WOMEN IN IRELAND who’ve been affected by birth trauma say an inquiry is needed to reflect the scale and impact of the crisis.
It follows a report published in the UK which found that good maternity care in Britain was “the exception rather than the rule”.
More than 1,300 women made submissions, recounting their traumatic experiences with the NHS, ranging from patients being “treated as an inconvenience” to being left with life-changing injuries as a result of alleged medical malpractice.
The Journal spoke to women in Ireland who have their own stories.
Apart from the physical trauma of labour, some women say they now fear the healthcare system as they still deal with the emotional distress caused by a lack of empathy, information and, in some cases, consent.
Women who spoke to The Journal felt that while the baby’s health is always prioritised, the mother’s isn’t.
They also said there is a lack of information about the “real risks” involved in having a baby.
Roisin says she went into her pregnancy “with a lot of trust”, but the experience was negative from start to finish.
She says she was criticised for being overweight, but would later be diagnosed with gestational diabetes, a disease that develops for the first time during pregnancy and for which an exact cause is unknown.
Her care was “shame-based”.
Roisin, who is a nurse herself, said she felt like she was being blamed for “harming” her baby and wasn’t believed when she told HSE staff that she was following the diet recommended to her.
When she was in hospital waiting to go into labour, a catheter was put in without her knowledge or consent when she was numb from the waist down. She says, as a nurse herself, this is not how she would perform a “very intimate procedure”.
It felt like a violation.
When it came to the delivery, it was recommended that she have a Caesarean section.
“[The ward manager] said from the door to the midwife, ‘she’s for section’ – speaking about me like I wasn’t even there.”
She says she was “really scared”, but the doctors needed her consent to proceed with the C-section.
Her husband was “ignored” when he asked what was written in the document she was told to sign. “[The staff] were really really pissy with him about it.”
Roisin agreed to the C-section, feeling under pressure.
She says that in the minutes after her son was born, she was “treated like a piece of meat” and “gaslit” about the severity of her condition.
“I was left on my own and I knew something was happening … Nobody was talking. It was really tense.”
She said she started shaking and when she mentioned it to the anaesthetic registrar, she was told it was a side-effect of medication they had given her.
“I just knew something was wrong.”
“Afterwards they told me I lost a bit of blood … a little bit more than usual.”
Roisin would later find out that she lost 1.3 litres of blood.
The first time I heard the word “hemorrhage” was when I read it in my discharge notes, which I probably shouldn’t have even read.
She said that, while she understands that staff may have not wanted her to panic, “you don’t have to lie to someone to reassure them”.
In a statement to The Journal, the HSE said “many” of its 19 maternity units have birth reflection clinics, “where women and their partners can meet with clinical staff to discuss the trauma they may have encountered during their pregnancy and labour”.
Roisin decided not to make an official complaint after a birth reflection over the phone triggered a “spiral of depression”.
She was diagnosed with postpartum depression but believes her symptoms are consistent with PTSD.
When she got a positive pregnancy test again last year, she was “terrified”.
She experienced flashbacks when she had to return to an emergency department following a miscarriage of that pregnancy.
She is looking into counselling for her birth trauma.
Mim Moran is an antenatal educator and birth trauma resolution therapist, regularly working with mothers and their partners who have had negative past experiences.
She says the chances of patients developing PTSD and other mental health issues after a physically traumatic birth is reduced if patients are “calmly explained through things, given ample choice at decision time, and [feel] happy with the decisions they made”.
“A huge amount of stuff that people are traumatised by is how they’re spoken to: if they felt coerced, if they felt bullied into something, if they felt dismissed.”
The HSE collected data on women’s birth experiences between 2019 and 2020 and only half of women reported that they were always involved in decisions about their labour and delivery.
Moran says this is a “travesty” that indicates there is “something seriously wrong with the system”.
The HSE said that the quality and safety of maternity services “is of utmost importance” and pointed to low mortality rates among pregnant and labouring women in Ireland.
The Maternity Experience Survey will be run again in early 2025, the findings of which the HSE says it “will act on”.
Sinead had a “dream pregnancy” until a scan at 35 weeks where her consultant couldn’t see the baby’s organs. She was sent from her home county to a hospital in Dublin, where from then on she was “treated like a number”.
She said she was “taken aback” by the “lack of empathy” from staff from when she arrived.
“When I walked into the room I was met with seven doctors and a nine inch needle and told that they’re going to stick this needle into my baby through me.”
Sinead said they explained that the baby had an ovarian cyst. She agreed to let them drain the cyst and was told the fluid was sent for analysis.
She was not allowed to leave the hospital so that scans could be done daily while they waited for the results. During this time, her husband was staying with a relative an hour away and visiting Sinead every day.
Then the consultant told me that she’d heard that my brother was living in Dublin and could I not couch surf.
“The consultant asked could I leave because I wasn’t sick enough to be there.
“I was seen as a bit of an inconvenience because it wasn’t an emergency case.”
Sinead ended up having a C-section, which she says was as traumatic for her husband as it was for her.
Sinead was very unwell and did not see her baby, who was in the neonatal intensive care unit (NICU), until she was four days old.
“We weren’t sure what was going on … we were left in limbo the whole time.
“There was no facilitation … I couldn’t see her, she couldn’t see me.”
The baby was bottle fed, which Sinead was not given a say in.
When they were discharged, Sinead had to stay in Dublin, where she rented an apartment temporarily, so that she could bring the baby into hospital every day to be checked and weighed.
She says she was given out to by staff and accused of not feeding her baby as their weight had dropped slightly.
Two days after being discharged Sinead got very sick, but was turned away at the emergency department as “nothing was wrong.” After her condition deteriorated for another day, her husband insisted on taking her back to the emergency department, where she was then told her C-section wound was infected.
She couldn’t see her baby while in hospital because there was flu on the ward she was sharing with others.
Now Sinead has made a full recovery, but the emotional impact still lingers, especially for her husband, who says he never wants to have another child due to this experience.
“For him, he really felt the impact of carrying the weight of the world on his shoulders,” she said.
He was always trying to put on a brave face, but there was no support there at all from anyone.
“Given what we’d been through, no one once said, ‘do you want to see a counsellor’.”
Sinead’s husband ended up seeking counselling himself through a charity.
Elaine was diagnosed with PTSD and postnatal anxiety after a “near death experience” having her twins. She says that her second pregnancy almost five years later was triggering.
She said there was lack of acknowledgment by the hospital of the potential psychological effects caused by a difficult birth experience. “It’s not mentioned at all.”
She said, however, the public health nurse who she was assigned to after the birth was conscious of her story and was always kind. This was a sentiment also shared by other women who spoke to The Journal.
Despite her second pregnancy going more smoothly, Elaine felt it brought up her previous trauma. She ended up seeking counselling privately, where she got her diagnoses.
“There’s so much about postnatal depression, but there’s not much about postnatal anxiety … then I didn’t get help sooner because I felt what I was going through was just normal.”
Heather suffered a third-degree tear during labour and still struggles with incontinence two years after the birth of her son.
She told The Journal that having her baby around Christmas time, when there was only a skeleton staff in the hospital, impacted her care.
Despite suffering from severe incontinence in the days after the birth, she was discharged and it was weeks before someone checked in with her.
“There was a bit of time straight after [the birth] where I just really felt like no one was looking out for me.”
The staff were “amazing” and gave her lots of information during labour, but she said that she wishes she’d been better educated beforehand about tears and other risks involved in childbirth.
Staff suggested an episiotomy and forceps to deliver the baby, due to the baby’s size, which Heather agreed to.
“I think I would’ve made a different decision [about the use of forceps] if I had known more about the risks in the lead up to labour.”
Heather says she still feels anxious about her incontinence.
“You don’t expect as an adult to not have control over your bladder or bowels. I really struggle with it.”
Roisin said an independent inquiry is needed in Ireland so that women’s stories can be heard and the system can be changed.
“There needs to be transparency between patients and doctors about the actual risk of things,” she said.
Heather echoed this: ”People don’t want to scare pregnant people, but I think we really do a disservice to people by not telling them what might happen.”
Everyone The Journal spoke to acknowledged the stress many HSE staff are under.
Moran says nurses and midwives being overworked and underpaid creates an environment where there’s no time or energy to empower new and expectant parents.
Routine and policy are taken as more important than what the woman is feeling.
More education is needed within the medical field too, says Roisin, particularly for doctors, “because the nurses and the midwives know this stuff”.
“The midwives are the ones trying to work within the system to be patient-centred, but [also] work with policies so they can keep their jobs.”
Five postnatal hubs were opened this year, which the HSE says are designed to ensure women have access to appropriate support and care after they are discharged from hospital.
A further four clinics have been funded in the recently launched Women’s Health Action Plan, and these are to be rolled out during 2024 and early 2025. Birth reflection clinics will form part of the postnatal hubs.
The HSE said debriefing services are “hugely beneficial, particularly after a traumatic birthing experience or where emergency action was required to safeguard the wellbeing of the women and her baby”.
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