Second Opinion: Women must be in control of their pregnancies

Ireland’s maternity services are unfit for purpose. The maternity unit in Portiuncula Hospital in Ballinasloe, Co Galway is the latest to come under scrutiny. A full review of services will be carried out and the report added to the plethora already available.

In 2001, the national health strategy, Quality and Fairness: A Health System for You, promised "a new model of maternity care" that is "woman-centred, equitable, safe, accessible, and accountable".

The 2006 inquiry into Caesarean hysterectomies at Our Lady of Lourdes Hospital, Drogheda was scathing about maternity services and noted “there has to be a more constructive, complementary and fluid relationship between midwives and obstetricians which is patient- centred”.

The 2013 Hiqa inquiry into the maternity unit in University Hospital Galway, and the country generally, found that women needed “modern day” services and “it is impossible to assess the performance and quality of maternity services nationally”. Last year’s report into the maternity unit in Portlaoise showed that it “lacks many of the important criteria required to deliver a safe and sustainable maternity service”.

The barbaric practice of symphysiotomy is still costing taxpayers millions. Every time a problem is exposed in any of the 19 maternity units in Ireland, a consultant obstetrician assures us that services are among the safest in the world. The truth is that they are as safe as all other EU countries. So what? We expect a little more from our maternity units than women and babies not dying.

Misogynistic

The Maternity and Infant Care Scheme (Mics), introduced in 1954, determines the services delivered to pregnant women.

The consultant-led model driving the scheme is misogynistic and paternalistic. Health professionals know best, while women cannot be trusted, do not know what’s good for them and do not understand their own bodies. Mics ensures that pregnancy and birth are controlled by doctors with midwives relegated to a subsidiary role.

With the exception of the midwife-led units in Our Lady of Lourdes hospital and Cavan General Hospital, Mics means that the majority of women are assigned a doctor whether they need one or not.

The model is highly interventionist, and in the past decade the number of instrumental births has increased by 46 per cent. Obstetricians make the decisions even when they are absent, effectively disempowering midwives.

In practice, women have little choice about how, when and where to give birth.

The Association for Improvements in Maternity Services Ireland carried out a survey of 2,836 women who had babies between 2010 and 2014. The findings of What Matters to You, in relation to informed consent during pregnancy, labour and birth, were published last month and showed that more than half of those surveyed "did not receive information on potential implications to have or not have tests, procedures, treatments to assist with their decisions, and only 50 per cent felt able to make an informed refusal during their labour and baby's birth".

Best for informed consent was the midwife-led unit in Drogheda (74 per cent) and worst was Portlaoise (35 per cent). Best for informed refusal was also Drogheda (74 per cent) and worst was Kilkenny (31 per cent). Respondents reported having their waters broken and being given episiotomies without being asked.

Women living in Ireland will never be equal until they control their reproductive health. This includes decisions about all aspects of pregnancy including antenatal care, labour, birth, and postnatal care.

Fourteen years after the publication of Quality and Fairness: A Health System for You, we still do not have a modern maternity strategy. The Department of Health has been discussing it for two years and has completed a literature review. Why?

A 2013 Cochrane Collaboration study found that midwife-led continuity models of care are better for women and babies than models of consultant-led care.

According to the Department of Health press office, a high-level policy paper is being developed and “a high-level working group with appropriate stakeholder involvement will be established”. It seems that women are not going to benefit from a new maternity strategy any time soon.

Health workshops

The National Women’s Council of Ireland (NWCI) and the HSE are running workshops on gender and health this month, in Letterkenny (March 4th), Waterford (March 11th) and Mullingar (March 20th). Participants at the workshops will have an opportunity to contribute to the draft HSE National Healthcare Charter for Maternity Care.

The NWCI is also organising a “soapbox” event for International Women’s Day on Saturday, March 7th, at the Central Bank in Dublin. The soapbox will be managed from noon until 4pm so go along and have your say. See nwci.ie for more information.

drjackyjones@gmail.com Dr Jacky Jones is a former HSE regional manager of health promotion and a member of the Healthy Ireland Council