No Country For Fertile Women

Oh dear, Ireland. What are you doing? What are you doing to the women who live within your jurisdiction? When will your patriarchal misogyny end? When will your tyranny wear itself out? When you start to treat women like equals? Are you completely incapable of learning from your past?

 

It is 2013 and women in Ireland are dying for the want of access to legal, safe, abortion. Savita Halappanavar is not the only woman who was treated inhumanely when she arrived at NUIG, in the early stages of a miscarriage. This is how women are treated in hospitals in Ireland.

 

We’ve been here before. Women have had to leave this country in their thousands for abortions that they cannot legally procure in Ireland. Now, in the past 48 hours, we have heard that our government is set to propose abortion legislation that will ‘allow’ women who are pregnant, a termination of that pregnancy if they are suicidal. Provided no fewer than six (six!!) consultants – two obstetricians and four psychiatrists – concur that she is, indeed, suicidal. Oh yes! And one of those psychiatrists must be a perinatal psychiatrist – of which there are only three in the country.

 

I don’t know where to begin with this one.  Do you know how difficult it is to assess suicidal ideation with any degree of certainty? To be blunt, you can only be 100% sure that someone is suicidal when they have completed suicide. Do you know how difficult it is to get six people to agree on anything? Let alone six medical consultants who bring their own moral, ideological and religious beliefs to the consultation?

 

When and how would these assessments take place?  Six different appointments with six different consultants? Or one appointment with all six? Where would the assessment/s take place? In a hospital? If so, of which variety – mental or maternity? In the woman’s home? Or somewhere else entirely?

 

Who would foot the bill? What if the woman had a medical card? Some consultants don’t see public patients.  And – have you seen the waiting lists for consultants? You could be waiting months to see one. I have a sneaking suspicion that that’s part of the plan, though. That if a woman who is four weeks pregnant has to wait six months to see a consultant, by the time she does so, it will be too late to terminate the pregnancy. Or she’ll have already killed herself, thereby relieving the consultants of calling it either way. Or, as is more likely, she’ll have taken the boat or the plane out of this jurisdiction to somewhere the laws are more humane.

 

There’s something that worries me more than this six consultants nonsense (for it is nonsense): In this country, under the 1871 Lunacy Act – which is still in force today – it takes just two doctors to decide that a person should be forcibly detained in a mental hospital. So, theoretically, a suicidal pregnant woman could present, seeking six consultants to decide whether or not they believe her (I’ll get to that in a second) and two of them could have her committed to a mental ward for the duration of her pregnancy. THAT scares me.

 

Then there’s the notion that women are devious little feckers who run off and get pregnant on a whim and then decide to fake their suicidal ideation in order to hoodwink doctors into ‘allowing’ them to have abortions. That sickens me. It speaks of how women are still infantalised in Irish society. How they are presented as generally un-trustworthy and incapable of making decisions for themselves and their families.

 

In the same vein, attendees at the Home Birth Association’s annual conference today were reminded that, should they dare to attempt to birth at home without ‘permission’ from the HSE, they can be forcibly removed from their homes by members of An Garda Siochana and brought to a hospital. Once there they be subjected to procedures that they neither want nor need – and many of which, are in fact, not evidence-based.

 

Why does Irish society fear women so much? Why does Irish society fear our wombs so much that it feels the need to control our reproductive rights?  Let’s not forget that this is the only country in the world where the CEO of a maternity hospital is called (and insists on being called) a ‘Master’.  That single fact tells us so much about how women are perceived in this country. We’ve a long way to go – and for the moment, Ireland is no country for fertile women.

 

 

No Country For Pregnant Women

Yes, yes, I know…..you’re sick of hearing me banging on about pregnancy and the state of maternity “care” in Ireland.

But it’s getting worse, not better.  I heard from Jene Kelly at AIMSI (the Association for Improvements in Maternity Services, Ireland) today. She told me a shocking tale. Alas, I have to report that I am shocked, but not surprised. This is how women are treated in Ireland. We are still second class citizens, we are still treated as though we are incapable of making informed decisions for and about ourselves. We are still subjected to a patronizing, patriarchal maternity system that, crucially, is not evidence-based

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 Coombe 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.

Imagine if ‘Mother A’ was your mother, or your sister, or your cousin, or your daughter, or your friend, or your partner or your wife, or you.

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 8)? 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.”