Pregnant Kilkenny woman Aja Teehan will find out today if she will be able to have a home birth with a midwife contracted to the HSE following a judicial review at the High Court.
Teehan applied to the HSE to have a home birth with a self-employed community midwife for her second child – however, as she had a caesarean section on her previous pregnancy, she was told this makes her ineligible for a home birth.
Below, campaigner Sinéad Redmond discusses Aja Teehan’s case and the implications it has for families across Ireland…
RECENT NEWS THAT the HSE has made the inexplicable decision to withdraw necessary, potentially lifesaving medical care for pregnant diabetic women, while it outraged me, sadly did not shock me. The HSE all too frequently take it upon themselves to make decisions for pregnant women, decisions they would never make themselves, in the face of all available evidence.
In the last few months alone, it has come out that the HSE has: gone to the High Court to prevent Kilkenny woman Aja Teehan having a home birth (which would be paid for by her and her husband and attended by an independent midwife), issued a document urging medical professionals to bring pregnant women to the High Court to force them into particular forms of medical treatment and surgery against their will (as attempted by Waterford Regional in the ‘Mother A’ case), and attempted to essentially make birthing at home inaccessible for Irish women by demanding that two midwives attend every home birth.
There are only 17 independent midwives to cover all 26 counties of the Republic: many women, myself included, cannot find one to cover a home birth. This implementation would, in the words of the Association for the Improvement in Maternity Services (AIMS) Ireland, “deeply restrict homebirth in many areas and threaten the existence of independent midwifery”.
This assault on families’ birth rights has drawn little or no comment from most Irish media outlets. For some reason our society does not trust pregnant women to make the best choices for themselves and their children until after they give birth. Miraculously, though, after women give birth, we are transformed into the only possible creatures who can or should care for our babies, with minimal state support. The problem with these assertions is that not only are they incredibly hurtful and offensive to women who want the right to choose what happens to them – they’re not even accurate.
Our perinatal mortality rate (the rate of stillbirths and infant deaths near birth) is, according to the ESRI, ranked 10th of 16 EU countries measured. It’s higher than Holland’s; a country where between a third and a quarter of women giving birth choose to do so at home. A 2009 Dutch study of over half a million women giving birth found that the perinatal mortality rate had “no significant differences between women who gave birth at home with those who had a planned hospital birth.”
Our Caesarean section rate, which the WHO says should be between 10-16 per cent, stands at 29 per cent and rising. It’s even higher in the private system of maternity care (led solely by obstetricians, not midwives) at 36 per cent. This system costs women and the State more money, and leads to more adverse effects on them physically. If you’re a first-time mother in Kilkenny, as Aja Teehan was, you have nearly a one in two chance of having a C-section.
The Active Management of Labour system, which is routinely practised in the majority of Irish delivery suites, was first initiated in Holles Street in 1963. This system, which dictates that every woman’s labour must proceed at a dilation rate of 1cm per hour, is not based on any medical or scientific evidence. The NHS National Institute for Health and Clinical Evidence (NICE) issue evidence based and systematically reviewed guidelines which are often referred to by the HSE in many areas – just not maternity care. NICE guidelines recommend that “active management of labour” should not be routinely offered.
It is not safer for the baby and increases the likelihood of unnecessary and potentially traumatic intervention for the woman. It was based entirely on the desire for a hospital system which could control and manage the number of women in their care – rather than considering the situation of an individual woman at a given time.
Today, the National Maternity Hospital has a normal birth rate for first time mothers of only 4 per cent. You have a 43.5 per cent chance of having your perineum (the skin between the vagina and anus) cut with a scalpel if you’re giving birth for the first time in Holles Street – a painful procedure called an episiotomy. It is indeed occasionally necessary, as the UK midwife I spoke to confirmed – but she said that she’s only found it necessary to perform two in her entire career thus far. Are the women in Ireland really that drastically anatomically different? I find it very hard to believe so.
If you are a woman who’s previously had a Caesarean section and you wish to attempt to give birth vaginally (VBAC) – safest for both you and your baby – as Mother A, in Waterford Regional Hospital, did, then in other Western countries your chances of success would be higher than 70 per cent.
If you attempt a VBAC in the Coombe your chance of success is less than half that, at 35.6 per cent. If you’re from Kilkenny, as Aja Teehan is, your chances of a successful VBAC are a tiny 2 per cent. If you wish to continue your pregnancy until the end of what is defined as ‘full term’, 42 weeks – as Mother A did – you will, unless very lucky, find yourself under a barrage of pressure from obstetricians to be induced before you are willing to consent to do so.
The HSE assert that they do not have to support women in making choices they deem to be unsafe, but do not deign to explain why exactly they deem these choices to be unsafe.
Furthermore the HSE do not seem to be interested in holding the hospitals they run to the same standards. It’s against both NICE and HSE guidelines, for example, to routinely put low risk women on electronic monitoring when they present in labour. This is because this monitoring, invented in the 80s with the aim of reducing the rate of stillbirths as well as babies born with cerebral palsy, has not succeeded in reducing either of these things, but has led to an increased amount of unnecessary, painful and traumatising interventions performed on women.
However, this HSE recommendation has not been implemented by any maternity hospital in Ireland. Routine monitoring happens on admission in all maternity units in the country, with the exception of the midwife-led units in Drogheda and Cavan.
Why is it that women who want to make informed decisions in their care are brought to court, but hospitals who actively go against best practice for women aren’t held to the same standards? All we’re asking is to make decisions for our own care. This is a very basic request.
Sinéad Redmond is a mother, scientist, and campaigner for reproductive rights for women in Ireland with the Abortion Rights Campaign (www.abortionrightscampaign.ie) and the Association for the Improvement in Maternity Services Ireland (www.aimsireland.com).
This article was first published on 9 August 2013
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