We expect more from maternity services than women not dying

Tue, Dec 4, 2012, 00:00

SECOND OPINION:At last women who give birth in Irish hospitals may have at least one of their human rights respected and vindicated. The Report of the Expert group on the Judgment in A, B and C v Ireland says that legislation to regulate access to lawful termination of pregnancy in Ireland is “constitutionally, legally and procedurally sound”.

The State must “provide effective and accessible procedures to establish a woman’s right to an abortion as well as access to such treatment”.

Maternal mortality rates are often quoted by anti-abortion campaigners to show that new legislation is not needed because Ireland’s maternity services are among the best in the world. These rates are meaningless when used to support an anti-abortion stance.

A 2012 analysis of maternal mortality in European perinatal health surveillance systems, including Ireland, shows that current data are insufficient for comparison between countries, because the tiny numbers and statistical variability from year to year are difficult to interpret.

In developed countries, women are not expected to die during pregnancy and birth, and maternal mortality figures are so small they are expressed as rates per 100,000 births.

The 2012 report from the UN Population Fund shows that, for the top 30 countries with the lowest maternal deaths, rates varied from two in Estonia to 12 per 100,000 in the UK. Ireland was in 13th place with a rate of six per 100,000 births. Statistical tests on these rates show that there is no difference between them other than can be explained by chance or random fluctuation.

Mortality rates

Using maternal mortality rates to argue against legislating for abortion is disingenuous and specious, as even one fewer or more death in any year can move a country up or down several places in the “maternal mortality league table”.

Maternal death rates in developed countries are irrelevant to the need for abortion legislation.

Ireland needs this legislation to respect and vindicate women’s rights, not to make childbirth safer. Almost all women in Ireland give birth in hospital and they need to know that if there is a real and substantial risk to their life which can only be averted by terminating the pregnancy, they have a right to an abortion by law.

This is not the only human right that needs to be respected and vindicated during pregnancy. Women have little or no say in the medical and surgical interventions that are carried out on them during the birthing process, including induction of labour, episiotomy, and the use of instruments such as forceps and vacuum extractors.

Rates for these procedures vary dramatically from country to country, and from hospital to hospital. Since women’s bodies are not that different, it is obvious that hospital policy determines whether or not an intervention takes place, rather than best practice and women’s rights.

Do Irish women have the right to refuse to be induced, not have an episiotomy or not have instruments used on them without their explicit consent?

Medical need

Induction of labour should take place only when there is a clear medical indication for it.Among EU countries, the Czech Republic has the smallest number of inductions at 5 per cent of all births and Malta the most at 38 per cent. Ireland’s rates vary from 31 per cent in the Mid-West Regional Maternity Hospital in Limerick, to 27 per cent in University Hospital, Galway, and 0 per cent in the Midwife-led Unit, Cavan.

The use of instruments during birth also varies dramatically between countries. Ireland has the highest number of instrumental births at 16 per cent and Slovenia the lowest at 3 per cent.

There is overwhelming evidence that episiotomies should be performed only in strict well-defined situations.

Rates for this procedure vary wildly from 80 per cent of all deliveries in Portugal to 9 per cent in Denmark. In Ireland, rates vary from 27 per cent in the National Maternity Hospital to 16 per cent in Mayo General, and 0 per cent in the Midwife-led Unit, Cavan.

What are women’s rights in relation to these interventions and what would happen if a woman said “no thanks” or “I will take my chances”? Who knows?

Irish women need legislation to establish their right to an abortion when their lives are at risk and also to specify their human rights to request or refuse medical and surgical procedures during childbirth. In the 21st century we expect a little bit more from our maternity services than women not dying.

Dr JACKY JONESis a former HSE regional manager of health promotion