Giving birth in Ireland: why such scaremongering by female journalists?

Maternity care in Ireland has very much been in the spotlight in the last few weeks. Aja Teehan’s High Court case has been to the forefront of this but we’ve also had some interesting studies published including this one that says Irish women have more C-sections than their European counterparts and this one that says women fare better in pregnancy and birth when they are under midwife-led care.Strong and conflicting opinions are being expressed on all sides. Some are fervently in favour of women choosing a home birth after a Caesarean section (HBAC) if they feel it’s right for them. Others are just as passionately opposed to the concept concerned for the perceived risk to mother and baby. That’s all fine. Everyone is entitled to their opinion whatever their reasoning may be. You’d like to think their opinion is informed but that’s really the best we can hope for.

However some people’s opinion is more important than others. It’s importance lies not in the bias of the opinion itself, but on it’s influencing power. Specifically, I’m talking about the opinions of female journalists who are writing in this space. Whether you agree with a journalist or not, the fact remains that anything they write has a hugely influencing factor on their readers and as we all know, with power comes responsibility. This is something that has been deeply lacking in media commentary on maternity care, and specifically Aja Teehan’s case, in recent weeks.

I’ll pull out two examples for you: Sinead Ryan in the Evening Herald a couple of weeks ago and Fiona Looney in yesterday’s Daily Mail (I can’t link to them for you as neither are available online). Both women are known for their intelligent, witty takes on life and have many years’ journalism experience between them. Yet on this particular subject, their professionalism and journalistic skills were thrown out the window. Both women are opposed to the idea of HBACs, which of course is fine as they are entitled to their opinion however both women cite their own birthing experiences as reasons to not go down this path.

Fiona told us about her first emergency C-section which saved her preterm baby’s life and how a subsequent birth ended in another emergency C-section because she had been deemed to have “failed to progress”. A third pregnancy was an elective C-section. Sinead Ryan also had an emergency C-section and implied that she had suffered a uterine rupture – a terrifying and extremely rare occurrence. My heart goes out to both women. Those of us who have been pregnant and/or given birth know how vulnerable women are at this time and when something goes wrong it is a deeply upsetting experience with potentially long term emotional and psychological implications. It is easy to see from reading both columns how much their birth experiences affected them. But – and this is a very, very big but – this does not excuse them from their responsibility to properly research their subject matter and present the facts of the situation.

An opinion piece is exactly that but it CANNOT be peppered with factually incorrect information to suit a purpose. In this specific subject, where expectant mothers, women who have recently given birth and women who are trying to conceive are soaking up everything they can get their hands on, journalists have an even greater responsibility to ensure they have the right information. Women will make choices based on what they read.  They need to make sure they’re making the right ones based on the correct information.

So, here I’d like to correct the inaccuracies that both women reported in their articles in the hope that other women might read this and it will correctly inform their decisions. Sinead cited that uterine rupture occurs in 1 in 100 women. (It is worth saying here that this figure is grossly incorrect). Fiona Looney’s headline said C-section “is better than being dead” (!). Fiona also said that she was told that attempt a vaginal birth after two Caesareans (VBA2C) was “dangerous”, “risky”, “reckless” and the word “rupture” was mentioned. She was also advised that after three babies born by C-section, she should have no more children despite wanting more. Fiona made her decisions based on the information she received and she can’t possibly be blamed for that. But the information she received was incorrect. Here are the facts:

  • The rate in Ireland is 2 per 1000 women overall, or 1 per 1000 for women in spontaneous labour who did not receive oxytocin augmentation (Turner et al, 2006).
  • Of the small percentage of women who do rupture, even a smaller percentage of women will lose their baby or require a hysterectomy. In the rare instance of rupture, 94% of babies survive. (Guise et all 2004 via Midwife Thinking)
  • Uterine rupture is associated with women whom have had a previous caesarean section, however, uterine rupture can occur with women with no previous Caesarean history.
  • The risk of uterine rupture during a VBAC is actually lower to those of other possible birth complications of which are present in all vaginal births. First time mums are at risk for complications that are equally serious to uterine rupture and occur at a similar rate. For example, placental abruption, (Deering 2013) cord prolapse, (Beall 2012) and shoulder dystocia. (Allen 2011)
  • VBAC is safe. Overall, around 70% or more of women who try VBAC will give birth vaginally. If a woman has given birth vaginally previously, this rises to 90% (9 out of 10 VBAC women will birth vaginally)

Regarding Fiona’s comment on C-section being better than being dead and a general perception that C-sections are extremely safe, here are some facts:

  • While the risks are relatively small, as with all major surgical procedures, there is a risk of death. The risk of death in a woman following a Caesarean section is believed to be less than 1 in 2,500. The risk of death in a woman following a vaginal birth is believed to be less than 1 in 10,000. There is a higher risk for emergency Caesarean Sections vs planned Caesarean Sections.  Cunningham FG, et al. (2005).

Looking at the questions around VBA2Cs and the number of pregnancies a woman can have:

  • The clinical practice guidelines from the Institute of Obstetricians and Gynaecologists and the HSE state: “in individual circumstances where a woman strongly desires a trial of labour after two previous CS, it may be considered. If the head is engaged, if the cervix is favourable, if there is a history of a prior vaginal delivery and if labour starts spontaneously the risk of a successful VBAC may be high and the risk of UR may be low. However, the risks and benefits of a TOLAC (trial of labour after Caesarean – my addition) in such cases should be documented antenatally in the notes. There is also a case for not using oxytocic agents either to induce or augment labour in such circumstances (Turner, 2002). Women with >1 previous CS should also be advised to attend their maternity hospital early if they experience any abdominal pains or signs of labour.”
  • The NICE guidelines in the UK recommend that practitioners should “inform women who have had up to and including four CS that the risk of fever, bladder injuries and surgical injuries does not vary with planned mode of birth and that the risk of uterine rupture, although higher for planned vaginal birth, is rare”

Finally, Fiona states that HBACs don’t happen in the UK because they’re not allowed. They are and they do. In the UK, the place of birth is ultimately left to a mother to decide. I think I’ve covered all the inaccuracies that both women mentioned in their articles. If I’ve missed one, please let me know and I’ll add it. Personally, I don’t care where anyone gives birth just as long as they have made an informed choice and it is the place that they feel the most comfortable and safe. Also, when I write about this subject, I like to include the data to back up my arguments. Sinead and Fiona, in fairness, it would have taken you five minutes to Google the correct information. References: AIMS Ireland Cuidiu Birth Statistics per unit in Ireland: http://www.bump2babe.ie/statistics/ Midwife Thinking: VBAC: Making a Mountain out of a Molehill:http://midwifethinking.com/2011/02/23/vbac-making-a-mountain-out-of-a-molehill/ Deering, S. H.; Smith, C. V. Abruptio Placentae, 2013. Medscape.http://emedicine.medscape.com/article/252810-overview#a0199. Beall, M. H.; Chelmow, D. Umbilical Cord Complications, 2012. Medscape.http://emedicine.medscape.com/article/262470-overview#a30. Allen, R. H.; Chelmow, D. Shoulder Dystocia, 2011. Medscape.http://emedicine.medscape.com/article/1602970-overview#a03

30 thoughts on “Giving birth in Ireland: why such scaremongering by female journalists?”

  1. Great post Sylda! It’s sad when you see women like this who judge everything based on their own experiences. I find so many of these stories could have been totally preventable (of course we don’t know that for sure, but you have to wonder when “failure to progress” is cited) if the labour hadn’t been so managed. It also never ceases to amaze me how so many highly educated intelligent women willingly “do what they’re told!” Science, research and personal resposibility go out the window because a doctor said so. It beggars belief. Doctors are the new priests. The sad thing is this continues long after birth as we see so often with breastfeeding yet again the woman just goes along with it. We hear language like “I was allowed” or “I wasn’t allowed” or “I was told” or “I had to!” SAYS WHO? Where is the informed consent?

    On the HBAC thing, uterine rupture is always mentioned. What about the 40%+ of women who’s labour is augmented with oxytocin? Were they warned of the risk of uterine rupture – the exact same risk statistically – as that of a VBAC? Doubtful. Women need to step up and take charge of their bodies and health, as long as we keep handing ourselves over to the establishment nothing will change. It’s like most feminist issues, women themselves perpetuating the issue at hand are the biggest problem. :/

  2. As usual, right in the button. I’ve found that women who express the kind if views these journalists express, have a great need to debrief their experiences. Most women who’ve had those experiences don’t have access through public media. What surprises me is the lack of professionalism – giving inaccurate info. Student antenatal teachers with Cuidiu spend a lot if time debriefing birth experiences – both postive and negative. There’s no way they could help clients without that. Journalists should consider same. Pity it’s not you writing in national papers!

    1. You know what Ann-Marie, I’ve often thought that about women in the public eye. Their pregnancy and maternity experiences must be very different. It’s not like they can just pop along to a group antenatal class or a breastfeeding support group, for example, and have the same comfort of privacy that the rest of us have. It must be very hard for them.

      And thank you for the lovely compliment! 🙂

  3. Hi Sylda (hope I’ve got your name right); I read your piece with great interest; you’re absolutely right about the fact that writers like Sinead and I have a broad platform and a duty to get our facts right. I can’t speak for Sinead – nor did I read her piece – but I tried to make it clear in my own column that my opinion was entirely based on my experience and on the medical advice I received at the time, which, to reiterate, was that I was absolutely NOT permitted to have a HBAC (this was 1999, in the UK, on the NHS). I was so desperate not to have a second C section at that time that I actually contemplated simply not presenting at the hospital at all, but in the end, I felt my first duty of care was to my two year old child, and so I followed all the medical advice I received. The very fact that Aja Teehan has lost her appeal (and my heart does genuinely go out to her) is surely evidence that the weight of medical opinion goes against HBAC. All that being said, I think your post raises some excellent questions and I’m really glad that women like you continue questioning what we too often take as the only available option. For what it’s worth, I don’t write the headlines on my articles: I, too, blanched a little when I saw that one.

    1. Hi Fiona,

      Thanks so much for your considered response. In a million years, I never expected to hear from you and I don’t think the readers of this blog did either, so can I just say fair play to you, you are a bit of a legend.

      I hope I didn’t cause you any offence in my post. I went out of my way to try and be as sensitive to yourself and Sinead as possible because every woman’s birth experience is so personal to her, there is no room for criticism there I feel. As I mentioned in an earlier comment, it must be very hard for people in the public eye to have private experiences at milestones in their lives that the rest of us enjoy without social commentary. Thank you for your honesty about your births.

      As a counter-argument to your comment on Aja Teehan’s case, the judgement was based centrally on the issue of insurance and the judge specifically said that she couldn’t make a judgement on any of the medical evidence, but we can stand on opposing sides of an opinion as we’re both entitled to do.

      Finally, I think an awful lot of people will be very interested to hear that you don’t write your own headlines. Every day is a school day!

      Again, thank you for taking the time to read and comment. It’s very much appreciated.

      Sylda

  4. Sylda, this is a brilliant post! Thank you for every word of it; and the comments from others show the appreciation for the information you have provided in one piece. Well done.

  5. Great post Sylda, delighted to see AIMS Irelands Points to consider being put to good use. What readers would also be interested to note, the expert who provided evidence against Aja Teehan is also one of the policy makers who created the HSE criteria for homebirth in Ireland. He also published an article in the BMJ supporting a mother’s right to choose a non-medically indicated Caesarean Section, citing directly the right to informed choice despite the associated risks. So, why are women who choose to birth outside an obstetric care model (home or hospital based Midwife-Led care) not afforded the same right?

    1. Thanks Jene. I can’t agree with you more. Informed choice needs to cover the full spectrum to include normal birth, not just choice in surgical options. I think all the coverage in the last couple of weeks including the study on midwife-led care is making people who wouldn’t normally have an interest sit up and notice. Conversations are happening in the mainstream and that’s no bad thing. Very slowly, catchy monkey…

      1. Keep on writing, Sylda!! So important the information gets out! Well done again on a great article! Shared on AIMS Ireland Facebook and twitter.

  6. Thanks so much for the excellent post, Sylda. I second the gratitude for the mention of AIMS Ireland. It’s imperative that the correct info and evidence get out there, into the mainstream. Published articles in popular newspapers by well known women can have far reaching implications. It’s important for journalists to be given some scope for opinion but, particularly on contentious or sensitive issues, that opinion should be noted and should be balanced with fact. A superb job by you in including both, here.

  7. Great article Sylda. Well researched and presented – excellent journalism. It’s so important that facts are presented and not scaremongering.

    1. Thanks Doireann! Much credit to AIMS Ireland who regularly put this kind of information on maternity services out there for women.

  8. Great article Sylda- thanks 🙂 As its my first pregnancy and may have to have a C-section, I cant get over why some women (and I mean some!) love to share their horror stories – it can be frightening enough as it is. As journalists they have a responsibility here and I am so happy you pointed this out…
    Keep you the good work

    1. First baby Zatt! Congratulations! Your life is about to change forever in the best possible way 🙂 The very best wishes to you x

  9. Hi Sylda
    This is a great piece of writing full of great facts and figures. However after reading this piece and especially some of the comments from your other readers, I feel very lonely, hurt and a dismissed. I read your blog post last night, and can’t believe how much it upset me. Of course being a well informed aware woman, I’m sure this was not your intention or your readers intention. But none the less, I felt compelled to response. I suffered two birth trauma’s. My first pregnancy I had planned a home birth, I did my research and was well informed but my baby had other plans. My son presented breech, and was born with a congenital condition called Cylothorax. We went though transfer to Dublin with him and two months between The Rotunda NICU and Temple street Hospital. On my second pregnancy I decided on the advise from my doctor and my own research to go Vbac, again I was well informed on the facts and statistics, but if I’m honest my gut was telling me to go for a c-section, but I went with the facts and tried vbac. I went into spontaneous labour myself and laboured quickly, but things took a very nasty turn for the worst and i ended up with a uterine rupture. It was a complete tear of my previous c section scar, and only for my daughter was well into the birth canal and could be quickly saved by forceps, she would be dead. I went though all of this with no pain relief. The pain of a uterine rupture is something I can’t ever describe , the feeling of heaviness in my chest from internal bleeding was so severe. My daughter thankfully due to the speed at which the doctor acted, is a healthy little girl. I didn’t hold or see my baby, I was rushed to surgery to save my own life. The absolute trauma of it all will never leave me. I understand that uterine rupture during vbac is very rare, but it happened to me. It is very hurtful reading articles diminishing(maybe my own personal perception) uterine rupture and using words such as scaremongering about woman who want share their experience in a bid to heal. There is so much talk about women making informed decisions and making sure they have all the facts but why do we believe they are not well informed. The facts and figures are very easy to find. Maybe we should have more faith in women and consider the fact that they may have all the information but made a decision based on heart and emotion, after all these are our babies we are talking about. Does going with your gut and emotions not come into it. I look back and wish I gone with my gut and my heart but I made my decision based on the facts and figures. I was a well informed woman but I didn’t listen to my gut, I will have no more children. No one is to blame for this but I would like to heal, and feel like a human being rather than a statistic.
    I read a very good piece the other day which talked about the gaslighting tactic that goes on by people in regard to birth trauma (http://wholewoman.hubgarden.com/you-are-not-crazy-you-are-traumatised/) It talks mainly about people in the healthcare profession making comments which make woman feel ashamed or dismissed in regard to their birth trauma experience. And I quote Deb here(one of your readers) “It also never ceases to amaze me how so many highly educated intelligent women willingly “do what they’re told!” Science, research and personal responsibility go out the window because a doctor said so. ” Just because a woman makes a decision that goes against statistics, doesn’t mean she wasn’t well informed or hadn’t researched her options, maybe it was as simple as going with her instincts and gut feelings. And I quote Zatt (another readers comments)here ” I cant get over why some women (and I mean some!) love to share their horror stories – ” and now I quote a piece from this article regarding gaslighting
    “Regardless of the intention of the person who says it, the effect is the same. it silences the woman and makes her doubt her perceptions”
    I have to admit reading comments such as these two quotes above has made me feel I should be silent and ashamed for sharing. Do we really want women to feel they can’t or shouldn’t speak about their painful experiences. I also feel your piece implied that women of today simply make a decision based on an article in a paper, I don’t think this is the case. I think when it comes to such personal and serious decisions I firmly believe women make them having researched all their options. May I just add I am not on any side of an argument, I’m just a woman who believes I have a right to share my story.
    I am also a fan of your blog and think we need to hear more positive birth stories and options out there for women, but I’m afraid this one just hit a bit to close to home, and I couldn’t not share my feelings.
    Sandra x

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