Caesarean court action criticised by midwives

The Irish Midwives Association (IMA) has expressed deep concern over a High Court case in which it emerged that the HSE attempted to force a woman to have a caesarean section against her will.

The IMA welcomed Judge Michael Twomey’s ruling in the case that such a forced surgical procedure would constitute a “grievous assault” and said it fully supported the right of all pregnant women “to informed consent, informed refusal and full bodily autonomy”.

In his judgment on Wednesday, Mr Twomey refused to grant the HSE an order forcing a pregnant woman to have a caesarean section against her will, so as to vindicate the right to life of her unborn child.

The judge said that while he could not see why the woman would choose to take on an “unnecessary” risk of injury or death to herself or her child by not undergoing the procedure, it was a “step too far” to order a forced caesarean.

The increased risk to the woman and the child did not justify the court effectively authorising the woman having “her uterus opened against her will”, he said.

It would constitute a “grievous assault” if done on a woman who was not pregnant, he noted.

The HSE sought the order after doctors advised that, if the woman’s fourth child was delivered naturally, there was a risk her uterus would rupture, posing risks to her life and health and to that of the unborn child.

A natural birth in such circumstances was “unheard of” here, the court was told.

Birth

The day after the emergency court hearing, which was held in private in recent weeks and believed to be the first of its kind in the State, the woman agreed to a caesarean delivery after her waters broke.

The child was born healthy.

The unborn had been represented separately at the hearing. The child’s father had not been represented.

The woman’s refusal to follow medical advice in the context of her unborn child was a more difficult issue because of the Eighth Amendment, which protects the right to life of the unborn, the judge said.

However, the increased risk to the unborn did not justify a court order forcing the woman to have the caesarean, he ruled.

IMA spokesperson Ali Murphy said: "This ruling has considerable implications for practice, which might only become apparent over time.

“As midwives, we have a duty to respect a woman’s right to make informed choices for both herself and her baby, whilst working in an environment that is risk averse.”

The IMA drew “particular attention to our duty ‘to protect and promote the autonomy of patients: respect their choices, priorities, beliefs and values’.” she said.

“We strongly believe in a woman’s right to choose her care in pregnancy and birth and in her right to informed consent and refusal,” she said.

The IMA also supported the judge’s ruling “to lift the in-camera status [of the case], as requested by the mother” and said it is “concerned that the HSE objected to her waiving anonymity”.