Forcing women to give birth within a specified timeframe is abuse
New National Maternity Plan shows that treating pregnancy and childbirth as normal physiological processes is not going to happen any time soon
There is overwhelming evidence that midwife-led care is best for 80 per cent of women, but in Ireland obstetricians are in charge – this is an abuse of power
Recent disclosures by women about sexual abuse show the extent of the pervasive, physical, sexual, and psychological violence against women that exists everywhere in society.
This abuse is perpetrated by men from all walks of life.
The volume of disclosures shows that abuse of, and violence against women, is routine, par for the course, a default position for many men. As has been pointed out by several commentators, abuse of, and violence against women is not about sex but about the abuse of power.
The Council of Europe Convention on preventing and combating violence against women notes that “violence against women is a manifestation of historically unequal power relations between women and men, which have led to domination over, and discrimination against, women by men and to the prevention of the full advancement of women”.
Homes and workplaces are not the only places where women experience abuse. Power is misused and abused on a daily basis in Ireland’s maternity care system.
Earlier this year the UN Committee on the Elimination of Discrimination against Women found that “the State party has a policy of having three births per 24 hours for every bed in maternity wards, which does not respect the normal birth process”.
The committee was particularly concerned that “child delivery is highly medicalised and dependent on artificial methods to accelerate the process”.
Forcing women to give birth within a specified timeframe is abuse.
There is no other word for it.
Maternity services must be the only health service left where best practice does not apply
The National Maternity Strategy – Creating a Better Future Together 2016-2026 – was supposed to change all this by “recognising that pregnancy is a normal physiological process” and ensuring that women “are front and centre in all decisions about their care”.
Since its publication outcomes for pregnant women have actually worsened. More births are induced now than before with induction rates for first-time mothers ranging between 29 and 48 per cent in the State’s 19 maternity hospitals/units. Caesarean section rates have also increased with a rate as high as 56 per cent in one hospital for first-time mothers and 11 maternity hospitals/units have rates three times that recommended by the World Health Organisation.
Unfortunately, the National Maternity Strategy Implementation Plan, launched in October by the Minister for Health Simon Harris, shows that treating pregnancy and childbirth as normal physiological processes is not going to happen any time soon. Maternity services must be the only health service left where best practice does not apply.
Although the strategy concluded that “midwifery-led care is as safe as consultant-led care for low-risk women; women are more likely to be satisfied with their care if led and delivered by a midwife; midwifery-led care is cost effective; and midwifery led care results in fewer interventions”, this will not happen. Obstetricians want to retain their power over childbirth and will not allow midwives to lead unless they do it as part of a multidisciplinary team. There is overwhelming evidence that midwife-led care is best for 80 per cent of women, but in Ireland obstetricians are in charge.
This is an abuse of power. What else is new?
The three care pathways described in the strategy – supported care (midwife-led), assisted care (obstetrician-led), and specialised care (obstetrician-led) – are to be offered in just one hospital in each network by 2018. Only 20 per cent of women, rising to 30 per cent by 2019, are to be offered the supported care pathway. Lack of resources and a midwife shortage means women who want midwife-led care will be unable to avail of it. Women in rural Ireland will be particularly discriminated against.
For most women it will be business as usual. Their labours will be speeded up whether they like it or not. They will be induced whether they like it or not.
Examples of abuse included using restraints such as stirrups
Ireland is not the only country that treats women badly during pregnancy and childbirth. Pregnant women experience disrespectful, abusive, and neglectful treatment in health facilities around the world. A recent analysis of 65 studies from 34 countries concluded that mistreatment occurs at the level of interaction between women and health professionals as well as systemically. Examples of abuse included using restraints such as stirrups, using coercive language to ensure women comply with hospital birth policy, no informed consent for many procedures including episiotomies, unnecessary and frequent physical examinations, and loss of autonomy.
Systemic abuses, such as lack of privacy and speedy labour policies, occur because of staff shortages and inadequate facilities.
These abuses happen because only women become pregnant and women are fair game for abuse everywhere.