LAST UPDATE | 11 Apr 2019

THE HSE has apologised to the women who have shared their traumatic childbirth stories on RTÉ’S Liveline programme over the last two weeks. 

In a statement to this website this afternoon, the HSE said:

“Listening to those we provide a service to is at the core of the National Maternity Strategy. The HSE apologises to those women where our service has failed to meet their expectations. We also apologise that women have felt compelled to ring RTÉ to have their concerns heard. This should not happen.”

The statement goes on to say that when someone is dissatisfied with their clinical care, or the manner in which they were treated, “they can make their views known directly to the hospital or through the Your Service Your Say service.

“The HSE will always endeavour to address these concerns in a compassionate and professional manner. In this way we can continually improve the service we provide,” it adds. 

The HSE said it is committed to providing the best maternity services possible to women and infants, and their families. “Irish maternity services are good and compare well with those in other countries in terms of safety,” said the service provider, adding that patient outcomes have improved in recent years.

Over the last fortnight, many women have taken to the national airwaves to share their stories of childbirth. 

The stories detail how many of the women were left traumatised by their experiences in Irish hospitals and suffered extraordinary pain in some cases. Other women spoke about an inappropriate attitude they experienced at the hands of consultants, nurses and midwives during their labour. 

RTÉ’s Liveline programme has been inundated with phone calls from women who want to share their experiences of Irish maternity services, both historical and recent.  

Believing women

The powerful accounts shared by the women document a litany of concerns, with the women telling broadcaster Joe Duffy that the concerns they raised with medical staff were ignored. 

“Once again, women are not being believed,” Duffy said this week. 

While some of the cases related to issues that occurred many years ago, some stories were from Irish maternity hospitals just a few weeks ago. 

One woman, who had a complicated C-section a few years ago, said the midwife later told her the complications were due to her being “so fat”. The woman said the words were cutting, particularly at a time when she was at her most vulnerable. 

Another caller said she told hospital staff that she could feel her baby was coming. The woman said the staff were washing the floor, and said her baby was not on the way. The caller said she had to get her husband to help her on to the bed, and in a matter of ten minutes, her baby was born. She said she gave birth in the full view of everyone in the prenatal ward.

“I was in a complete state of shock,” she said. 

Another woman, Rachel, said her baby was put on emergency oxygen in the ICU straight after birth. A midwife told her this was her fault and that she shouldn’t have asked for an epidural when she was only 7 centimetres dilated.

One caller said her midwife told her to get up, that she was well able to walk after the birth of her child. When she stood up, she collapsed. Others spoke of feeling like they were being scolded by the medical staff for “not being able to do it [childbirth] properly”.  

Speaking to TheJournal.ie about the stories shared on the national airwaves, Fine Gael TD, Kate O’Connell said there is still a “paternalistic attitude to the care of women” in Irish hospitals.

O’Connell said “it is key that women are listened to”.

‘Hangover from the past’

“There are huge difficulties with our services. People often talk about how great the outcomes we have, but there is a hangover from the past,” said O’Connell. 

“Having babies is a serious business and it doesn’t always work out, but at least if you feel you are in some sort of control of the situation, and you are listened to,” she added.  

The Fine Gael TD said sometimes doctors have to make decisions in the moment and in the best interest of women.

“Sometimes there are situations where decisions are needed, where consent forms for a C-section are shoved under a woman’s nose and she is barely conscious – but in some ways that is unavoidable if you have a child stuck in the birth canal and it needs to come out through a C-section. I would say paperwork is the least of your worries, in my opinion. But a woman knows her body best. Mammy knows best, and for a woman that is conscious and there is no sense of an emergency, she should be listened to,” said O’Connell.

“Another issue brought up on Joe Duffy was women saying something is wrong with their child and being ignored. Again, I would go back to ‘Mammy knows best’ – there is that connection, there is that animalistic connection when you have a baby. It is key that women are listened to.”

Sinn Féin’s health spokesperson Louise O’Reilly said she has been moved to tears listening to women telling their stories on the radio. 

‘Paternalistic nature of care’

She agreed that the stories show the paternalistic nature of care in hospitals, stating that similar concerns were raised in the recent Scally report on the CervicalCheck scandal. 

O’Reilly said it is important to remember that the vast majority of women have a positive experience of the maternity services, however, she welcomed that such an open and honest discussion about women’s health was taking place. 

She acknowledged that there is an issue around resources, and also space in Irish maternity hospitals, which is having a knock-on impact on services. 

A number of women who have told their story to Joe Duffy detailed difficult court cases that followed their labours.   

Open disclosure

O’Connell said many women she has encountered, who ended up settling their cases, were initially told that “whatever happened to them during the birth was natural and unavoidable”. 

“In the fog after having a baby perhaps there’s not enough honesty around a situation, and I hope this can be dealt with through open disclosure [legislation],” she said. 

She said a lot of work has to be done in relation to how women are treated after suffering catastrophic injuries during childbirth.

“For the woman to have to prove the extent of her injuries, she has to go through a a very invasive process,” she said, stating that there must be a better way to treat Irish women. 

O’Connell said there is far too much duplication in the court case, stating that women are often subject to multiple physical examinations, which “retraumatise” women.

Shutterstock / Vasilchenko Nikita Shutterstock / Vasilchenko Nikita / Vasilchenko Nikita

She said taking hospitals to court has a huge impact on women.

“I do think there is still an element of paternalistic care, and I do think mediation as opposed to an adversarial method is needed. We really have to look at what women are put through in the aftermath,” she said.

Such cases can also take years, she added. 

“It can be too much sometimes, you just get worn down and you just want to thank your lucky stars that your child is alright and get on with your life, but for those women who take their cases to the steps of the High Court, they need to be praised for their bravery.”

Third and fourth degree tears during childbirth

Over the last two weeks, women also spoke about the trauma of having a third or fourth degree tear during childbirth. 

Fourth-degree vaginal tears are the most severe. They extend through the anal sphincter to the rectum. They are usually repaired under anesthetic — rather than the delivery room — however one woman told the radio show that she was stitched straight after delivery. Despite her objections about the pain, the doctor failed to stop. 

Many of the women who spoke on the radio talked about the complications they have experienced after these tears, such as fecal and urinary incontinence and painful intercourse.

The women told Joe Duffy that such things are not spoken openly about in Ireland, as it is seen as embarrassing. 

AIMS Ireland (The Association for Improvements in the Maternity Services – Ireland) has said this week that it welcomes consistent coverage of women’s lived experiences on the national radio.

The organisation said it wanted to recognise the “courage and bravery” of the many women who have taken to the airwaves.

“We rarely get to hear women speak out, uninhibited, and without the assumed need to devalue or undermine them by sharing positive stories or by focusing on the needs of staff. However AIMS would like to point out that these experiences are not a rare occurrence, nor are they for the first time coming to light,” said the group. 

Dignity and respect for women

AIMS Ireland Chair Krysia Lynch said there “is no doubt that clinicians mostly do their best with limited resources, but many of the issues raised by maternity service users in general have absolutely nothing to do with funding. They are about dignity and respect. These cost nothing, but are in short supply in our maternity services”.

Lynch said the many women are “profoundly wounded emotionally and physically and until this week they have been utterly ignored”.

The Irish Nurses and Midwives Association (INMO) spokesperson said while it cannot comment on individual cases, “many of our members have listened to these recent stories with great sadness and empathy”. 

It added:

Many midwife members have contacted us to emphasise that patient care is always at the heart of their work and that they do not recognise the services being described. Ireland’s midwives work to provide dedicated care 24/7, year-round, but are forced to do so in understaffed, underfunded and overcrowded services.

We have been calling for sufficient resources for maternity services for several years. Much-needed funding to implement the maternity strategy was recently halted and we are awaiting the Minister’s response to our queries on the matter.

The Minister for Health Simon Harris also did not provide a comment to this website, however the Department of Health in a statement to TheJournal.ie said:

The Department of Health is conscious of the concerns that have been raised regarding difficult personal experiences with regard to maternity services that a number of women have discussed in the media recently.

The department said the National Maternity Strategy sets out a clear vision as to how Irish maternity services will be developed, improved and made safer over a ten-year lifespan.

“The strategy represents a significant development in the delivery of national maternity policy that will fundamentally change how maternity care is delivered. At its centre the strategy recommends that services should be woman-centred, and provide integrated, team-based care. The strategy aims to increase choice to women whilst ensuring that services are safe.”

The new model of integrated care will provide “choice and quality so that every woman will be able to access the right level of care, from the right professional, at the right time and in the right place, based on her needs and choice,” said the department. 

The implementation of the strategy is the best way to deliver the safe, quality and compassionate maternity service that the women of Ireland expect and deserve.

It is important that the development and provision of maternity services is conducted in a way that listens to and considers the voices of women to ensure that their experiences can inform policy and help to improve such services into the future.

The Health Department noted that the National Care Experience Programme (NCEP) is currently developing a National Maternity Care Experience Survey in relation to maternity care and services in Ireland.