Earlier this month I wrote a blog post about the Hamilton v HSE High Court case that saw Justice Sean Ryan set a couple of precedents that have very serious implications for pregnant women in Ireland and the concept of informed consent.
So the High Court rubberstamped a human rights violation last week. In the same fell swoop, it also gave a big fat thumbs up to denying a pregnant woman’s right to informed refusal; removing a woman’s right to be the decision-maker and expert of her own body; and supporting provider preference for delivering non-evidence based care. The country was up in arms! Oh wait, hang on… Continue reading The High Court says we can’t say no→
I had my baby at home. It was a planned homebirth but it was a decision we only made half way through my pregnancy as we learned more about birth options and preferences we might have. I wanted a natural birth without intervention and I have always been extremely uncomfortable in medical settings so I began to question if my anxiety around being in a hospital might impact on my ability to labour effectively. I was afraid this “holding back” might eventually lead to the interventions I desperately wanted to avoid.
I was lucky to be in a position to choose to change to a homebirth option. I was a low risk candidate in the small catchment area of a maternity hospital with a homebirth programme. It’s one of the advantages of living in a city. As with most things in life, the more people there are, the more options are available.
The day I gave birth to my son greatly exceeded my expectations. In hindsight, things that I didn’t realise were important became hugely so. The foremost of these was privacy and as a direct consequence, freedom. There was no one there but myself, my husband and our midwives. There were no unexpected interruptions and there were no strangers. I wandered the house and laboured in the kitchen, on the stairs, in my bedroom, on the loo, in the birth pool and then finally delivered my son on the kitchen floor. I leaned on the counters, on chairs, against the bathroom wall, on my hands and knees, all over my poor husband’s shoulders and arms. I stripped out of my clothes and laboured and delivered naked. There was no calculation or premeditation in my behaviour, I just did.
It was a privilege and a gift.
My expectations for any further pregnancies and births are high and I think they should be.
All women, regardless of location, education, social class, financial status and personal circumstance, have the right to “just do” when they are giving birth. They have the right to choose how they want to deliver their baby and where they deliver their baby. They have the right to labour and give birth in a safe, private setting with adequate, appropriate, supportive medical care. They have a right to feel safe and secure. They have a right to be attended by professionals who they trust and who put their needs and their babies needs first, above all else. They have a right to be properly informed of all medical procedures – both necessary and optional – that may be performed on them and what the pros and cons of those procedures might be. Once informed, they have the right to refuse or consent to those procedures having made an educated decision on what is the best option for them. They have the right to have their refusal respected.
All of these rights are human rights. They are unusual human rights in that they apply only to females. This is probably why they are denied or violated on a routine basis. Men have the distinct privilege of having full body integrity and autonomy when it comes to men’s health. The same cannot be said of women. It is the unique circumstances of having a uterus – and particularly when that uterus is growing and nourishing a new life – that suddenly our bodies seem to be public property, where women are “patients” and we need to seek permission from third parties to make decisions about how we care for and use our bodies, and how we bring our children into the world.
Homebirth in Ireland is currently available on a limited basis. If you have a low risk pregnancy and are in the catchment area of a maternity hospital who runs a homebirth programme it may be possible to have a homebirth if you meet their criteria. There are also a small number of Self-Employed Community Midwives (SECMs) who work independently around the country. They provide homebirth services in a limited geographical area and to a limited number of women, due simply to the fact that there are so few of them. They are fully insured and bound by the terms of a Memorandum of Understanding (MOU) agreed with our national health authority, the HSE. The MOU outlines strict criteria under which the SECM can attend pregnant women and operating outside of these criteria nullifies the SECMs insurance and leaves them open to fines and prosecution. So there is no alternative but to sign the MOU. There are currently plans underway to further limit the criteria under the MOU by requiring the attendance of two SECMs at every homebirth. The logistics of pushing through this change mean that homebirth for women outside of maternity hospital programmes will cease to be an option because the numbers of SECMs required to facilitate this simply don’t exist (There are currently 20 listed with the HSE). This means that the vast majority of pregnant women in Ireland will be denied a homebirth and must deliver their babies in hospital. This lack of choice is a human rights violation.
When giving birth in a hospital in Ireland, women are not afforded privacy. In fact, even those who pay for private maternity healthcare do not have access to privacy and it is pot luck as to whether they will have a private room during their hospital stay. Women labour is large rooms together with a curtain separating them from the labouring woman next door. In some cases, there can be two labouring women in a delivery suite, again with a curtain dividing them – but curtains aren’t sound proof. There usually isn’t an option to dim harshing bright lighting or draw curtains across large windows. There can be a constant stream of strangers coming in and out of your labouring space. In the post natal wards, it is not unheard of for a newly post-partum woman to have another new mother wheeled inside her curtain area in the middle of the night due to a lack of space. There are such huge staffing deficiences in maternity hospitals that one midwife can be attending a number of labouring women or supporting a large group of women trying to establish breastfeeding. Do these sound like the optimum conditions to have a baby in?
When limited to giving birth in a hospital, women may find themselves and their preferences secondary to managing a overburdened maternity system. In this situation, they may experience interventions that are performed to hospital policy rather than in the best interests of the mother and her baby. Of course this is only an issue if a woman is not happy or not complicit in the intervention. The unfortunate reality is that often informed consent is not correctly sought or respected when refused and in other cases, some medical professionals have been known to portray the situation in a way that will ensure the outcome that they desire rather than those of the woman and her partner.
But it’s all okay in the end once there’s a healthy mother and baby. Isn’t it?…
I have no issue with hospital births. For the vast majority of women this is where they feel safest and therefore that’s the best place for them to give birth. Most births take place in hospital, it is the societal norm. Many women have a positive birth experience with trusted caregivers that they were very happy with in hospital. Others feel that they weren’t listened to or respected and their birth was traumatic and largely outside of their control. The problem stems from the fact that women are not necessarily treated like consumers using the services of a provider rather they are treated like patients or children who are told what to do or what is happening to them or given permission to take decisions about their own pregnancy and birth. This has to change. Maternity care in Ireland needs to move to a mother and child centred model. This means women making informed choices about their pregnancies, birth and children. By further restricting homebirth to a privileged few advantaged by their location, we are getting further and further away from this model. We talk large and loud about equality and fairness in the country but it rings more hollow by the day.
Feminism is about choice. It’s about women being free to choose whatever is right for them, whether other people like it or not. Women should be free to choose where and how they give birth. It is their human right. In Ireland, it is currently being denied and the proposed changes to the Self-Employed Community Midwives MOU will further narrow Irish women’s birth rights. Please sign the AIMS Ireland and Home Birth Association of Ireland‘s petition to protect and enforce Irish women’s human rights in childbirth. It’s not about hippies hugging trees and chanting while giving birth (do it if you want though), it’s about freedom of choice.