are flooded with drugs at birth, who are bruised and upset, who may be separated from their mothers in those first critical moments.  We end up with mothers who are dealing with negative physical and emotional consequences of birth, feeling “blue,” rather than enjoying their babies at this defining period of attachment.  And when surgery is employed, we end up with women for whom each subsequent birth by surgery is more and more dangerous for her and her babies.
Imagine a doctor whose individual practices and preferences lead him to cut open 50% of the women who come to him for his services.  Or, perhaps it's a doctor who believes that Cesarean surgery is "almost risk-free"--contrary to every scrap of current evidence (see here, here, and here).  Would we give these men unilateral authority to decide whether or not we give birth by surgery?
These things are not acceptable, in the United States, in Ireland, or anywhere else.  Respect for motherhood, for the mother-baby cycle, and for the life event of birth is a human right.  It’s time to demand that we are respected as the decision-makers about our bodies and our babies. 
The state does not have a uterus nor does it have breasts.  It was not given the gift of the creation of life and it is not entitled to your body or your baby.  It is not more invested in our children than we are.
Does your doctor love your baby more than you do?  Does your government lie awake watching him breathe at night?  If the answer is “no”—and I believe it is—then who dares to come between a mother and her baby?
As American parents, Irish parents, any parents, it is our right and our responsibility to make decisions that affect every facet of our children’s lives.  It is no different in birth.  

We must protect our bodies if we are to protect our babies. And no one can protect your baby like you can.

Huffington Post, March 6, 2013, "C-Section rates vary across U.S. hospitals", January 23, 2013, "U.S. Hospitals held accountable for C-section rates"
American College of Obstetricians and Gynocologists' News Release, March 21, 2013, "Vaginal delivery recommended over maternal request cesarean"

For more current, science-based research, go to

Cristen Pascucci joined national nonprofit in the U.S. run by and for mothers--after the birth of her baby in December 2011.  She is now vice president of the organization, which advocates for evidence-based care and humanity in childbirth, and she writes regularly about the need for respect in childbirth.  Prior to that, she was a political and communications strategist in Baltimore, Maryland.