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.


QUESTION NO: 140

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.

REPLY.
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.

QUESTION NO: 488

DÁIL QUESTION 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.

REPLY.
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.

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 Chair@aimsireland.com or Support@aimsireland.com

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.

L.R.

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.”


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