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

Replacing the 8th won't address autonomy issues.

Article in Today's Irish Times looking at Constitutional law and challenging the view that the 8th Amendment must be replaced if repealed.

This is an incredibly important issue and one that has been continuously missed in the conversation from many politicians and many in the Irish media with regards to Repeal the 8th.

AIMSI members voted unanimously for Repeal the 8th without replacement due to the legal ramifications personhood laws have on bodily autonomy on all health care options and full range of maternity services once a person becomes pregnant.  All care options in continuum of pregnancy are within the scope of "maternity services" and those utilising services in Ireland deserve a full range of evidence based care options and full duty of care. Including access to abortion, pregnancy screening, evidence based antenatal/labour/birth/postnatal, options on place of birth/lead care provider, maternal mental health services,  bereavement, hospice, and full recognition and guidance of principals of informed decision making, to consent or decline, like our EU / UK counterparts.

Repealing the 8th Amendment and replacing it with similar legislation, giving equal  rights to the foetus in some or all instances, results in no change for pregnant women/people in happily continued pregnancy.  With shared rights a pregnant women/person is automatically reduced in capacity - in the ability to make an informed decision, (consent to/or decline ) in care options and interventions during 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 - 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.

This conversation must be opened to include continued pregnancy and the dangerous ramifications the 8th has in maternity care.

From Article:
"The people should not be asked to constitutionally enshrine a particular set of restrictions on abortions, but only to remove a constitutional impediment to legislative reform."

Irish Times: http://www.irishtimes.com/opinion/there-is-no-reason-why-we-can-t-simply-repeal-the-eighth-amendment-1.2850568

"There is no reason why we can’t simply repeal the Eighth Amendment"