Picture this:
A healthy labouring woman, fully dilated, is ready to start pushing. She has taken the responsibility of informing herself of the pros and cons of hospital and home-birth and has chosen the best and safest option for herself and her family; a home-birth. She is eagerly awaiting the birth of this child – her fourth – and is happy that her labour is progressing smoothly. She feels powerful and energised. Confident of her body’s ability to birth, this woman is surrounded by carefully chosen birth attendants: Chief among them is her midwife, who has cared for this woman since the 8th week of her pregnancy.
This midwife has met with this woman and her family a dozen times during the pregnancy. She has nurtured her and her family throughout. Her kindness, care and experience have helped create an atmosphere of calm. She has met with the family in the comfort, safety and privacy of their own home and answered all their questions. She has worked hard and diligently with the family to achieve the optimum birth. She has earned their trust.
Just as the pregnant woman is about to start pushing her baby into the world, there is a loud rapping at the door (in spite of the note pinned to it asking callers to return later, as a birth is in progress). When the bewildered father-to-be answers the door, he is confronted by uniformed Gardaí. They have come to arrest the midwife. The HSE has decided that her attendance at this birth is illegal because the woman’s last baby (her third) was over 9lbs in weight.
This midwife faces up to 10 years in prison and a €160,000 fine for exercising her profession to the best of her ability.
Sounds crazy, right? Well, that’s exactly the scenario that could be enacted up and down the country if the HSE has its way. The Department of Health is currently preparing to put a Bill before the Dáil which would virtually outlaw homebirth in Ireland and leave self-employed midwives at the risk of being vilified, arrested, fined and imprisoned.
The proposed Bill would strip midwives, who attend women outside the criteria dreamt up by the HSE, of insurance. Most of the criteria currently proposed by the HSE are not evidence-based and violate a woman’s right to make an informed choice with regard to where she births.
These guidelines and sections form an architecture of coercion. Mothers who fall outside the draconian and prejudicial terms laid down by the State may be forcibly hospitalised. Midwives who, like other professionals, seek to exercise their autonomy may face a jail sentence of up to 10 years. Draft HSE guidelines recently circulated go so far as to define the Garda Siochána as ‘relevant stakeholders’ in home birth.
‘Section 40 of the Bill, in effect, undermines women’s rights by withdrawing access to midwifery care in childbirth. Women have the right to appropriate health care, to bodily integrity and to self-determination. They also have the right to decline medical intervention. This Bill effectively denies women the freedom to give birth as they wish’, said Dr Krysia Lynch of the Home Birth Association.
Self-employed midwife Philomena Canning puts it most succinctly: ‘The Bill, as it stands, threatens the future of midwifery, criminalises autonomous midwifery practice, conflicts with a midwife’s duty of care and denies midwives the right to run their own profession, a right enjoyed by all other health professionals in law.’
‘The Bill places the midwife in an intolerable dilemma,’ she continues. ‘She must decide whether to assist the mother under circumstances where she is no longer indemnified––and possibly be jailed for doing so – or stand idly by. Withdrawing care from a mother who suddenly ceases to conform to insurance criteria in mid-labour is an appalling vista.’
I sit here and wonder how I have ended up raising daughters in a country where women’s and children’s rights can be systematically trampled over by its own government. This is a witch-hunt against midwives who want to practice their profession. It is another attempt by the government of Ireland to violate women’s human rights. It is another example of the Irish government telling Irish women that they must do what they are told – that they must conform and be ‘good girls’. It is another example of the Irish government deciding it knows what is best – even if international research and evidence does not support their stance.
I am shocked and saddened that Irish society has progressed so little. This treatment of women, by the Irish government, is not a million miles from what they did to women in the infamous ‘laundries’. I am disgusted at the lack of respect this proposed Bill shows for women and children.
This issue is not about home birth versus hospital birth. It is not about hippy women ‘refusing to listen’ to doctors. It is not about ‘stupid’ women refusing medical care. It is not about women who ‘just want to be different’. It is about the proposed violation of the rights and integrity of the women and children in this society. Peace on earth begins with peace at birth. Women must feel respected and at peace with their decisions when they give birth. They must be allowed to make informed decisions based on their own histories and their own research.
Let us not forget that this proposed Bill is also unconstitutional: Article 40.3.1 of Bunreacht na hEireann and Article 3 of the European Convention of Human Rights state that ‘free and informed consent is the cornerstone of medical treatment.’ For consent to be free and informed, it must be based on information and choice, neither of which feature in the proposed legislation. Thousands of Irish men and Irish women stood by and allowed the government – aided and abetted them, even – to treat Irish women and children despicably in ‘homes’ and ‘laundries’ and ‘under State care’ until the 1980s. Are you going to stand by and allow them to repeat their contemptuous treatment of women and children?
If not, you can voice your opposition by signing the petition to have the Bill amended: http://www.gopetition.com/petition/39693.html
Hazel Katherine Larkin is a mother, journalist, writer and doula who spent 10 years in Asia working in the media before returning to Ireland six years ago. She is currently working on a memoir and looking forward to returning to Asia in 2011 – chiefly because she believes Ireland is no place for young women.
This is a very powerful & informative piece Hazel. At the end of the day it is all about choice, as you say. Six of my neices & nephews were born happy & healthy at home with absolutely no complications. In each case wonderful, caring and experienced midwives were present. Birth is after all the most natural process in the world.
In my own case I had significant medical intervention twice due to complications. However, I would absolutely support any woman who wishes to decide for herself. We are after all responsible, caring adults.
Thanks for taking the time to read and comment, Eleanor. I agree that families should be allowed to decide for themselves what suits them best.
I even question this relatively new notion of insisting that the man be there to witness the birth. Some women don’t want their husbands/boyfriends/partners there!
Personally, I don’t care where any woman chooses to birth – but choice is only real when it is informed.
Hazel
Fantastic piece, I had no idea the HSC was pushing this. I must say I have always been deeply suspicious of so many induced births at hospitals, as though running to a schedule.
I refused oxytocin to induce second birth as baby 1 had got into difficulties when I had it previously (this was followed by an emergency section & much panic) & I was frightened. The impatiance of the nurse was unreal! I really had to fight my case & she eventually went & phoned my consultant. I had discussed this with him and he, to his credit, said “under no circumstances give that woman oxytocin”. The battles you have to fight when you’re so vulnerable.
That’s awful Eleanor.
Thanks for taking the time to read and comment, Arlene. You are right – hospitals (and consultants) are running to a schedule. Women are expected to dilate one centimetre per hour – and if they don’t, the cascade of intervention begins. Women are expected to ‘perform’ and if they don’t they – and their babies are punished by a system that doesn’t concern itself with anything other than keeping the stats for live births up.
Hazel
In regulation, less is often more! This seems like foolish and illiberal regulation; the power to decide how a birth is managed should lie with the mother.
Thanks for your comments, Shane. As you can see, most of us here agree with you!
Hazel
This is a great post and I will certainly be signing the petition. In my view midwives are criminally undervalued in Ireland and there is far to much reliance on consultants treating women with normal, healthy pregnancies at great cost. Consultants should only be required to step in where complications arise. I wrote a post on this very subject on my own blog recently and called it ‘Leave it to the Midwife’. Sounds like the HSE has other ideas.
Hi Catherine!
Thanks for reading and commenting. I agree with the points you raise – and look forward to reading your blog later today.
Hazel
Great post. I cant believe we are heading back to the dark ages with this piece of legilation. Anyone ever read the brilliant: Witches, Midwives and Nurses, A History of Women Healers by Barbara Ehrenreich and Deirdre English? It historically relates how women were sidelined by the ‘medical establishment’ who vilified them as witches and wanted to take the power of medicine for themselves, sound familiar? The book appears to be in its second addition and available on google books, really worth a read to put this in historic perspective.
Hi Helen
Thanks so much for the recommendation – I’ll hunt that book down and have a read of it.
Hazel
My brother-in-law and sister-in-law were feature in this article in the Indo a few months ago about home births:
http://www.independent.ie/lifestyle/parenting/dads-sidelined-in-maternity-wards-2326041.html
The had their first child in a hospital and their second at home. They much preferred the home birth because the main difference is that there are no restrictions on how long the father can stick around. Another backwards rule by the HSE/hospitals is that fathers can’t stay at the hospital outside certain visiting hours after the birth when the mother needs him the most. This bill adds insult to injury for dads too who just want to be able to help out in the first few days of their child’s life without any hospital time restrictions.
Wow! What a great article. Thanks for the link. The point is very well made in it – that fathers should have the right to choose their own level of involvement. Giving birth is about building families, after all – and families are the building blocks of societies. If we want a peaceful society where bonds and inter-generational communication is optimum, then we need to encourage families to *feel* like families right from the start.
We have a long way to go.
Hazel
Dear Hazel – excellent piece and I am so grateful! Thank you so much for writing this and for the Anti-Room for posting it. Please, continue spreading the word and lend your support to all birth activists both w/in Ireland (AIMS Ireland, Home Birth Association, Community Midwives Association, Doula Association of Ireland, Clare Birth Choice, Keeping Mum, etc etc) and abroad who continue to fight for women’s rights – choice, control and dignity in birth. It seems as though internationally, this push to criminalise home birth, birthing women and midwives is increasing – it’s frightening and disturbing to say the least. Thank you to all like Hazel who are taking a stand and raising awareness and speaking out against these measures.
Thank you for your kind words, Christine; I could feel your passion for the subject lifting off the screen. I would like to echo your thanks to the Anti-Room for posting my piece; we need our citizens to know that their rights are being fiddled with!
Hazel
Good work, Hazel. I will be letter-writing this weekend, I’ve been watching the progress on facebook. I feel so disheartened to see who is in control of our laws and advances – it’s not just birth they have a painful misunderstanding of – it’s a lack of creative and spiritual thinking across the board, through education and care of the sick and the environment.
All symptoms of people really lacking in depth and understanding of the way the world could work, if we allowed it to. Killers of innovation and best practice.
Hi Jo!
Thanks so much for reading and commenting. I agree with you that there is a lack of creative and spiritual thinking across the board; personally, I think we need to go right back to birth and, once we’ve ‘fixed’ that, everything else will fall into place.
How naive am I?!
Hazel
‘as though running to a schedule’
But they are running to a shedule. They have 9,000 plus births booked this year, and can accomodate 2,000 plus.
They have a chart they use on mothers – you have to dilate one centimetre an hour or they induce you. They know that dilation doesn’t work that way – especially for first time mothers, who might take a day and a half to get to five and then do the rest in an hour or two.
They know theis – but they can’t accomodate it in terms of space and time – so they use it on women to push inductions.
‘Your baby’s in trouble. There seems to be a problem. etc etc.’ And who can argue with that?
Modern hospital birth scared the pants off me. I had my first child at home – there was great delay but her heart rate was fine. She was finally born, with her chord round her neck. If I’d been in hospital, they would have induced me and the unnaturally strong, relentless induction contractions would have stressed her by putting pressure on the chord – and I would hav had a section. As it was, I had a healthy home birth because I was with an independent midwife.
This puts that under threat.
Great article, Hazel! So well written and clear. I have passed it on to my niece who is planning to study midwifery next year. I hope she and her age group who are the future of Ireland will rally around this and get involved too. I feel like we are being stealthily pushed back into the dark ages here in this country. I hope this story can get some attention in the midst of all this bailout news. Let’s keep it in the forefront.
Hi Maya!
Thanks for taking the time to read, comment and forward!
I know it doesn’t sound like much, but I think if we started with changing the title of the CEO of a maternity hospital from ‘Master’, it would make a huge psychological difference.
We’re the only country in the world who uses the term. I still find it shocking and distasteful.
Hazel
I am shocked that we still uses terminology like ‘Master’ in ‘modern’ Ireland. I absolutely agree that the words we use have a huge psychological impact. Letters to the Editor of The Irish Times mightn’t go amiss.
Thank you so much for drawing my attention to this. My second child was born at home after a traumatic experience of “actively managed” labour in Holles Street with my first. The home birth experience was great. However, he weighed around 10 lbs (we couldn’t establish his exact weight as the midwife had driven over her baby scales that day so we used the kitchen ones which only went up to 10lbs!) which means that under this legislation, I would not have been allowed to have a third child at home. Incredible.
Hi SC
I, too, would be on the ‘banned’ list according to the HSE. Both my babies were born at home – but the first was premature, the second was 4.3kgs (over 9lbs) and I am over 35.
Irish obstetrics operate without as much as a cursory nod in the direction of evidence based practice for the most part. If any other profession – teachers, lawyers, dentists or bus-drivers – acted in the same way, there wouldn’t get away with it.
As a nation, we need to learn to ask questions of those who tell us they are in charge.
Hazel
That was a great article you wrote Hazel, its shocking what the HSC are doing in the name of ” safety”? it just seems like controli ssues again and going back to the dark ages which is what this country feels like now in 2010… im sure many many child bearing women are not aware of this law and it sounds more like a law from a less developed country… but how far have we really come in the last 50 yrs? we seem to be going backwards !
Thanks, Luarena! It is shocking but I’m delighted that so many people are shocked and signing the petition!
Hx
Yes, Hazel! It’s proven that violent birth practices make for violent society – like in the Ukraine, where they get babies breathing by… putting them under the cold tap
I agree that birth shapes society, and society shapes birth in return. People seem so divorced from any knowledge of what newborns need. Like, scientists seem surprised to find that premature babies benefit from … skin to skin contact and being held. Sigh.
Well Jo, it’s not so long ago since Irish babies were welcomed into the world by a sharp smack on the bottom administered by the consultant! Talk about a violent welcome. Think about that for a second – a baby’s first physical contact is an assault. Is it any wonder this country is in the state it is??!
Hazel
Hazel, thanks so much for this post. I don’t have children but hope to have them in the future and to be honest the idea of giving birth in a hospital scares me on a number of levels. Not because I think it is ‘wrong’ to give birth in a hospital or to have an epidural or c-section etc etc (far from it), but that it seems – from reading articles like this and talking to recent mothers – that mothers (especially first-time) don’t always have a choice in the birthing process and that things seem to run to someone else’s schedule.
I realise it is a complicated issue and that those working in the hospital have to do their best under a huge amount of pressure, but the idea that you have to give birth to a schedule (eg within 12 hours, or dilate 1cm every hour, etc) just seems so wrong to me. So at odds to the fact that every woman’s body is different (which is why each woman has a different experience giving birth).
And is it any wonder that when women hear so many bad stories about giving birth here, or feel they won’t be listened to or have to fit into a schedule, that some are afraid of giving birth?
In an ideal world, women would be able to choose if they want to give birth at home, or in the hospital, the process would be transparent, open, and supported 100% either way and they would have a midwife (and doula, etc, if they wish) supporting them through either experience.
It’s not about one way being ‘better’ – the best experience is surely the one where the woman feels most comfortable and knows her voice is being heard.
But to hear that midwives could be arrested for helping in homebirths, without any thought to what the women giving birth want…well, it really is frightening. Thanks for getting the word out about this.
Also, the article JJ linked to above is saddening – why on earth aren’t fathers allowed to be in the hospital at all times during and after a birth? It takes two to make a child and it must be distressing for dads to feel they are not needed at a time when they most certainly are.
Aoife
Hi Aoife
Thanks for that very considered response to my post. My hope for you – and all women birthing in Ireland – is that you have the choice of where, how and with whom you give birth, and that you feel safe, supported and encouraged throughout your labour and birth.
It is very sad that fathers are so side-lined when it comes to the birth experience. It’s a deeply profound one and to shut men out for no valid reason inflicts deep emotional and psychological wounds on them and their families. It’s another example of wanting things both ways – we expect our men to be hands-on dads, but deny them access to their families at crucial times. What are they supposed to do? How are they supposed to feel? It’s a terribly sexist thing to do and excludes and alienates men – pushing understanding of and appreciation of the sexes further apart.
That people are voicing their dissatisfaction with the system as it stands is a start, though – and fair play to all those wonderful fathers who are reacting to the bullying they are being out by the system. We need more like them!
Hazel
Great post. I’d love to read why the author is considering leaving because she believes that Ireland is not place for a young woman? Tell me more….
Hi Clare,
That line was a little tongue-in-cheek and a play on ‘no country for old men’ (which I’m sure you picked up on anyway), but I have two daughters and I don’t feel that Ireland offers them the opportunities other countries do.
Off the top of my head, here are a few reasons why I made the statement.
I can’t get the education or medical care that I want for my girls in Ireland.
For myself (I still consider myself a ‘young woman’) I can’t get the childcare in Ireland that I can get in Asia. Also, I have been single for 7 years – and if I stay in Ireland I think I’ll be single forever! I am much more likely to meet someone who melts my butter in Asia.
Finally, I have job offers (yes, plural!) in Asia – and none here.
Also, there are other, more personal – and I mean relevant to me as a person, rather than private – reasons to leave which have nothing to do with my sex or that of my children.
Hazel