tag:blogger.com,1999:blog-90227111561009441012024-02-19T02:12:49.813+00:00Ireland: No Country for Pregnant WomenAnonymoushttp://www.blogger.com/profile/05874066401296452492noreply@blogger.comBlogger102125tag:blogger.com,1999:blog-9022711156100944101.post-49120106012493912922017-04-23T20:10:00.002+01:002017-04-23T20:10:20.787+01:00AIMS Ireland calls on government to set a date for a referendum on the 8th, let the people grant bodily autonomy to all, and stop the dilution of democracy<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">AIMS Ireland calls on the government to set a date for a referendum on the 8th amendment without delay. The Citizens Assembly has again proven that there is a strong desire for change and that there is a belief that all people in pregnancy should be given choice and full rights over what happens to their bodies. </span></div>
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<b id="docs-internal-guid-fc884409-9c38-4255-265c-124738945faf" style="font-weight: normal;"><br /></b></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">AIMS Ireland would like to recognise the hard work, diligence and dedication of every member of the Citizens Assembly, who clearly, thoroughly considered all of the options put before them. AIMS Ireland Chair, Krysia Lynch said, “We believe the members were put in an impossible situation by the Government and that, while very interesting, the whole Citizens Assembly exercise is nothing more than an attempt by the government to avoid or at least delay the process of referendum or ‘kick the can down the road’.” </span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> “The Citizens Assembly has no mandate from the people. Constitutionally, it has no mandate to inform legislation. In our opinion it is a dilution of democracy. It must be affected individuals themselves who decide.” added the AIMSI Chair.</span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">AIMS Ireland feel very strongly that the 2 hugely relevant points failed to be discussed by the citizens Assembly:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">The effect of the 8th amendment on maternity care </span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">The effect of the 8th amendment on continued pregnancy, where a pregnant person has decided to continue her pregnancy to term.</span></div>
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<b style="font-weight: normal;"><br /></b></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">“We feel these important points were not presented to the Citizens Assembly for deliberation and as a result the Citizens Assembly recommendations can not be seen as having taken all the issues into consideration” added Krysia Lynch.</span></div>
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<b style="font-weight: normal;"><br /></b></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Throughout its 10 years in existence, the Association for Improvements to the Maternity Services in Ireland has supported maternity service users through becoming pregnant, through pregnancy and beyond and have seen many cases of consent being overridden by the 8th amendment. Service users have told their stories and continue to tell their stories to us daily. People working within the maternity services have told of their constraints under the 8th. AIMS Ireland demands that the 8th amendment be repealed, not reworded or replaced, for the safety and wellbeing of all our citizens.</span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">In 2014, AIMS Ireland carried out a survey of people’s experience of the maternity services. We had 3,000 respondents from all over Ireland. Only 50% of respondents felt were given an opportunity to make an informed refusal of a test, treatment or procedure in childbirth.</span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">The country’s national consent policy states that “consent is required from all pregnant women for any health and social care interventions” however because of article 40.3.3 of the constitution, “there is legal uncertainty over her right to refuse treatment”. Therefore, the 8th affects every pregnancy in Ireland.</span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">AIMSI recently queried Citizens Assembly Chair, Ms. Justice Laffoy, as to whether or not the 8th amendment can be used to legally justify a treatment or procedure taking place without a woman’s consent in a situation where the baby’s life is not in danger.</span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">In a letter to AIMS Ireland, Ms Laffoy clarified that in the opinion of the legal expert, Emily Egan SC, the 8th amendment cannot serve as a legal justification for carrying out a procedure or treatment without consent, if the life of the foetus is not in danger. However we have seen in previous cases, namely </span><a href="http://www.courts.ie/Judgments.nsf/09859e7a3f34669680256ef3004a27de/597235d07c04a26a80257d35004d7c25?OpenDocument" style="text-decoration: none;"><span style="background-color: transparent; color: #1155cc; font-family: Arial; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">Hamilton V HSE</span></a><span style="background-color: transparent; color: black; font-family: Arial; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, that consent and whether it is given or not is a very grey area and up for interpretation. As far as AIMS Ireland is concerned, the 8th amendment is still used as a justification tool for overriding consent in the delivery room.</span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">AIMS Ireland welcomes the clear views expressed by the Citizens Assembly regarding the separating of physical and mental health issues. </span></div>
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<br />Anonymoushttp://www.blogger.com/profile/15102063693461334158noreply@blogger.com11tag:blogger.com,1999:blog-9022711156100944101.post-2992514829369197692017-04-21T22:09:00.006+01:002017-04-21T22:09:56.830+01:00AIMSI response to the Statement from St Vincent’s Healthcare Group 21st April 2017<div dir="ltr" style="color: #333333; font-family: Georgia, "Times New Roman", "Bitstream Charter", Times, serif; font-size: 16px; text-align: justify;">
AIMSI response to the Statement from St Vincent’s Healthcare Group</div>
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Aims Ireland notes the decision of Vincent’s Healthcare Group to review plans for the National Maternity Hospital. We eagerly await the outcome of the review but stop short of welcoming the decision until the outcome is clear.</div>
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Aims Ireland reiterates that the only acceptable option is a national Maternity hospital which is an independent, secular, ethical maternity hospital based around clinical best-practice and evidenced based care.</div>
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We have represented maternity service users for 10 years and have had few issues that have caused such intense feelings of betrayal.</div>
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We know the hospital is badly needed but it can not be a case of take the hospital at any cost - the women of Ireland deserve more then that.</div>
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ENDS</div>
Anonymoushttp://www.blogger.com/profile/15102063693461334158noreply@blogger.com2tag:blogger.com,1999:blog-9022711156100944101.post-48491304580285452692017-04-20T18:59:00.000+01:002017-04-20T18:59:01.512+01:00BREAKING NEWS: AIMS IRELAND RESPONSE TO THE PROPOSED RELOCATION OF THE NATIONAL MATERNITY HOSPITAL TO A SITE OWNED AND GOVERNED BY THE SISTERS OF CHARITY RELIGIOUS ORDER<div style="background-color: white; color: #666666; font-family: Merriweather, Georgia, Times, serif; font-size: 14.4px; padding: 8px 0px;">
<strong>For Immediate Release</strong></div>
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Thursday, 20th April 2017</div>
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Maternity service users call for transparency and if necessary re-location of the National Maternity Hospital</h3>
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Maternity service users in Ireland are outraged by the decision to grant ‘ownership’ of the New National Maternity Hospital to a religious order. AIMSI, a consumer lead organisation representing service users, has received an unprecedented number of communications regarding the issue, since it came into the public realm earlier this week.</div>
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The association, which has for 10 years represented maternity service users in Ireland, is calling on the Minister for Health, Mr Simon Harris TD, to ensure the interests of women and babies are protected or rethink the entire NMH move.</div>
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“We are not denying that a new National Maternity Hospital is needed urgently” said AIMSI Chair, Krysia Lynch, “but a building owned by a religious order, operating via a company ‘owned’ by a religious order is not acceptable to service users.”</div>
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Krysia Lynch continued “Women of Ireland of all cultures and creeds, their babies and their families deserve and require care that is independent, follows evidence-based models, and is free from any and all religious, cultural, social or moral constraints.”</div>
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AIMSI also note that according to the Department of Health Statement on the ownership of the new National Maternity Hospital, the board will be made up of “9 directors; four nominated by SVHG, four by NMH, including the Master, and one will be an international expert in obstetrics and gynaecology.” This could potentially mean up to 4 nuns representing Sisters of Charity, the landlords, sitting on the board of the new maternity hospital. AIMSI note also that although mediator Mr. Kieran Mulvey didn’t “think it was anticipated” that nuns would sit on the board, nor did he say that it could not happen.</div>
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“We, the maternity service users in Ireland, would like to know how this decision came about in the form of publication of the discussion with the religious orders. If those minutes show that the decision to grant ownership to the Sisters of Charity is the only way for this hospital to be built on this land, then we demand a rethink on the location of this hospital” added the AIMSI Chair.</div>
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AIMSI maintains that if an agreement is in place which ensures the ethos and clinical practice of the new maternity hospital is protected, including ensuring no presence by the religious order at Board Level, then who owns the land is irrelevant. This is not the case with the current agreement. The proposed 9-person Board structure is not 100% independent as it could potentially seat 4 members of the religious order. Furthermore there are no details as to how the external expert will be sourced or the conditions of their tenure, or who has veto over their selection and continuing presence.</div>
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<strong>BOILERPLATE</strong></div>
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Maternity service users have been given a strong message by the state with this move. A message that the abuse they and their loved ones have suffered by religious orders do not matter. Without bringing the issue of redress into the equation (as it was not included in mediation discussions, which is in itself bizarre) let us not forget the women that have suffered and died in the maternity system because of religious interference in ethos. We all know who they are.</div>
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For more information or to arrange an interview please contact Krysia Lynch, Chair, AIMS Ireland on 0877543751 or Emily McElarney AIMS Ireland PRO on 0863856225.</div>
Anonymoushttp://www.blogger.com/profile/15102063693461334158noreply@blogger.com3tag:blogger.com,1999:blog-9022711156100944101.post-81884860420718902702017-03-05T23:18:00.000+00:002017-03-06T09:54:40.892+00:00AIMS Ireland Response to the Citizens' Assembly: Article 40.3.3 in the Delivery Room<div class="MsoTitle" style="text-align: justify;">
<span lang="EN-GB" style="color: #385623; font-family: "calibri" , "sans-serif"; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: minor-latin; mso-themecolor: accent6; mso-themeshade: 128;"><span style="font-size: large;"><b>AIMS Ireland Response
to the Citizens' Assembly: Article 40.3.3 in the Delivery Room</b></span><o:p></o:p></span></div>
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<span lang="EN-GB">AIMS Ireland in December 2016 submitted a factual, evidenced, and
referenced submission to the Citizens’ Assembly. This submission was based on
legislation, primary and secondary research, and the personal experiences of
women supported by AIMS Ireland who were directly affected by the 8th
Amendment, ranging from coercion to threats of the involvement of the HSE,
child protective services, or the initiation of legal proceedings in the High
Court.<o:p></o:p></span></div>
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<span lang="EN-GB">In that document AIMS Ireland made submissions on the operation of
the 8th Amendment to the Constitution (Article 40.3.3°) in continued pregnancy with
respect in particular to the following areas:<o:p></o:p></span></div>
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<ol>
<li><span lang="EN-GB" style="text-indent: -18pt;">Women Experiencing Miscarriage
or a Pregnancy with a Diagnosis of Fatal Foetal Abnormality (citing <i>X v Attorney General</i> [1992] IESC 1; <i>A, B, and C v Ireland</i> (2011) 53 EHRR 13;
and the tragic cases of Savita Halappanavar, Malak Thawley, and the woman known
as Miss Y)</span></li>
<li><span lang="EN-GB" style="text-indent: -18pt;">Respect for Informed Consent
and Informed Refusal (citing § 7.7.1 of the Health Service Executive’s National
Consent Policy QPSD-D-026-1.1 V 1.1, May 2016; the case of <i>HSE v Mother A</i> in March 2013; <i>HSE
v B & Anor</i> [2016] IEHC 605; AIMS Ireland’s What Matters To You? Survey
in 2014; and <i>Hamilton v HSE</i> [2014]
IEHC 393)</span></li>
<li><span style="font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span><span lang="EN-GB" style="text-indent: -18pt;">Capacity and advance directives
(citing the Assisted Decision Making (Capacity) Act 2015 and <i>P.P. v Health Service Executive</i> [2014]
IEHC 622)</span></li>
</ol>
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<span lang="EN-GB">During proceedings in the Citizens’ Assembly on Saturday, March 4th 2017,
a member of the Assembly asked if there is scope for abuse of Article 40.3.3º
in the delivery room, where procedures take place without women’s consent. The
response, from the Chair Ms Justice Laffoy, was that the legal opinion is that
there is no such scope and that if this were to occur it would be a question of
medical negligence.<o:p></o:p></span></div>
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<span lang="EN-GB">AIMS Ireland were not asked to present to the Citizens’ Assembly. We
wish to take this opportunity, as an organisation consisting of and
representing women/people accessing care in the Irish maternity services, to
outline the very real and substantial issues arising as a result of and as a
consequence of the 8th Amendment functioning in practice as a barrier to
consent in continued pregnancy and childbirth. It is our firm belief that
the 8th Amendment prevents the successful litigation of these abuses of the
rights of women and people accessing maternity care in Ireland; both because of
the legal ambiguity it creates in our legal system around rights in maternity
care, and also because of the necessary tension it establishes in Irish law
between the rights of the mother and of the unborn.<o:p></o:p></span></div>
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<span lang="EN-GB">The video of the query from the CA member and the answer from Emily
Egan, SC (first) and Ms Justice Laffoy (second – as paraphrased above) can be
viewed at this link, at 02:43 mins: <span style="color: windowtext; text-decoration: none; text-underline: none;"><a href="https://l.facebook.com/l.php?u=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DhEknurI2FH0&h=ATNV5Bkho50-sp3v-szENK5mVJ5pskfS7f8ZCKkDguzUdmGZwKUFpbpYLZBByeiUeb2DuNxl08cHL8XAvkAuzjKQ0cpL0YT_NlmegVp0W3_noA_PwkPN0BKxLJ7EARhc6mw0Ykh8G96r0vR9sl8&enc=AZMYY1R_i1B5at9aE_f0kop6Me4kW-_Zrqv6SjqrUGgYy-WxJS7Tx8KDmSlPhRxsX9IbaZei3icget2a6LD96FshcUVovBDE38W2ylY6-dDstgRlhigGyYFOS2U6uiojdKYiV3XNrKe0aSrfBS5Avr71yFgMC-K3PkOe2uoI2vACFg&s=1" target="_blank">https://www.youtube.com/watch?v=hEknurI2FH0</a></span></span> </div>
<h2 style="line-height: 150%; text-align: justify;">
<b><span lang="EN-GB" style="color: #385623; font-family: "calibri" , "sans-serif"; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: minor-latin; mso-themecolor: accent6; mso-themeshade: 128;">Overview</span></b><span lang="EN-GB" style="font-family: "calibri" , "sans-serif"; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: minor-latin;"><o:p></o:p></span></h2>
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The 8th Amendment hangs like a spectre over reproductive rights in
Ireland. Reproductive rights, maternal health, and the provision of maternity
services, are inherently interlinked. As a nation, our reporting and collection
of data is patchy. We do not have standardised care. Guidelines created to reflect
best clinical practice are not implemented at local level and individual maternity
units are under no obligation to do so. We barely have accurate, specific, and
detailed data on birth and interventions, and we have no data collected on
perinatal mental health. Regional variations in practice significantly affect
rates of interventions, near misses, and adverse outcomes. As a result,
it is impossible to have an accurate grasp of the scope that the 8th Amendment has
in the maternity services.</div>
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<span lang="EN-GB">The Citizens’ Assembly requested data and facts on how the 8th
Amendment has a direct legal impact on maternity care. For the foregoing
reasons, the only way to access this impact is to listen to, to hear, and to trust
the testimonies of women who have been personally affected in their pregnancies
and births. We must also listen to and hear the medical professionals when they
tell us that they do not feel protected in law to support a woman’s decisions.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span lang="EN-GB">No one records in medical notes when they use the 8th Amendment, as
outlined in §7.7.1 of the National Consent Policy, to justify a procedure or
intervention. In the handful of legal cases where the 8th Amendment and refusal
of consent were pleaded in High Court proceedings, and where the issue is
addressed at judgment, the jurisprudence is frequently vague on the 8th and the
legal implications it has on maternity services. The 8th Amendment itself is
ambiguous and that is exactly the concern which was argued by legal experts in
1983. It is was legally ambiguous then and it is still legally ambiguous today.</span> </div>
<h2 style="line-height: 150%; text-align: justify;">
<b><span lang="EN-GB" style="color: #385623; font-family: "calibri" , "sans-serif"; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: minor-latin; mso-themecolor: accent6; mso-themeshade: 128;">The National Consent Policy, the 8th Amendment, and Continued Pregnancy
and Childbirth</span></b></h2>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span lang="EN-GB">The right to informed decision making – both the giving of consent
and the refusal of it – in in one’s health care is recognised and protected in
Irish policy, law, and the Constitution. Informed consent is a cornerstone of
medical ethical standards, as well as a key principal of bodily integrity.
However, the National Consent Policy directly recognises and cites the 8th Amendment
to the Constitution as a barrier to informed consent in continued pregnancy and
childbirth, recommending the High Court as the appropriate arbiter where a
woman’s decisions in continued pregnancy go against the recommendations of a
health care provider.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span lang="EN-GB">Every individual in Ireland has the right to bodily autonomy, to be
the main decision maker in their health care, to control their own life, and to
decide what happens to their own body. This includes making informed decisions
– to consent to or to refuse treatment – which will have an impact on their
current health, as well as any short or long-term consequences for the
individual to consider. Health care providers are expected to present all the
information pertaining to the procedure in layman's terms (the benefits, risks,
and any future implications) in order to provide guidance to informed decision
making; however, the decision is ultimately that of the individual. Finally,
for consent to be valid, it must be also be voluntary, meaning that it is given
without the application of duress or coercion (whether that be by way of
threats or intimidation) from health care providers or external agents. These
central principles are outlined in §1 of the National Consent Policy:<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-left: 36.0pt; text-align: justify;">
<span lang="EN-GB">Consent is the giving of permission or agreement for an
intervention, receipt or use of a service or participation in research
following a process of communication about the proposed intervention. Consent
must be obtained before starting treatment or investigation, or providing
personal or social care for a service user or involving a service user in
teaching and research (all defined as ‘interventions’ for the purpose of this
policy). This requirement is consistent with fundamental ethical principles, with
good practice in communication and decision‐making and with national health and
social care policy. The need for consent is also recognised in Irish and
international law. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span lang="EN-GB">Furthermore, § 1.4 states that “Other than in exceptional
circumstances, it is important to note that treating service users without
their consent is a violation of their legal and constitutional rights.”<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span lang="EN-GB">The right to refuse consent to a proposed treatment is dealt with in
§ 7. The Policy states at § 7.7 that “If an adult with capacity to make an
informed decision makes a voluntary and appropriately informed decision to
refuse treatment or service, this decision must be respected, even where the
service user's decision may result in his or her death.” However, the Policy is
forced, because of the operation of the 8th Amendment, to dedicate an entire
section - § 7.7.1 – to the limitations on the rights of pregnant people around
consent to treatment. The constitutional constraints of Article 40.3.3° mean
that equal rights must be given to the pregnant person and to the unborn. In
other words, informed decision making ability in pregnancy – the right for
individuals to make the best decisions for them and their baby in their
specific circumstances in pregnancy and childbirth – has been removed.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span lang="EN-GB">The operation in practice of § 7.7.1 of the National Consent Policy
is as ambiguous as Article 40.3.3 itself. § 7.7.1 cites risk as the yardstick
by which the decision to overrule a woman’s refusal to consent to treatment is
to be measured, but it fails to define risk or what constitutes risk or ‘risk
to life’ of the unborn. This leaves interpretation open to opinion and bias,
and leaves pregnant people and health care providers in an unacceptable state
of limbo. The definition of risk within the Policy is subjective, and the
assessment of risk and whether it is significant enough to justify overruling a
refusal of consent requires a health care provider to balance the probability
of harm to the unborn against the risk of harm to or the burden placed on the
woman by the refused treatment. No guidance is given as to how the threshold
between a risk to health and a risk to life is to assessed, and there is no
recognition of the practical reality that there are in fact no absolute
guarantees in childbirth.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span lang="EN-GB">In practice the use of ‘risk’ by health care providers is often
cited as an indication to over-ride the right to informed decision making
(consent/refusal) in pregnancy, labour, and childbirth. The National Consent
Policy of Ireland addresses the issue of risk in § 3.3:<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-left: 36.0pt; text-align: justify;">
<span lang="EN-GB">Information about risk should be given in a balanced way. Service
users may understand information about risk differently from those providing
health and social care. This is particularly true when using descriptive terms
such as 'often' or 'uncommon'. Potential biases related to how risks are
'framed' are important; a 1 in a thousand risk to complication also means that
999 out of a thousand service users will not experience that complication.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span lang="EN-GB">AIMS Ireland have documented significant accounts of women reporting
the use of ‘risk’ coupled with the National Consent Policy as a barrier to
informed decision making. ‘Risk’ is often based on the perception of individual
health care providers and without supportive evidence. Pregnant women are often
told of the risks they are exposed to in refusal of medical recommendations,
but often they do not receive explanations of the risk factors inherent in
having the procedure, test, or treatment. Many routine practices in Irish
maternity units which are recommended by health care providers carry risk
factors and do not follow evidence based practice recommendations.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span lang="EN-GB">There are no absolute risks in childbirth and each care option poses
specific, individual risk potential. Truly informed choice occurs where a woman
receives the information that enables them to understand the benefits and risks
of each care option, so that she can then select the care option that she feels
most comfortable with.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span lang="EN-GB">Furthermore, the National Consent Policy suggests that the 8th Amendment
impacts only on refusals of consent to treatment, and not on the giving of
consent to treatment. Such a position is nonsensical. Refusal of a medical
procedure is not separate to, but is an equal facet of the principles
encompassing consent. One cannot consent while being unable to refuse. If a
person’s ability to refuse consent is constrained then so is their ability to
give consent. Consent given in the absence of an ability to refuse is not truly
free and voluntary. For consent to be valid by legal definition, it must be
voluntary, provided freely, without duress (<i>Fitzpatrick
& Anor v K & Anor</i> [2008] IEHC 104).<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span lang="EN-GB">The ambiguity of the National Consent Policy is further compounded
in its failure to provide scope for clarification on exactly when and how the
High Court may be considered the appropriate pathway for assessing the validity
of a woman’s decision to decline a medical recommendation.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span lang="EN-GB">In our ten years’ experience supporting women accessing maternity
care in Ireland, AIMS Ireland has seen patterns emerge in reports of regions’,
units’, and even individual health care providers’ use of coercion to achieve
women’s compliance with a proposed treatment. Certain maternity units, and even
individual health care providers, are named with more frequency than others by
women who appeal to AIMS Ireland for help when they feel they are being coerced
into accepting a particular proposed treatment or procedure. This coercion
takes various forms, from the use of threatening language including the threat of
the mother being found responsible for harm coming to the unborn child; to
threats of the involvement of child protective services; threats of High Court
litigation; and the involvement of legal teams. AIMS Ireland’s support services
have assisted individuals who have been threatened with legal action and social
protective services in an attempt to coerce consent. The majority of these
threats are never carried out, as women are fearful of the implications and
comply under duress.</span> </div>
<h2 style="line-height: 150%; text-align: justify;">
<b><span lang="EN-GB" style="color: #385623; font-family: "calibri" , "sans-serif"; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: minor-latin; mso-themecolor: accent6; mso-themeshade: 128;">Differentiating between (a) Medical Negligence and (b) Consent Violations
that Occur as a Consequence of Constitutional Constraints</span></b></h2>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span lang="EN-GB">It is important to differentiate between the law of medical
negligence, the law of consent as it operates within the tort of assault, and
the question of the validity of a consent that is given under duress that has
been leveraged as a consequence of the operation in practice of the 8th
Amendment.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span lang="EN-GB">The law of medical negligence is comprised of four core principles:<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;">
</div>
<ol>
<li><span style="font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span><span lang="EN-GB" style="text-indent: -18pt;">A medical practitioner has a
duty of care towards a patient;</span></li>
<li><span lang="EN-GB" style="text-indent: -18pt;">A medical practitioner breaches
that duty of care by acting in a manner that falls below the expected standard
of their profession;</span></li>
<li><span lang="EN-GB" style="text-indent: -18pt;">This breach of the duty of care
must directly cause damage to the patient, which may be psychological or
physical in nature; and</span></li>
<li><span lang="EN-GB" style="text-indent: -18pt;">The damage suffered by the
patient must be the result of the breach of the duty of care (this is known as
the ‘causal connection’).</span></li>
</ol>
<!--[if !supportLists]--><br />
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span lang="EN-GB">The idea of consent is comprised of two complimentary facets: (1)
the ability to make a decision to have a particular test, treatment or
procedure; and (2) the ability to make a decision to decline a particular test,
treatment or procedure. Consent actions are often tied in with medical
negligence actions but are in fact a cause of action in their own right under
the tort of assault. It would not be unusual for a lawsuit that includes a
claim for assault that is based on a breach of the rules on informed consent to
also seek relief in the tort of negligence. One may succeed in the medical
negligence action in the case, and fail in the assault action. In its legal
incarnation, the doctrine of consent has three key components:<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l1 level1 lfo2; text-align: justify; text-indent: -18.0pt;">
</div>
<ol>
<li><span style="font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span><span lang="EN-GB" style="text-indent: -18pt;">The patient must have capacity
to give or to refuse consent – meaning they must have the ability, at the
moment the decision is being made, to understand the ‘nature, purpose and
effects’ of the proposed test, treatment or procedure;</span></li>
<li><span lang="EN-GB" style="text-indent: -18pt;">The patient’s decision must be
voluntary – meaning it must be given freely, in the absence of coercion or
duress; and</span></li>
<li><span style="font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span><span lang="EN-GB" style="text-indent: -18pt;">The patient must have received
appropriate information regarding the risks and benefits of the proposed test,
treatment or procedure (this is known as ‘full disclosure’).</span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span lang="EN-GB">Finally, to succeed in an assault action based on the absence of a
valid consent to the treatment administered, the plaintiff will also need to
establish (a) that she suffered damage and (b) that she would not have gone
ahead with the procedure if she had been advised properly of the risk which has
caused the damage. The fact that any litigation on consent will necessarily
involve drafting medical negligence pleadings does not negate the fact that the
culture around the provision of maternity care in this country is soaked from
beginning to end in an atmosphere of subtle coercion, and that culture arises
from the legal uncertainty health care providers have to work in due to the
ambiguity of their responsibilities and obligations to the foetus under the 8th
Amendment. These responsibilities are, because of the way the 8th is drafted,
in direct opposition to and in conflict with their responsibilities to the
pregnant woman.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span lang="EN-GB">AIMS Ireland have supported many women who report experiencing
assault on their bodies in the Irish maternity services. Often these assaults
take place when medical interventions are administered which do not follow best
practice evidence which carry independent risks of morbidity. It is our
experience that these women are advised, both when they seek legal advice and in
the making of complaints to the relevant professional regulatory bodies, that it
is the woman’s word against the medical professional, and that success is
unlikely. Women seeking to litigate assault cases founded on violations of
consent in pregnancy and childbirth are generally counselled against taking proceedings.
A woman’s body being violated is often not enough to build a successful legal
case where there is no loss of life or long-term implications on health. The
presumption of a risk to the unborn having operated as a medical indicator to
justify the intervention is always present and overrides the woman’s refusal.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span lang="EN-GB">Medical records rarely self-implicate. Medical professionals do not
record consent violations implicating themselves, their colleagues, and their
place of work. This means both that an assault action based on a breach of the
doctrine of informed consent is notoriously difficult to successfully litigate,
but also that there simply does not exist data in medical records illuminating
the use of the 8th Amendment in this manner.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span lang="EN-GB">The case of <i>Hamilton v HSE</i>
[2014] IEHC 393 was an assault case founded on the principle of informed
consent, which also contained a consequence action of medical negligence. Ciara
Hamilton took legal action against the HSE on the basis of an invasive medical
intervention which she argued was performed without her consent. This
intervention contributed to long-term health issues for her baby. The High Court
found against her, stating in the judgment that it did not believe a woman
would deny a medical intervention recommended by a health care professional. As
the consent argument had failed, the consequence medical negligence action then
also failed and a costs order was made against Ms Hamilton.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span lang="EN-GB">In Ireland informed choice for women on ‘how, where and with whom’
they want to give birth is also prohibited by the HSE’s structure of maternity
services provision. For many women the only care option available to them – for
geographic, financial, and HSE policy reasons – is hospital care. Hospital care
in Ireland is obstetric led in practice and policy and includes many routine
interventions which increase distress to babies in labour and increase the risk
of adverse affects for women – in the form of intervention, assisted delivery,
or caesarean section. When a practice is said to be ‘routine’ this means that
the practice or procedure is done as a normal practice on every pregnant
person, not down to medical necessity or evidence, but hospital policy. Other
practices may not be routine for every woman, but are frequent in use despite
risks. For example recent research by the American College of Obstetrics &
Gynecology has shown the use of oxytocin, for induction of labour or to 'speed
up' labour, is an independent risk to babies and increases NICU admission. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span lang="EN-GB">Furthermore, best practice clearly states that patients should be
assessed on an individual basis on their current health and current medical
conditions, as well as their previous history. The HSE in maternity care does
not provide women with individual assessment, which is a fundamental principle
in evidence-based care. Women in Ireland are given extremely restricted choice
around their birth options as the perceived risks to the baby are considered
more important than women having control over how they give birth.</span> </div>
<h2 style="line-height: 150%; text-align: justify;">
<b><span lang="EN-GB" style="color: #385623; font-family: "calibri" , "sans-serif"; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: minor-latin; mso-themecolor: accent6; mso-themeshade: 128;">What Women Have Told Us<o:p></o:p></span></b></h2>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
In the 2014 AIMS Ireland survey, "What Matters to You?" we
looked specifically at the issue of consent. The WMTY survey had nearly 3,000
respondents who were self selecting. Our findings illustrated that informed
consent and refusal remain an issue of grave concern to women accessing the
Irish maternity services, with only 50% of individuals being provided with the
necessary information to assist them in informed decision making. The
qualitative data, comments from individuals, provide us with very worrying
information as many commented that consent was either implied as the procedure
was being carried out (e.g. a health care practitioner informing a woman “we
are just going to break your waters now” as rupture of membranes was being
performed); or that they felt coerced by hospital policy or a perceived risk to
their baby; or influenced by care providers’ opinion that was not based on
evidence; or that they were not provided with the information necessary to make
decisions for themselves and their baby. Some respondents felt that while they
consented, they did not have any choice in doing so.</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span lang="EN-GB">This is a selection of the comments received from women who
responded to the WMTY survey:<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-left: 36.0pt; text-align: justify;">
<span lang="EN-GB">“At every intervention I was threatened with catastrophic consequences
if I refused such as ‘if you don’t have an episiotomy right now the baby won’t
make it’…’if you don’t take antibiotics the baby might have cerebral palsy’”<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-left: 36.0pt; text-align: justify;">
<span lang="EN-GB">“I was told I had no choice when it came to my treatment, everything
was ‘hospital policy’”<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-left: 36.0pt; text-align: justify;">
<span lang="EN-GB">“Benefits of procedures to hurry Labour up were told, risks of these
procedures were not told. Benefits of waiting were never once told.”<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-left: 36.0pt; text-align: justify;">
<span lang="EN-GB">“The tests they did were as far as I was told compulsory and results
were just told to me and options were not discussed it was there way is best.
When we questioned it we were told we were putting our babies life in danger.”<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-left: 36.0pt; text-align: justify;">
<span lang="EN-GB">“At every intervention I was threatened with catostrophic
consequences if I refused such as ‘if you don’t have an episiotomy right now
the baby won’t make it’… ‘if you don’t take the antibiotics the baby might have
cerebral palsy”<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-left: 36.0pt; text-align: justify;">
<span lang="EN-GB">“I was given an episiotomy without being asked. I wasn’t even
informed that the consultant was going to do one it was just done”<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-left: 36.0pt; text-align: justify;">
<span lang="EN-GB">“They broke my waters without consent. I was told by the consultant
that she did not need my permission to break my waters.”<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-left: 36.0pt; text-align: justify;">
<span lang="EN-GB">“Nothing was done without my ‘consent’ but is it consent when you
are bullied into it… as how do you get round the ‘put the baby at risk’ card
even if you know that what you are asking is in line with best practice?”<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-left: 36.0pt; text-align: justify;">
<span lang="EN-GB">“The following procedures were performed on me without explanation
or my consent being sought: ARM, pushing back a cervical lip, a CTG machine was
applied to me and when I asked for it to be removed this was refused. My
attempts to remove it myself were prevented. I was physically restrained in a
position I was not comfortable in (flat on my back) and verbally abused when I
did not engage in purple pushing”<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span lang="EN-GB">The results from the WMTY survey to date are available on the AIMS
Ireland website at the following link: <span style="color: windowtext; text-decoration: none; text-underline: none;"><a href="http://aimsireland.ie/what-matters-to-you-survey-2015/">http://aimsireland.ie/what-matters-to-you-survey-2015/</a></span></span> </div>
<h2 style="line-height: 150%; text-align: justify;">
<b><span lang="EN-GB" style="color: #385623; font-family: "calibri" , "sans-serif"; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: minor-latin; mso-themecolor: accent6; mso-themeshade: 128;">Conclusion</span></b></h2>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span lang="EN-GB">AIMS Ireland strongly campaigns for recognition of informed choice
in maternity care. The decisions we, as pregnant women, as people, make in
pregnancy, labour, and birth have serious consequences; for the pregnant
individual, for their baby in both short and long-term health and quality of
life, and for future pregnancies and births. It is their body; their pregnancy;
their baby; their birth. The pregnant person is the best expert on them; their
baby; and their circumstances. Only they know what they are feeling and what is
important to them. They must be the ones making decisions which will affect
them and their baby. They must live with and be happy in the decisions they
make. They should be the one to decide 'how', 'where' and 'with whom' they give
birth. They should not be asked to give these important decisions away. Medical
experts can guide, assist with informed decision making, but they cannot and
should not make decisions on the behalf of a pregnant individual. However the
8th Amendment is often used as a method of coercion by the HSE and individual
health care providers to obtain consent through coercion.<o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-GB">AIMS Ireland supports pregnant women and other pregnant people. From
pre-conception to parenthood, we support a person’s right to informed decision
making and freedom to informed consent/refusal as is outlined and protected to
all other non-pregnant people in Ireland. The 8th Amendment acts as a legal
barrier to informed decision making in pregnancy, labour, and childbirth and is
directly cited within HSE policy as a constraint on the ability of individuals
to invoke this right. The 8th Amendment must be repealed to ensure human rights
are ensured in pregnancy.</span> </div>
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<b><span lang="EN-GB" style="color: #385623; font-family: "calibri" , "sans-serif"; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: minor-latin; mso-themecolor: accent6; mso-themeshade: 128;">About AIMS Ireland</span></b></h2>
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<span lang="EN-GB">AIMS Ireland (Association for Improvements in the Maternity Services
Ireland) is a voluntary organisation with charity status which was formed in
2007 by women who saw a need for a consumer driven organisation to support
pregnant people's human right to informed decision making in all aspects of
health; from pre-conception to parenthood and to push for the full
implementation of maternity care standards reflecting evidence based best
practice across Ireland. It is a consumer led, campaign pressure group operating
with a self-regulating committee elect and a body of members. AIMS Ireland
members in 2013 unanimously passed a motion to support Repeal of the 8th
Amendment and in 2016 to adopt the position of supporting access to free, safe,
and legal abortion services in order to support pregnant people in their right
to informed choice in their unique and specific circumstances.<o:p></o:p></span><br />
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Anonymoushttp://www.blogger.com/profile/15102063693461334158noreply@blogger.com2tag:blogger.com,1999:blog-9022711156100944101.post-34966176021978959942017-02-21T22:59:00.004+00:002017-02-21T23:00:55.289+00:00 AIMSI Statement - Citizens' Assembly Invitations to Present: 22nd February 2017<h2 style="background-color: white; color: #1d2129; font-family: Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; text-align: center;">
<b><br /></b><b>AIMSI Statement - Citizens' Assembly Invitations to Present: 22nd February 2017</b></h2>
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Aims Ireland were very disappointed that we were not asked to present on the topic of maternity care to the Citizens Assembly</div>
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AIMSI made a detailed submission to the Citizens' Assembly on the ramifications of the 8th Amendment on continued pregnancy and childbirth.</div>
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As an organisation who has campaigned a decade on this issue, conducted research, and supported many pregnant women/people directly affected, we are disappointed that our extensive experience of the ramifactions of the 8th amendment on maternity care, maternity services and maternity users will not be heard.</div>
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AIMS<span class="text_exposed_show" style="display: inline;">I was asked to make a submission to the Joint Oireachtas Committee in January 2013 (public submission on the Expert Group Report on A,B,C v Ireland - it is published on the Oireachtas website) and made a submission in May of 2013 on the Heads of PLDP Bill.</span></div>
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The ramifications of the 8th Amendment on abortion and the maternity continuum are inherently interlinked. The HSE directly citing the 8th as a barrier to consent once a woman/person becomes pregnant, effectively ensuring that every pregnancy in Ireland is potentially affected. We feel this is a key and overlooked aspect in discussions surrounding repeal of the 8th.</div>
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The many thousands of women/people we have supported and continue to support will also share our disappointment.</div>
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Speaking earlier today AIMSI Chair Krysia Lynch said "Any maternity service wrorth its salt in the 21st Century would not export women for routine health care procedures to another country, or leave them to self care without professional medical support in their own country. Any maternity service worth its salt would not have to enshrine a consent policy which effectively denies every woman and pregnant person in Ireland the final say in what happens to their body. These issues affect women, pregnant people and their families in continued pregnancy every day in Ireland, We estimate approximately 103,000 users of the maternity services are affected every year."</div>
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ENDS</div>
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Anonymoushttp://www.blogger.com/profile/15102063693461334158noreply@blogger.com1tag:blogger.com,1999:blog-9022711156100944101.post-23510959123280399162016-12-02T12:03:00.000+00:002016-12-02T12:09:05.046+00:00Additional Information regarding Fact Check: Ireland's safety record on maternal health<span style="font-size: large;">AIMS Ireland were contacted with regards to the Journal.ie Factcheck on a leaflet used by anti-choice campaigners highlighting an excellent record of safety in Irish maternity services. </span><br />
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<span style="font-size: large;">The Factcheck can be read here: </span><a href="http://www.thejournal.ie/yes-to-life-life-institute-8th-amendment-abortion-leaflet-facts-3058066-Nov2016/" target="_blank"><span style="font-size: large;">http://www.thejournal.ie/yes-to-life-life-institute-8th-amendment-abortion-leaflet-facts-3058066-Nov2016/</span></a><br />
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<span style="font-size: large;">AIMS Ireland had a brief exchange with Factcheck over twitter and requested to discuss further offline. Several days following the initial discussion, AIMS Ireland then privately sent in information which we feel is vitally important to assist in interpreting statistics provided by Factcheck as well as additional factors relevant in the discussion of the issue of safety.</span><br />
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<span style="font-size: large;">We have not had a response from Factcheck (2 weeks) so are publishing the additional information provided to Factcheck into the public domain.</span><br />
<span style="font-size: large;"></span><br />
<span style="font-size: large;">AIMS Ireland have been campaigning for improvements in the Irish maternity services, including the implementation of evidence based care practices and basic rights to informed consent, as well as providing advocacy to thousands of women and other pregnant people since 2007. This issue continuously arises in support services, as well as academic circles and between care providers.</span> <br />
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Hi Dan,<br /><br />Thank you for the offer to engage with us following our brief Twitter chat. Apologies for the delay in getting back to you - we are a wholly voluntary-run organisation with no funding and thus no full-time staff. <br /><br />AIMS Ireland is a maternity rights organisation which also provides advocacy to women within the continuum of maternity services.<br /><br />With regards to the Factcheck on Ireland being one of the safest places to have a baby, we have some points that we feel would help clarify. We have been contacted by individuals confused and upset by the Factcheck, as presented.<br /><br />With regards to WHO data, we feel it is relevant for the following to be quantified in order to assist in people’s understanding of the data.<br /><br /><br />Ireland is ranked joint 6th in WHO data.<br /><br />This ranking is made up of a 31 year average<br />Joint 6th does not mean that we are 6th in the world – there are 26 Countries whom have MMRs lower than Ireland. Ireland at 8 per 100,000 shares this rate with Croatia, France and FYR Macedonia. However the following 26 Countries have rates lower.<br /><br />Australia 6 Germany 6 Norway 5<br /><br />Austria 4 Greece 3 Poland 3<br /><br />Belarus 4 Iceland 3 Slovakia 6<br /><br />Belgium 7 Italy 4 Spain 5<br /><br />Canada 7 Japan 5 Sweden 4<br /><br />Cyprus 7 Israel 5 Switzerland 5<br /><br />Czech Rep 4 Kuwait 4 United Arab Emirates 6<br /><br />Denmark 6 Montenegro 7<br /><br />Finland 3 Netherlands 7<br /><br /><br />WHO statistics are global, which is problematic as it does not compare like with like; Western Countries (with access to basic hygiene, nutrition, antenatal care, technology, well trained health care providers, maternity units, etc) to Countries without the very basic of care.<br />
<br />Comparatively, looking at EU States, we rank 16th of 28 with the UK (9), Bulgaria (11), Estonia (9), Hungary (17), Latvia (18), Luxemborg (10) Malta (9) and Portugal (10) with higher rates.<br />
<br />For Western nations, with the availability of factors mentioned above, many (including AIMS Ireland) are of the opinion that maternal mortality alone should not be the sole indicator for measuring the safety and quality of our maternity services. Women have reacted strongly on this point, sharing stories of poor quality of care void of basic safety procedures. AIMS Ireland strongly recommends that any discussion of safety and quality must include morbidities; physical and psychological to mother and baby.<br /><br />Maternal Morbidities MAMMI Study Ireland 2016<br /><br />1/7 women in Ireland who die, die from suicide<br />¼ of maternal deaths have mental health issues and the State is not addressing this. There are 3 perinatal psychiatrists, all in Dublin, for the entire Irish population. Ireland also has no Mother-Baby units.<br />Ireland has the highest rates of postnatal depression in the OECD<br />4/10 women who give birth in Ireland are readmitted to hospital for their own health.<br />10% of maternal deaths in Ireland are due to maternal haemorrhage <br />Major Obstetric Haemorrhage (MOH) has increased from 1.5% to 4.1% in Ireland from 2001-2011<br />24% of MOH in Ireland are admitted to the UCU (near misses)<br />11.2% of MOH have hysterectomy<br />The National rate of MOH is 2.6 per 1000<br />Almost 2/3 of women report sexual health problems post birth. 1 in 5 women reported painful sex a year following birth.<br />Anal incontinence 12% of women who gave birth in Ireland<br /><br /><br />Also worthy of mention, the HSE directly cites the 8th Amendment in the National Consent Policy as a barrier to consent in continued pregnancy and childbirth. Informed consent/refusal is the cornerstone of medical ethics and evidenced best practice. A health system void of this most basic but core value is incapable of being considered in highest ranking.<br /><br />While AIMS Ireland understands that the Factcheck was in relation to accessibility to abortion, all care within the maternity continuum are inherently linked and should be inclusive of the full data.<br /><br />Regards,<br /><br />Jene and Sinéad<br />
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<span style="font-size: large;">** In addition, AIMS Ireland would like to reiterate that Ireland's ranking in WHO documentation is based on a <u>31 year average.</u> However, Ireland has only participated in the Maternal Death Enqiry (MDE Ireland) surveilance system since 2009. Disparities between MDE statistics and methods of classification/collection of these statistics prior to 2009 (under-reporting in CSO figures) are widely disucssed and it should be noted that our statistical ranking from a 31 year average is based on recognised classification definitions <u>only since 2009</u>. Further, MDE Ireland's recent report continues to highlight challenges within the Irish system, particularly through regional units and coroner's reports, which contribute to under-reporting of maternal deaths in ireland.</span> <br />
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Additional information on MDE Ireland ia available to read here: <a href="https://www.ucc.ie/en/mde/about/" target="_blank">https://www.ucc.ie/en/mde/about/</a><br />
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<br />Anonymoushttp://www.blogger.com/profile/05874066401296452492noreply@blogger.com78tag:blogger.com,1999:blog-9022711156100944101.post-53281265722508304102016-12-02T11:25:00.003+00:002016-12-02T11:25:44.339+00:00AIMS Ireland Statement on the publication of Judge Maureen Harding-Clark’s report into the Surgical Symphysiotomy Ex Gratia Payment Scheme and media commentary on the same.AIMS Ireland Statement on the publication of Judge Maureen Harding-Clark’s report into the Surgical Symphysiotomy Ex Gratia Payment Scheme and media commentary on the same.<br />
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The Association for Improvements in the Maternity Services (AIMS) Ireland is outraged at the suggestion that the survivors of symphysiotomy have exaggerated, or been in some way dishonest, in their claims in what has been a long and difficult struggle for them, in the pursuit of justice.<br />
<span style="font-weight: 400;">We at AIMS Ireland know that women are very slow to expose themselves to legal proceedings, especially when they have been traumatised in the past. The fact of the matter here is that medical records are missing.</span><br />
<span style="font-weight: 400;"></span><br />
<span style="font-weight: 400;">We are very disappointed that Judge Maureen Harding-Clark has made completely unfounded accusations of dishonesty against elderly women and their supporters, based on a lack of documentation and records. At the same time, she fails to hold the hospitals and medics responsible for not keeping that documentation, as is their responsibility.</span><br />
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<span style="font-weight: 400;">The claim that a woman’s medical record could prove or disprove that a procedure had taken place is laughable. Medical record keeping of the time was minimal to say the least. Many women’s medical records for a birth consist of a few lines, hardly comprehensive proof. All medical records prove is that a midwife or obstetrician wrote something once upon a time on a chart. Whether this is an accurate reflection of events is another story entirely. It is not uncommon to see issues with medical record keeping to this day.</span><br />
<span style="font-weight: 400;"></span><br />
<span style="font-weight: 400;">Further, AIMS Ireland is at a loss to understand why, in an era where women not only had no access to abortion, but also had no access to contraception as well as no legal right to not be raped within marriage, women who had further pregnancies after symphysiotomy are deemed by the judge to not have been traumatised by the symphysiotomy. Women of the time had no say over whether they became pregnant or not regardless of their state of health and wellbeing, and as of course is still the case, they had no say over whether they remained pregnant or not. Becoming pregnant was not something a woman had any say whatsoever in. </span><br />
<span style="font-weight: 400;"></span><span style="font-weight: 400;"><br /></span><span style="font-weight: 400;">This report is a further violation of those women, who are and were entitled, in their latter years, to expect more of a state that claims, with little evidence, to be more enlightened.</span><br />
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<span style="font-weight: 400;">Women who have experienced mistreatment know that it has happened. They are neither hysterical nor litigious as suggested by those who should know better. It is beyond belief, that those practicing medicine in today’s world, would turn to the ancient argument of the hysterical woman.</span><br />
<span style="font-weight: 400;"></span><br />
<span style="font-weight: 400;">The biggest issue for AIMS Ireland today, is the establishment’s complete failure to hold a mirror to its practices both past and present. It demonstrates to women today how little value is placed in their well-being. It further illustrates that ‘the professionals’ in this country have rights over women’s bodies which would not be given in other jurisdictions. </span><br />
<span style="font-weight: 400;"></span><br />
<span style="font-weight: 400;">In media commentary this week, the point has been made that symphysiotomy is still used in poorer countries where alternatives are lacking. The key point here is “where alternatives are lacking”. This was not the case in Irish hospitals in 1965, with access to trained surgeons, surgical theatres and antibiotics.</span><br />
<span style="font-weight: 400;"></span><br />
<span style="font-weight: 400;">There is no valid reason for the fact that though symphysiotomy was dropped and even banned as a procedure in other Western countries, it </span><span style="font-weight: 400;"> continued to be used in Ireland as late as the 1980’s, no matter how frequent its use was. </span><span style="font-weight: 400;">Points have also been made regarding the life-saving potential of symphysiotomy in specific situations. No one is questioning that. We are questioning the medical need to perform these procedures in Irish hospitals in the years in question, when evidence showed a caesarean section was a viable alternative. </span><br />
<span style="font-weight: 400;"></span><br />
<span style="font-weight: 400;">We at AIMS Ireland find it appalling that women’s experiences, trauma and injuries at the hands of what was a highly patriarchal and religious-led maternity care system, could be so lightly dismissed, and their suffering labelled as in some way “normal”.</span><span style="font-weight: 400;"><br /></span><span style="font-weight: 400;"><br /></span><span style="font-weight: 400;">Women should not be suffering either emotionally or physically after childbirth in Ireland. </span><br />
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<span style="font-weight: 400;">#ENDS</span>Anonymoushttp://www.blogger.com/profile/05874066401296452492noreply@blogger.com1tag:blogger.com,1999:blog-9022711156100944101.post-35148934941238143242016-11-08T08:51:00.000+00:002016-11-08T08:51:31.164+00:00<div style="-webkit-text-size-adjust: auto; font-family: Arial; font-size: 11pt; orphans: 2; padding: 0px; text-align: center; widows: 2;">
<span style="font-weight: 700;">Statement from AIMSI on the publication of the MAMMI STUDY </span></div>
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<span style="font-style: italic; font-weight: 700;">Dublin, Tuesday November 8th 2016</span></div>
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The Association for Improvements in the Maternity Services in Ireland (AIMSI) welcomes today’s publication of the MAMMI <span style="background-color: white; color: #1d2129; font-size: 10.5pt;">(Maternal health And Maternal Morbidity in Ireland)</span> study. AIMSI is keen to point out, however, that up until this point, the safety of the Irish maternity system has been measured purely by maternal mortality, which according to AIMSI Chair Krysia Lynch is “crude and uninformative”.</div>
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The study findings show alarming prevalence of life changing health issues - issues that make everyday life hugely challenging for Ireland’s mothers. AIMSI is also concerned by the under-reporting of such issues illustrated in the findings, for example 70% of women reporting pelvic pain in pregnancy, but only 5.8% documented as having such issues in hospital records.</div>
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Speaking in Dublin following the publication of the study, AIMSI Chair, Krysia Lynch said, “Women enter our maternity services every day feeling well and leave feeling unwell with morbidities that are rarely discussed; pelvic floor problems, mental health problems, incontinence, scar breakdown and infection. Women need to be aware of these risks and how to minimise them. The only way to do this is for women to be able to access high quality evidenced based information such as this study illustrates.”</div>
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"Women need to know that certain settings and care providers have greater associations with certain morbidities” she added, “a fact which is rarely discussed in Ireland. In particular, given our soaring birth by caesarian rate, women need to be aware that birth by c-section carries morbidities for both mother and baby and women should factor them into any choices made about their birth setting, care provider and mode of birth".</div>
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AIMSI also notes commentary that suggests women are not reporting or discussing health issues because of inexperience, embarrassment and fear. The Association would prefer if society could stop blaming women asks if we should be asking our health professionals if they are listening instead.</div>
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Anonymoushttp://www.blogger.com/profile/05874066401296452492noreply@blogger.com1tag:blogger.com,1999:blog-9022711156100944101.post-88171252523932457092016-11-04T14:59:00.000+00:002016-11-04T15:12:50.386+00:00AIMS Ireland: Maternity Care based on medical best practice, NOT Constitutional Amendment.<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEizfKxosJ_Le_Inz4kVOwyTMDZA6WSNkmyfhRZsBLmp28jiW0_kxKxc3dZPekQSHeAM_jLkK8AdYJEvD8bQGvSP0-dABmfSS5iflvpdn_PtWwstKaOzADdEoZCnW_1QEvAihJCWFIrJvfI/s1600/maternity.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><em><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEizfKxosJ_Le_Inz4kVOwyTMDZA6WSNkmyfhRZsBLmp28jiW0_kxKxc3dZPekQSHeAM_jLkK8AdYJEvD8bQGvSP0-dABmfSS5iflvpdn_PtWwstKaOzADdEoZCnW_1QEvAihJCWFIrJvfI/s320/maternity.jpg" width="240" /></em></a></td></tr>
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<strong><span style="font-size: large;">Maternity</span></strong> : <strong><span class="dbox-pg">adjective, </span> </strong></div>
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<strong>"of, relating to, or for the period in which a woman is pregnant or has just given birth to a child."</strong> </div>
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<strong>What is Maternity Care?</strong> </div>
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Maternity Care covers a wide base of health services to women and other pregnant people, responding to the needs of various eventualities in the Maternity Continuum which may occur from the moment a woman becomes pregnant, to birth and the postnatal period. This definition covers a wide range of services, including abortion. As a campaign and support organisation, AIMS Ireland further extends this definition to include women planning a pregnancy, (pregnancy prevention, fertility services, etc,) and we also supports women whom contact us years (sometimes decades) after a traumatic birth. </div>
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AIMS Ireland campaigns for the implementation of evidence based best medical practice. Any discussion on evidence based best practice cannot be had without the inclusion of bodily integrity, autonomy, informed decision making. Whatever your terminology of preference, this issue, the right to informed consent / informed refusal, is the very cornerstone of medical ethics and best care practice in all realms of health. This right is eroded in Ireland in maternal health; reproduction, abortion and in continued pregnancy, labour & childbirth due to the 8th Amendment of the Irish Constitution. A non-pregnant woman with full capacity is legally recognised to make decisions on her health care - the right to informed consent/refusal. However, the moment she becomes pregnant, her capacity is immediately diminished. <br />
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The State removes viable care options from her.<br />
The State owns her decisions and body. <br />
The HSE directly cites the Constitution as a barrier to consent in her health care should she decided to continue her pregnancy. </div>
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A health care system which fails to provide the full range of safe, accessible care options with scope for informed decision making is void of best care practice. Removal of choice is never best practice. As a Maternity Rights and Advocacy organisation, is futile to have a position on rights violations in continued pregnancy and birth under the 8th without also including abortion. And vice versa. The two are inherently linked as part of the maternity continuum and equally restricted by ramifications of the 8th Amendment.</div>
<div align="justify">
</div>
<div align="justify">
AIMS Ireland holds a position which supports full autonomy, to all women, in all aspects of her healthcare. As elected unanimously by our members. We support a position of maternal requested abortion and birthing autonomy. A maternity system based on full care options, medical best practice, and maternal autonomy. Not Constitutional Amendment.</div>
<div align="justify">
</div>
<div align="justify">
<strong>Maternal Requested: </strong><strong>What is it? Why does AIMS Ireland support it?</strong></div>
<div align="justify">
<strong></strong> </div>
<div align="justify">
AIMS Irleand supports every woman to make an informed decision on her healthcare in her personal circumstances. It is never about the choice, or if you would make it for yourself. Its about supporting a woman's right to weigh the risks, for and against, the options being presented to her in order to make the best decision for her, in her current personal circumstances, taking on board her medical history. There are no absolutes in maternity care, its about balancing risks and making a decision you feel safest in *at that moment* with scope to revisit the issue if medical indication arises.</div>
<div align="justify">
</div>
<div align="justify">
Maternal requested - the woman is the lead decisioin maker in HER healthcare based on HER personal circumstances. </div>
<div align="justify">
</div>
<div align="justify">
Maternal requested abortion.</div>
<div align="justify">
Maternal requested Caesarean.</div>
<div align="justify">
Maternal requested Homebirth.</div>
<div align="justify">
Maternal requested Foetal screening.</div>
<div align="justify">
Maternal Requested. </div>
<div align="justify">
</div>
<div align="justify">
AIMS Ireland work with pregnant women. We have supported thousands of women in the last decade. Women make good decisions. They are articulate, informed, and acutely aware of their circumstances and what they are capable of. To deny women agency over their decisions and body, to ask them to give their decisions away to strangers, is a gross violation of rights of half the Irish population. It also creates an unsafe medio-legal environment for service users and health care providers alike. The 8th Amendment fails to protect anyone, and in fact, actually creates more risk for all individuals within the maternity continuum. Women needing abortion. Women in happy healthy pregnancies, prevented from making decisions in pregnancy, labour and birth which they feel is best, safest, for themselves and their baby. Failure to provide a full continuum of services, failure to provide evidenced best practice.</div>
<div align="justify">
</div>
<div align="justify">
</div>
<div align="justify">
<strong>AIMSIreland believe all maternity services should be publicly funded </strong></div>
<div align="justify">
</div>
<div align="justify">
<span data-ft="{"tn":"K"}"><span class="UFICommentBody _1n4g">With all its many flaws, which are very serious and at times dangerous, one of the most positive aspects about the Irish maternity system is that it is free to all who enter its doors, whether resident here or visiting at any time, and that the midwives are highly trained to 4 yr degree standard. Healthcare should not be dependent on ability to pay nor should it differienciate duty to care by whom is worthy, or not, based on their personal circumstances, needs, choices, or medical history. Abortion should be a part of any evidenced safe maternity services in order to maintain a duty of care for all within the maternity continuum. The moment we begin selecting whom may or may not have duty to care, a medio-legal conflict is created with devastating direct consequences on the most vulnerable service users. As recent and past cases have shown. </span></span><br />
<br />
Shiela Hodges.<br />
Michelle Harte.<br />
Savita Halappanavar.<br />
Mother A.<br />
Ms Y.<br />
Mother B.<br />
</div>
<div align="justify">
<span data-ft="{"tn":"K"}"><span class="UFICommentBody _1n4g"></span></span> </div>
<div align="justify">
<span data-ft="{"tn":"K"}"><span class="UFICommentBody _1n4g"></span></span> </div>
<div align="justify">
<span data-ft="{"tn":"K"}"><span class="UFICommentBody _1n4g"><strong>Repealing the 8th and Maternity Care</strong></span></span></div>
<div align="justify">
</div>
<div align="justify">
</div>
<div align="justify" class="text_exposed_root text_exposed">
The 8th Amendment affects women's autonomy to birth. The HSE directly citing it as a barrier to consent in continued pregnancy and childbirth. AIMS Ireland have reiterated this issue since 2010, that the 8th Amendment has direct consequences on the rights of birthing women in Ireland. AIMS Ireland has supported many women whom have been threatened with High Court proceedings for their birth choices, most consent under duress of the threats, however recent court proceedings - HSE v Mother B - realises the extent of this issue to the public issues which we have witness for a decade.</div>
<div align="justify" class="text_exposed_root text_exposed">
</div>
<div align="justify" class="text_exposed_root text_exposed">
Repealing the 8th and replacing it with similar legislation which gives equal rights to the foetus in some instances will result in no changes for pregnant women/people in happily continued pregnancy. With shared rights a pregnant women/person is automatically considered of reduced capacity in the ability to make an informed decision, consent to, or decline care options and interventions in continued pregnancy, labour, and childbirth. </div>
<div align="justify" class="text_exposed_root text_exposed">
</div>
<div align="justify" class="text_exposed_root text_exposed">
The HSE directly cites the 8th as a barr<span class="text_exposed_show">ier to consent in continued pregnancy and childbirth. Further, The Capacity Act legislation outlines the importance of Advanced Health Care Directives, as being legally binding to ensure patient wishes, but outlines that these directives can be overruled in the case of pregnancy. </span></div>
<div align="justify" class="text_exposed_root text_exposed">
<span class="text_exposed_show"></span> </div>
<div align="justify" class="text_exposed_show">
Pregnant women/people should be the lead decision maker on their care - if, where, how, with whom they give birth. In no other realm of health is a person with full capacity's right to bodily autonomy diminished. </div>
<div align="justify" class="text_exposed_show">
</div>
<div align="justify" class="text_exposed_show">
Bodily autonomy is the cornerstone of medical ethics. Removal of this right in the instance of pregnancy is discrimination. Removal of choice is never best practice. </div>
<div align="justify" class="text_exposed_show">
</div>
<div align="justify" class="text_exposed_show">
The Repeal conversation must be opened to include continued pregnancy and the dangerous ramifications the 8th has on ALL aspects of maternity care in Ireland. The 8th Amendment effects EVERY pregnancy.</div>
</td></tr>
</tbody></table>
<div class="def-set">
</div>
<div align="left">
** Note: AIMS Ireland fully recognises that not all individuals who become pregnant identify themselves as women. We try to use inclusive language as much as possible. The use of "woman" is reflective of the majority of individuals seeking our support. However, we fully recognise that discussions surrounding maternity services and the 8th Amendment should be inclusive to all whom are affected.</div>
Anonymoushttp://www.blogger.com/profile/05874066401296452492noreply@blogger.com5tag:blogger.com,1999:blog-9022711156100944101.post-20588891678615106612016-11-03T11:53:00.000+00:002016-11-03T11:53:23.350+00:00What people are missing - HSE v Mother BThere has been a lot of commentary in the last 24 hours in regards to the HSE v Mother B case questioning the decision VBAC3; Why would a woman question medical advice and take this case to the High Court.<br />
<br />
What people are missing - it's not about the choice, or if you would make it for yourself. It's about supporting a woman's right to weigh risks for and against each care option and make the best decisions for her in her current circumstances taking on board her medical history. Informed choice. A cornerstone of medical ethics.<br />
<br />
The unit in question refused to engage with this woman and instead decided threatening her & taking her to court was the best option. And they were backed by our National Health Service under Constitutional personhood law.<br />
<br />
The foetus, like many other cases, had its own legal representation against it's mother.<br />
<br />
If we want to make it about "risk", if discussing the 3% chance of uterine rupture, we must discuss all the risks and that it's up to the woman to weigh them out. There are real and substantial risks in repeat Caesarean; most severe maternal morbidities in Ireland (the near misses) are involving repeat Caesarean section. There are no absolutes in maternity care, it's about balancing risk and making the decision you feel safest in *at that moment * with scope to revisit the issue if medical indication arises. As in this case. The woman requested a Caesarean when she no longer felt vbac was a safe option.<br />
<br />
Women are not stupid. Women do not take risks. They make good decisions for themselves and their baby. They need to be supported, not violated and threatened.<br />
<br />
<br />
<br />Anonymoushttp://www.blogger.com/profile/05874066401296452492noreply@blogger.com1tag:blogger.com,1999:blog-9022711156100944101.post-59469154972474437002016-11-02T19:44:00.000+00:002016-11-03T11:21:50.775+00:007 POINTS ON THE HIGH COURT’S REFUSAL TO FORCE A WOMAN TO UNDERGO A C-SECTION AGAINST HER WILL<div style="color: #333333; font-family: Georgia, "Times New Roman", "Bitstream Charter", Times, serif; font-size: 16px;">
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<span style="color: #444444; font-family: Verdana, sans-serif;">These points relate to the case of HSE vs B. The in-camera reporting of the case was lifted on 2nd November 2016, over a month after the original case was heard. The case relates to the HSE who took a heavily pregnant woman, Ms B to the High Court to seek an order for a forced sedation and c-section against the woman’s consent.</span></div>
<ol style="font-size: 14.4px; list-style: none; margin: 0px 0px 0px 20px; padding: 10px 0px;">
<li style="list-style-type: decimal; margin: 0px 0px 0px 20px; padding: 5px 0px;"><span style="color: #444444; font-family: Verdana, sans-serif;">This case is clear proof of what AIMS have been saying for years now; that the HSE coercively use the existence of the 8th amendment to the Irish Constitution against birthing women. The fact that they tried to prevent their defeat in this case being publicly reported is cause for ongoing concern about their continued desire to bring further cases of informed refusal to the High Court.</span></li>
<li style="list-style-type: decimal; margin: 0px 0px 0px 20px; padding: 5px 0px;"><span style="color: #444444; font-family: Verdana, sans-serif;">That this woman had the support and strength to go and vindicate her right to informed refusal in the High Court whilst heavily pregnant makes her very unusual. Ms. B deserves our very great thanks for publicising this practice by the HSE.</span></li>
<li style="list-style-type: decimal; margin: 0px 0px 0px 20px; padding: 5px 0px;"><span style="color: #444444; font-family: Verdana, sans-serif;">Whilst a case with a formal judgement such as this is unusual, AIMS Ireland are aware of many cases in which heavily pregnant women have been threatened “with the guards coming to get them” if they don’t turn up for their scheduled induction. In fact a cohort of women reported such statements are regular commentary at antenatal classes at one particular hospital. AIMSI can also confirm that there are other women who felt they had no other option than to be coerced into a section they did not freely consent to.The fear of being taken to the High Court and being sedated for forced obstetric procedures is usually enough to ensure that women comply with whatever the HCP may be suggesting whether it is evidenced based or not.</span></li>
<li style="list-style-type: decimal; margin: 0px 0px 0px 20px; padding: 5px 0px;"><span style="color: #444444; font-family: Verdana, sans-serif;">AIMS Ireland are aware of these situations in a variety of settings and geographic locations. It is not limited to large tertiary referral hospitals or to smaller units. It is endemic and a result of article 40. 3. 3 which informs the HSE National Consent Policy, enabling High Court Actions to be taken against pregnant women who exercise their right to informed refusal of medical treatment.</span></li>
<li style="list-style-type: decimal; margin: 0px 0px 0px 20px; padding: 5px 0px;"><span style="color: #444444; font-family: Verdana, sans-serif;">The ruling makes clear that the 8th amendment can be, and is used against women in continued pregnancy and birth. It finds in this particular instance that the threat to the baby’s life is not great enough to warrant forcibly sedating and sectioning a woman, but it gives us no examples of when that threat might be great enough. This leaves the door open to the HSE to continue to interpret this “risk” as they please. It enables women to be forced into processes and procedures such as CEFM (Continuous Electronic Fetal Monitoring) which the evidence base acknowledges does not improve outcomes for mothers or babies.</span></li>
<li style="list-style-type: decimal; margin: 0px 0px 0px 20px; padding: 5px 0px;"><span style="color: #444444; font-family: Verdana, sans-serif;">The judge’s comments on Ms. B having to bear the whole financial weight of any potential care baby B would have needed shines a light again on an issue that AIMS Ireland have repeatedly highlighted; that of babies who need lifelong care from injuries acquired at birth only being financially supported if someone is found to be ‘at fault’ for those injuries.AIMS Ireland have long argued that instead of the State Clinical Indemnity Scheme paying out huge sums in compensation and families needing to pursue litigation, a care fund should be established, from which monies can be allocated for the lifelong care of any child injured at birth <strong>without</strong> the need to assign blame.</span></li>
<li style="list-style-type: decimal; margin: 0px 0px 0px 20px; padding: 5px 0px;"><span style="color: #444444; font-family: Verdana, sans-serif;">Ms. B’s decision to request a c section despite having been vindicated in her right of refusal goes to prove AIMS Ireland’s position that women’s experiences of their care are differentiated entirely by whether their autonomy is respected or not, rather than what form their birth actually takes. It is clear that Ms. B did not want to avoid a section at all costs including her own health and the health of her baby, but instead to be supported by her healthcare providers in her decision to attempt a trial of labour as far as she felt was safe, with the most information and support she could obtain available to her. AIMS Ireland is delighted that Ms. B fought and won this right for herself, and by extension all other women in Ireland in her position.</span></li>
</ol>
<div style="background-color: white; color: #1d2129; font-family: verdana, sans-serif; margin-bottom: 6px; text-align: justify;">
Ultimately this case highlights supporting a woman's right to weigh risks for and against each care option and make the best decisions for her in her current circumstances taking on board her medical history. The unit refused to engage and instead decided threatening her & taking her to court was the best option. And they were backed by our National Health Service under Constitutional personhood law. The foetus, like many other cases, had its o<span class="text_exposed_show" style="display: inline;">wn legal representation against its mother.</span></div>
<div class="text_exposed_show" style="background-color: white; color: #1d2129; display: inline; font-family: verdana, sans-serif; text-align: justify;">
<div style="margin-bottom: 6px;">
If we want to make it about "risk", if discussing the 3% chance of uterine rupture, we must discuss all the risks and that it's up to the woman to weigh them out. There are real and substantial risks in repeat Caesarean; most severe maternal morbidities in Ireland (the near misses) are involving repeat Caesarean section. There are no absolutes in maternity care, it's about balancing risk and making the decision you feel safest in *at that moment * with scope to revisit the issue if medical indication arises. As in this case. The woman requested a Caesarean when she no longer felt vbac was a safe option. Women are not stupid. Women do not take risks. They make good decisions for themselves and their baby. They need to be supported, not violated and threatened.</div>
</div>
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<div style="font-size: 14.4px; line-height: 1.9; padding: 8px 0px;">
<span style="color: #444444; font-family: Verdana, sans-serif;">Find out more on this case here <a href="http://www.irishtimes.com/news/crime-and-law/judge-refused-to-order-woman-to-undergo-caesarean-section-1.2852130" style="text-decoration: none;" target="_blank">http://www.irishtimes.com/news/crime-and-law/judge-refused-to</a></span></div>
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Anonymoushttp://www.blogger.com/profile/15102063693461334158noreply@blogger.com1tag:blogger.com,1999:blog-9022711156100944101.post-20455480378059822772016-11-02T18:03:00.000+00:002016-11-03T11:19:15.023+00:00AIMSI points: HSE v B<div style="text-align: justify;">
<span style="font-size: 14.4px;"><span style="color: #444444; font-family: Verdana, sans-serif;">These points relate to the case of HSE vs B. The in-camera reporting of the case was lifted on 2nd November 2016, over a month after the original case was heard. The case relates to the HSE who took a heavily pregnant woman, Ms B to the High Court to seek an order for a forced sedation and c-section against the woman’s consent.</span></span></div>
<ol style="list-style: none; margin: 0px 0px 0px 20px; padding: 10px 0px;">
<li style="list-style-type: decimal; margin: 0px 0px 0px 20px; padding: 5px 0px; text-align: justify;"><span style="color: #444444; font-family: Verdana, sans-serif;">This case is clear proof of what AIMS have been saying for years now; that the HSE coercively use the existence of the 8th amendment to the Irish Constitution against birthing women. The fact that they tried to prevent their defeat in this case being publicly reported is cause for ongoing concern about their continued desire to bring further cases of informed refusal to the High Court.</span></li>
<li style="list-style-type: decimal; margin: 0px 0px 0px 20px; padding: 5px 0px; text-align: justify;"><span style="color: #444444; font-family: Verdana, sans-serif;">That this woman had the support and strength to go and vindicate her right to informed refusal in the High Court whilst heavily pregnant makes her very unusual. Ms. B deserves our very great thanks for publicising this practice by the HSE.</span></li>
<li style="list-style-type: decimal; margin: 0px 0px 0px 20px; padding: 5px 0px; text-align: justify;"><span style="color: #444444; font-family: Verdana, sans-serif;">Whilst a case with a formal judgement such as this is unusual, AIMS Ireland are aware of many cases in which heavily pregnant women have been threatened “with the guards coming to get them” if they don’t turn up for their scheduled induction. In fact a cohort of women reported such statements are regular commentary at antenatal classes at one particular hospital. AIMSI can also confirm that there are other women who felt they had no other option than to be coerced into a section they did not freely consent to.The fear of being taken to the High Court and being sedated for forced obstetric procedures is usually enough to ensure that women comply with whatever the HCP may be suggesting whether it is evidenced based or not.</span></li>
<li style="list-style-type: decimal; margin: 0px 0px 0px 20px; padding: 5px 0px; text-align: justify;"><span style="color: #444444; font-family: Verdana, sans-serif;">AIMS Ireland are aware of these situations in a variety of settings and geographic locations. It is not limited to large tertiary referral hospitals or to smaller units. It is endemic and a result of article 40. 3. 3 which informs the HSE National Consent Policy, enabling High Court Actions to be taken against pregnant women who exercise their right to informed refusal of medical treatment.</span></li>
<li style="list-style-type: decimal; margin: 0px 0px 0px 20px; padding: 5px 0px; text-align: justify;"><span style="color: #444444; font-family: Verdana, sans-serif;">The ruling makes clear that the 8th amendment can be, and is used against women in continued pregnancy and birth. It finds in this particular instance that the threat to the baby’s life is not great enough to warrant forcibly sedating and sectioning a woman, but it gives us no examples of when that threat might be great enough. This leaves the door open to the HSE to continue to interpret this “risk” as they please. It enables women to be forced into processes and procedures such as CEFM (Continuous Electronic Fetal Monitoring) which the evidence base acknowledges does not improve outcomes for mothers or babies.</span></li>
<li style="list-style-type: decimal; margin: 0px 0px 0px 20px; padding: 5px 0px; text-align: justify;"><span style="color: #444444; font-family: Verdana, sans-serif;">The judge’s comments on Ms. B having to bear the whole financial weight of any potential care baby B would have needed shines a light again on an issue that AIMS Ireland have repeatedly highlighted; that of babies who need lifelong care from injuries acquired at birth only being financially supported if someone is found to be ‘at fault’ for those injuries.AIMS Ireland have long argued that instead of the State Clinical Indemnity Scheme paying out huge sums in compensation and families needing to pursue litigation, a care fund should be established, from which monies can be allocated for the lifelong care of any child injured at birth <strong>without</strong> the need to assign blame.</span></li>
<li style="list-style-type: decimal; margin: 0px 0px 0px 20px; padding: 5px 0px; text-align: justify;"><span style="color: #444444; font-family: Verdana, sans-serif;">Ms. B’s decision to request a c section despite having been vindicated in her right of refusal goes to prove AIMS Ireland’s position that women’s experiences of their care are differentiated entirely by whether their autonomy is respected or not, rather than what form their birth actually takes. It is clear that Ms. B did not want to avoid a section at all costs including her own health and the health of her baby, but instead to be supported by her healthcare providers in her decision to attempt a trial of labour as far as she felt was safe, with the most information and support she could obtain available to her. AIMS Ireland is delighted that Ms. B fought and won this right for herself, and by extension all other women in Ireland in her position.</span></li>
<li style="list-style-type: decimal; margin: 0px 0px 0px 20px; padding: 5px 0px; text-align: justify;"><span style="color: #444444; font-family: Verdana, sans-serif;"><div style="background-color: white; color: #1d2129; margin-bottom: 6px; text-align: justify;">
Ultimately this case highlights supporting a woman's right to weigh risks for and against each care option and make the best decisions for her in her current circumstances taking on board her medical history. The unit refused to engage and instead decided threatening her & taking her to court was the best option. And they were backed by our National Health Service under Constitutional personhood law. The foetus, like many other cases, had its o<span class="text_exposed_show" style="display: inline;">wn legal representation against its mother.</span></div>
<div class="text_exposed_show" style="background-color: white; color: #1d2129; display: inline; text-align: start;">
<div style="margin-bottom: 6px; text-align: justify;">
If we want to make it about "risk", if discussing the 3% chance of uterine rupture, we must discuss all the risks and that it's up to the woman to weigh them out. There are real and substantial risks in repeat Caesarean; most severe maternal morbidities in Ireland (the near misses) are involving repeat Caesarean section. There are no absolutes in maternity care, it's about balancing risk and making the decision you feel safest in *at that moment * with scope to revisit the issue if medical indication arises. As in this case. The woman requested a Caesarean when she no longer felt vbac was a safe option. Women are not stupid. Women do not take risks. They make good decisions for themselves and their baby. They need to be supported, not violated and threatened.</div>
</div>
</span></li>
</ol>
<div style="font-size: 14.4px; line-height: 1.9; padding: 8px 0px;">
<div style="text-align: justify;">
<span style="font-family: "verdana" , sans-serif;">AIMSI Press release:</span></div>
</div>
<span style="font-family: "verdana" , sans-serif;"><a href="http://aimsireland.ie/statement-from-aims-ireland-on-the-lifting-of-in-camera-status-in-the-case-of-mother-b-vs-hse-heard-in-the-high-court-dublin-on-30th-september-2016/">http://aimsireland.ie/statement-from-aims-ireland-on-the-lifting-of-in-camera-status-in-the-case-of-mother-b-vs-hse-heard-in-the-high-court-dublin-on-30th-september-2016/</a></span><br />
<span style="font-family: "verdana" , sans-serif;"><br /></span>
<span style="font-family: "verdana" , sans-serif;">Irish Times reporting:</span><br />
<span style="font-family: "verdana" , sans-serif;"><a href="http://www.irishtimes.com/news/crime-and-law/in-camera-judgement-released-in-case-where-hse-sought-surgical-delivery-1.2852130">http://www.irishtimes.com/news/crime-and-law/in-camera-judgement-released-in-case-where-hse-sought-surgical-delivery-1.2852130</a></span>Anonymoushttp://www.blogger.com/profile/05874066401296452492noreply@blogger.com3tag:blogger.com,1999:blog-9022711156100944101.post-58411892654319544312016-11-02T12:14:00.000+00:002016-11-02T12:15:31.895+00:00Replacing the 8th won't address autonomy issues. Article in Today's Irish Times looking at Constitutional law and challenging the view that the 8th Amendment must be replaced if repealed.<br />
<br />
This is an incredibly important issue and one that has been continuously missed in the conversation from many politicians and many in the Irish media with regards to Repeal the 8th.<br />
<br />
AIMSI members voted unanimously for Repeal the 8th without replacement due to the legal ramifications personhood laws have on bodily autonomy on all health care options and full range of maternity services once a person becomes pregnant. All care options in continuum of pregnancy are within the scope of "maternity services" and those utilising services in Ireland deserve a full range of evidence based care options and full duty of care. Including access to abortion, pregnancy screening, evidence based antenatal/labour/birth/postnatal, options on place of birth/lead care provider, maternal mental health services, bereavement, hospice, and full recognition and guidance of principals of informed decision making, to consent or decline, like our EU / UK counterparts.<br />
<br />
Repealing the 8th Amendment and replacing it with similar legislation, giving equal rights to the foetus in some or all instances, results in no change for pregnant women/people in happily continued pregnancy. With shared rights a pregnant women/person is automatically reduced in capacity - in the ability to make an informed decision, (consent to/or decline ) in care options and interventions during continued pregnancy, labour, and childbirth.<br />
<br />
The HSE directly cites the 8th as a barrier to consent in continued pregnancy and childbirth. Further, The Capacity Act legislation outlines the importance of Advanced Health Care Directives, as being legally binding to ensure patient wishes, but outlines that these directives can be overruled in the case of pregnancy.<br />
<br />
Pregnant women/people should be the lead decision maker on their care - where, how, with whom they give birth. In no other realm of health is a person with full capacity's right to bodily autonomy diminished.<br />
<br />
Bodily autonomy is the cornerstone of medical ethics. Removal of this right in the instance of pregnancy is discrimination. Removal of choice is never best practice.<br />
<br />
This conversation must be opened to include continued pregnancy and the dangerous ramifications the 8th has in maternity care.<br />
<br />
From Article:<br />
"The people should not be asked to constitutionally enshrine a particular set of restrictions on abortions, but only to remove a constitutional impediment to legislative reform."<br />
<br />
Irish Times: http://www.irishtimes.com/opinion/there-is-no-reason-why-we-can-t-simply-repeal-the-eighth-amendment-1.2850568<br />
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"There is no reason why we can’t simply repeal the Eighth Amendment" </h1>
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Anonymoushttp://www.blogger.com/profile/05874066401296452492noreply@blogger.com5tag:blogger.com,1999:blog-9022711156100944101.post-74324700230176093482016-08-12T11:55:00.001+01:002016-10-14T00:59:45.344+01:00Bereavement Standards - Terminology Clarification on Fatal Foetal Abnormality<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgfU89jUkRe5F90OdIcscvjW8ayGFJ5ZHlM7atp6-YXSqrGmxRQAdOusfcUzCKw3emD1sJbuDf3CGvFq83ttDoVHi9SageW-IHZu0jwjV_b_Zl-3uRFpBiKHYuZvr5Qkmvq9cczlXMA69M/s1600/aims+ffa+photo.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgfU89jUkRe5F90OdIcscvjW8ayGFJ5ZHlM7atp6-YXSqrGmxRQAdOusfcUzCKw3emD1sJbuDf3CGvFq83ttDoVHi9SageW-IHZu0jwjV_b_Zl-3uRFpBiKHYuZvr5Qkmvq9cczlXMA69M/s320/aims+ffa+photo.jpg" width="320" /></a></div>
This photo, taken by an AIMSI committee member, is from the Bereavement Standards Following Pregnancy Loss and Perinatal Death which was launched on August 10, 2016 and attended by AIMSI. <br />
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Contrary to belief within some circles, the term 'fatal fetal abnormality/anomaly' IS IN THE DOCUMENT, where it is explained (see photo) that there is no legal, medical, ethical or 'right' way to refer to these tragic cases. The point was also made by each of the speakers (Dr Ciaran Browne, Mr Tony O'Brien & Minister Simon Harris) that there is no symbolism in the language used and the terms are interchangeable and self determined. Indeed, each of the speakers used various terminology throughout the launch. <br />
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Hope this clears up any misinformation. <a class="_58cn" data-ft="{"tn":"*N","type":104}" href="https://www.facebook.com/hashtag/bereavmentstandards?source=feed_text&story_id=1144061785653543"><span aria-label="hashtag" class="_58cl">#</span><span class="_58cm">bereavmentstandards</span></a> <a class="_58cn" data-ft="{"tn":"*N","type":104}" href="https://www.facebook.com/hashtag/ffa?source=feed_text&story_id=1144061785653543"><span aria-label="hashtag" class="_58cl">#</span><span class="_58cm">FFA</span></a> <a class="_58cn" data-ft="{"tn":"*N","type":104}" href="https://www.facebook.com/hashtag/tfmrireland?source=feed_text&story_id=1144061785653543"><span aria-label="hashtag" class="_58cl">#</span><span class="_58cm">tfmrireland</span></a>Anonymoushttp://www.blogger.com/profile/05874066401296452492noreply@blogger.com1tag:blogger.com,1999:blog-9022711156100944101.post-29294225902738675512016-08-11T17:24:00.000+01:002016-08-11T17:24:04.421+01:00Human Rights for Jess #humanrightsforjess #repealthe8thThis morning AIMS Ireland posted this photo with the caption: <br />
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"Spotted in Dublin this morning.... #repealthe8th #humanrightsforjess"<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrRMseiuEEGHH2dSW2Y5YpBMbUQ-b0uMwj7zlWr7kCJ3og7-FhoHr3tvLhWp7zdtDabCBFlx-gqVbEW3u5kKLyq6zvIZ6kGfcuyF5pvz_NwoC_FDGXarMgItPK3TY0HUk35ajeLShXVbI/s1600/jess+aims.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrRMseiuEEGHH2dSW2Y5YpBMbUQ-b0uMwj7zlWr7kCJ3og7-FhoHr3tvLhWp7zdtDabCBFlx-gqVbEW3u5kKLyq6zvIZ6kGfcuyF5pvz_NwoC_FDGXarMgItPK3TY0HUk35ajeLShXVbI/s320/jess+aims.jpg" width="320" /></a></div>
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A bit more on Jess...The 8th Amendment affects pregnant people who want to be pregnant as well as those who do not. Jess's right to informed consent and informed refusal is removed due to the 8th Amendment. The National Consent Policy of Ireland directly cites the 8th Amendment as a barrier to informed consent/refusal in pregnancy, labour, and childbirth. Jess should be supported to enjoy the same freedom to consent which is outlined (and protected) to all other non-pregnant people in Ireland. Jess's ability to informed decision making - to make the best decision for her & her baby in their specific circumstances in pregnancy & childbirth has been removed from her. AIMSI speak to pregnant people daily whom have had their rights removed. Human rights in childbirth is real. <a class="_58cn" data-ft="{"tn":"*N","type":104}" href="https://www.facebook.com/hashtag/humanrightsforjess?source=feed_text&story_id=1143606629032392"><span aria-label="hashtag" class="_58cl">#</span><span class="_58cm">humanrightsforjess</span></a> <a class="_58cn" data-ft="{"tn":"*N","type":104}" href="https://www.facebook.com/hashtag/repealthe8th?source=feed_text&story_id=1143606629032392"><span aria-label="hashtag" class="_58cl">#</span><span class="_58cm">repealthe8th</span></a><br />
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More on Human Rights violations in Ireland as a ramification of the 8th Amendment:<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhMbalGastpz_dA04KN5wK4Pr39dGo6dXsKMmUchx4sk3sflljon0uNsCsgs6OQSmS1WWlJ21iysF6q0YZDS3JgetRKrx4QrxUr7AakT9xS1wVlzWV85TBUP9HFcVxub8RWepQFpzuJs60/s1600/jess+aims+2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhMbalGastpz_dA04KN5wK4Pr39dGo6dXsKMmUchx4sk3sflljon0uNsCsgs6OQSmS1WWlJ21iysF6q0YZDS3JgetRKrx4QrxUr7AakT9xS1wVlzWV85TBUP9HFcVxub8RWepQFpzuJs60/s320/jess+aims+2.jpg" width="189" /></a></div>
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<br />
Full article by AIMSI Secretary Sinead Redmond <a href="https://feministire.com/author/sineadredmond/" target="_blank">HERE</a><br />
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Anonymoushttp://www.blogger.com/profile/05874066401296452492noreply@blogger.com1tag:blogger.com,1999:blog-9022711156100944101.post-74961273829511242072016-04-24T00:17:00.002+01:002016-05-04T21:22:06.075+01:00AIMSireland issues Proclamation to the Birthing Women of Ireland<h2 style="font-family: Georgia, 'Times New Roman', 'Bitstream Charter', Times, serif;">
<span style="color: #274e13;">AIMSIreland Proclamation</span></h2>
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<span style="color: #274e13;">This proclamation from AIMSIreland to the Birthing Women of Ireland is to mark the centenary of the original Irish Proclamation which was read from the GPO 100 years ago today. The original proclamation strove to ensure equal rights for all the future citizens of Ireland, a worthy aspiration that has yet to be fully realised.</span></div>
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There are many areas of maternity care which are not equitable, not evidenced based and in which women and the babies they are birthing could be better served. Under the 8th amendment to the Irish Constitution women are not treated as equal citizens once they become pregnant. They surrender bodily autonomy to the State and as such are not free. AIMSIreland strives to fight these inequities and to ensure that all women who birth in Ireland have the right to safe, compassionate, evidenced based care and bodily autonomy.</div>
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</span></div>
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<span style="color: red; font-size: large;"><a href="https://www.youtube.com/watch?v=EqyDMKPEDY4" target="_blank">Watch our Proclamation video here</a></span><br />
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<h2 style="font-family: Georgia, 'Times New Roman', 'Bitstream Charter', Times, serif;">
<span style="color: #274e13;">AIMSIreland to the Birthing Women of Ireland</span></h2>
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WOMEN of Ireland: In the name of all those women who have gone before you and of the dead generations from which you draw your strength to birth, AIMSIreland summons you to our Charter for Safe Maternity care and strikes for the freedom of all women to choose, to be fully informed and to be treated with compassion and dignity in our maternity services.</div>
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Having organised and trained her advocates through her outspoken organisation; and through other Irish voluntary birth advocacy organisations, having resolutely waited for the right moment to reveal itself, AIMSIreland now seizes that moment, and supported by her sister global advocates, but relying in the first on her own strength, she strikes in full confidence of victory.</div>
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We declare the right of the women of Ireland to the ownership of their bodies and to the unfettered control of their destinies, to be sovereign and indefensible. The long usurpation of that right by the state and health care professionals has not extinguished the right, nor can it ever be extinguished except by the destruction of all women in Ireland. In every generation women of Ireland have asserted their right to bodily autonomy and sovereignty; countless times during the past hundred years they have asserted it collectively and individually. Standing on that fundamental right and again asserting it on social media in the face of the world, we hereby proclaim the bodies of the birthing women of Ireland as independent and autonomous and we pledge our lives and the lives of our fellow advocates to the cause of its freedom, of its welfare, and of its equality among citizens.</div>
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AIMSIreland hereby claims the allegiance of all women of Ireland to call for improved maternity care. We demand equal rights and equal opportunities for all women in birth, and declare our resolve to pursue the happiness and prosperity of all birthing women, cherishing all of the birthing women of the nation equally, and oblivious of the differences carefully fostered by the State, which have divided a minority from the majority in the past.</div>
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Until our advocacy has brought the opportune moment for the establishment of a safe compassionate dignified maternity service we will carry the mantle of ceaseless questioning.</div>
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We place the cause of Improving the Irish Maternity Services under the protection of the moral high ground Whose blessing we invoke upon our campaign and we hope that no one who serves that cause will dishonour it by cowardice.</div>
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In this supreme hour AIMSIreland must, by its valour and determination, and by the readiness of its committee and membership to work voluntarily for the common good, prove itself worthy of the august destiny to which it is called.</div>
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<strong>Signed on behalf of AIMSIreland</strong></div>
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Krysia Lynch</div>
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Breda Kearns</div>
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Jene Hinds Kelly</div>
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Sinead Redmond</div>
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Helen Guinane</div>
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Lucy Peprah</div>
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Barbara Western</div>
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Rebecca Hegarty</div>
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Nuala Hoey</div>
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Lisa Finnegan</div>
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Edel Quirke</div>
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Aisling McCarthy</div>
Anonymoushttp://www.blogger.com/profile/15102063693461334158noreply@blogger.com1tag:blogger.com,1999:blog-9022711156100944101.post-27640472135095836612016-01-27T21:20:00.003+00:002016-01-27T21:28:24.132+00:00Launch of the Maternity Strategy for Ireland 2016-2026<h2 style="text-align: center;">
<b>The Association for the Maternity Services Ireland (AIMSI) welcomes the Maternity Strategy for Ireland 2016 - 2026</b></h2>
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<b>www.aimsireland.ie</b></div>
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<b><br /></b></div>
<div style="text-align: center;">
<b>For more information call Krysia Lynch 0877543751</b></div>
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AIMSI welcomes the Maternity Strategy for Ireland launched today 27th January 2016. by Minister Leo Varadkar. AIMSI was delighted to be able to participate in the steering group for the last nine months via its Chair Dr.Krysia Lynch.<br />
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The Maternity Strategy when implemented will offer women and their families increased choices in maternity care. Women who are experiencing a normal straightforward pregnancy will have the option of birthing at home, in an alongside birth centre or in a specialist birth centre. The first two options will offer women with a normal pregnancy a much increased chance of a normal birth, with interventions not being routine but only carried out on request or necessity, and where the lead carer will be a midwife.<br />
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Women who are of medium risk or of high risk will not have any increased choices, and will birth in an obstetric led specialist birth centre. AIMSI are disappointed that for women who have only transient risks or marginal increased risks there will be no choice in care setting as there is for example in the recently launched GAIN guidelines in Northern Ireland. AIMSI are further disappointed that free standing birth units are not recommended in this strategy, even though the evidence for their safety is stronger than for home birth, which the Strategy does recommend, and even though there was a clear overwhelming demand for in the public consultation.<br />
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AIMSI welcomes the Minister's comments on perinatal mental health at the launch of this strategy and the need for increased service provision in this area that the strategy recommends. AIMSI also welcomes the increase in a community midwifery service that this Strategy recommends for antenatal, postnatal and intrapartum care as being cost effective, designed to meet the growing demand for women to have more care within the community and cognisant of the views of the many service users who took part in the consultation.<br />
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AIMSI welcomes the increased provision that the Strategy recommends for information and audit. The strategy recommends that evidenced based information be made available in a one stop shop for for women and that women be advised of their options at the start of their pregnancy using evidence rather than clinician preference. The Strategy also recommends that HIQA will annually audit the maternity services, which AIMSI welcomes.<br />
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The Strategy recognises the effect of birth trauma on women and the Minister made reference to this in his speech at the launch. AIMSI are delighted to hear that there will be recommendations to assist women who experience birth trauma, as so many of our calls come from women who have had traumatic experiences in our maternity services.<br />
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AIMSI are delighted to see that the Strategy recommends the provision of alongside birth centres even in smaller units. AIMSI also welcomes the provision made for smaller units to comply with dedicated home from home rooms to act as alongside birth settings with midwives as lead carers until an alongside birth centre can be built as this will ensure continued provision of maternity services in rural areas.<br />
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AIMSI welcomes the importance that this Strategy places on breastfeeding and its role in life long health. We welcome the recommendations that all hospitals achieve Baby Friendly Status and that women should have free access 24/7 to lactation consultants within hospital settings and also free access in the community.<br />
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Finally, AIMSI welcomes the provision made for service user representation in the implementation of the Strategy and in continuing review of the maternity servicesAnonymoushttp://www.blogger.com/profile/15102063693461334158noreply@blogger.com1tag:blogger.com,1999:blog-9022711156100944101.post-19980582947696220292015-05-27T13:49:00.002+01:002015-05-27T13:50:03.511+01:00Strategic review of the maternity services: the importance of service user representationOn Saturday 23rd May 2015, the Irish Times printed an article which highlighted a letter sent from the Institute of Obstetricians and Gynaecologists of Ireland to the Minister for Health Leo Varadkar about the Membership of the Strategy Review Steering Group.<br />
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AIMSI Ireland through their Chair Krysia Lynch has a place on the committee representing the views of service users. Also on the committee are two service users whose babies died in Portlaoise Hospital.<br />
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In the letter, Prof Robert Harrison,
said his members were "dismayed about the make-up of the group". He stated that the
presence of three obstetricians and no anaesthetists or critical care
specialists, compared to nine people from a midwifery background and
three lay people, “does not reflect a fair balance of those who work in
maternity services today”.<br />
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The letter implies that those who work in the maternity services should dominate how future maternity services are delivered and planned. It discusses ratios of those that work in the maternity services today and assumes wrongly, as it turns out, that obstetricians should have the majority of seats. There are many more midwives working in the maternity services than obstetricians; it is logical that the majority view around the table should be from midwives. Perhaps what the statement really means to imply is that obstetricians have grown accustomed to dominating discussions surrounding maternity services, and suddenly finding themselves not in a majority is unfamiliar and unwelcome territory.<br />
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The reporting of the letter in the Irish Times implies that the querying of the service
users by Prof Harrison was insensitive and inappropriate given the way
these women had been treated by the members of his own profession. <br />
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Whilst the comments re service users made in the letter received a lot
of publicity, little commentary was made on the demands from the Institute of Obstetricians and Gynaecologists of Ireland for the inclusion of a
critical care representative and the inclusion of an anaesthetist representative; both of which were duly appointed following the request
from the Institute. <br />
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An interesting question that the letter does not address is whether the inclusion of two service users and one advocacy organisation is sufficient. AIMSI would argue (along with the other service users representatives) that 70,000 maternity care service users might deserve even more than two service users representing them. To this end AIMSI also wrote to the Strategic
Review Committee suggesting the inclusion of a further consumer
representative who had perhaps experienced a
different model of care and a different outcome to those already included. AIMSI were told no further representatives could be added.<br />
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On Tuesday 25th May 2015 AIMSI issued the following statement:<br />
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"The recent comments in the Irish Times questioning the inclusion of two service users was unhelpful. This group might not be sitting if it were not for the experience of the service users on the committee. Their bravery in coming forward and the support they received from advocacy groups is an important aspect of improving maternity services for women in Ireland, and AIMSI would if anything be advocating for more service user inclusion on the group"<br />
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The full article can be read here<br />
<a href="http://www.irishtimes.com/news/health/obstetricians-query-inclusion-of-mothers-in-group-1.2222952">http://www.irishtimes.com/news/health/obstetricians-query-inclusion-of-mothers-in-group-1.2222952</a><br />
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The second article following Prof Harrison s resignation can be read here<br />
<a href="http://www.irishtimes.com/news/health/institute-of-obstetricians-withdraws-portlaoise-letter-1.2224543">http://www.irishtimes.com/news/health/institute-of-obstetricians-withdraws-portlaoise-letter-1.2224543</a>Anonymoushttp://www.blogger.com/profile/15102063693461334158noreply@blogger.com0tag:blogger.com,1999:blog-9022711156100944101.post-80111776164079056432015-05-18T10:53:00.000+01:002015-05-18T11:35:25.920+01:00SHOUT BACK - YOUR SAY: A Note on the Issue of BalanceAIMSI have received quite a few messages on our SHOUT BACK - YOUR SAY submissions; passionate pleas to include positive stories in the interest of balance. <br />
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AIMS Ireland spent 42 weeks highlighting positive, healthy birth in Ireland. (<a href="http://www.42weeks.ie/">www.42weeks.ie</a>) <br />
42 weeks was well received, particularly by health care providers. However, during this campaign, many women contacted us who felt isolated; that their voice and experience was not represented. <br />
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SHOUT BACK - YOUR SAY represents a safe place for women to share their experiences which were not positive. These submissions are vitally important as they represent a voice which rarely has the opportunity to be heard; those who survive. AIMS Ireland passionately believe that experiences of abuse, disrespect, assault, unsafe care practice should not matter less simply because the woman and baby survive. Yet these experiences are too often dismissed consistently by our politicians, policy makers, care providers, and media. <br />
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Baby alive. Mother alive. Non story. Regardless of the profound impact on the physical and psychological wellbeing of women, babies, families - the health and lives of all involved. <br />
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Assistance with complaints and birth trauma is the #1 reason why women make contact with AIMS Ireland. The SHOUT BACKs representing a small percentage of what comes into our inbox. <br />
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We need to be very careful that in a desire to create balance, we do not dismiss the experiences of women who have not had positive experiences. The SHOUT BACKs are difficult to read. They represent everything we hope to change in the Irish maternity system. These experiences are real and need to be heard in their own light, not buried. Its so important we do not dismiss these women's experiences by asking for the focus to change - to make us all feel more comfortable, by including positive stories. <br />
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It is in everyone's interests that these experiences are acknowledged and the courage that these women and families have shown in coming forward is respected. They are heartbreaking and very difficult reading but their place in the maternity care system is of huge importance; it is as a result of this opportunity to share, just at this particular time, that REAL change may come about. <br />
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Balance is about hearing and facing up to the difficult things. People are living with the repercussions of such treatment - often alone, isolated, while taking care of their young families - and up to now they have remained unheard and unacknowledged. <br />
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It is vital that we do not look back at this opportunity in 20 years time and say "if only we'd listened".<br />
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<br />
<br />Anonymoushttp://www.blogger.com/profile/05874066401296452492noreply@blogger.com0tag:blogger.com,1999:blog-9022711156100944101.post-43545731115235917542015-04-17T18:36:00.001+01:002015-04-17T18:44:10.404+01:00More of this please! Positive stories set the bar MORE OF THIS PLEASE! <br />
<br />
AIMSI are delighted to hear that women are reporting positive experiences and hopefully this trend will continue. <br />
<br />
We acknowledge the many individual care-givers, unit leaders, and other individuals in the Irish maternity system whom are attempting, in so far as hospital protocols allow them, to introduce more woman-centred care which realises evidence based findings and the significance optimum care has on women's physical, mental and emotional well-being; which has far-reaching impact on not only her health, but that of her family and baby.<br />
<br />
The long term benefits of providing evidenced, supportive, women-centred care would also be seen down the line in terms of demands on the health services and other resources. <br />
<br />
It is becoming clearer, as more research is done internationally in this area, that disrespectful and uncaring, and thoughtless treatment of a woman at such a significant time leaves lasting, very often hidden scars, unresolved physical injury, and often serious trauma which can go unrecognised and untreated. AIMS Ireland's support and advocacy services witness this on a daily basis.<br />
<br />
It is wonderful to read this positive story in the Times, however, AIMS Ireland recognise that this level of care is not offered to all women accessing maternity services in Ireland. This should not be.<br />
<br />
AIMSI will continue unceasingly in its efforts to ensure that every woman in the Irish maternity system has access to evidence based, kind, supportive care with a strong emphasis on informed decision making in order to support each woman to make the best decisions for her and her baby in her unique circumstances. <br />
<br />
Very much remains to be done to realise this reality, including:<br />
<br />
recognition of woman's rights in pregnancy<br />
Informed decision making; consent, refusal<br />
providing clear, unbiased information<br />
a range of evidence based, safe care options<br />
effective use of resources<br />
listening to women and their experiences <br />
humanising care for women with "high risk" status and caesarean births - such as skin to skin, baby in recovery, individual assessment, etc<br />
<br />
Women should not have to be dependant on the attitude of individual care-givers or unit leaders for respectful and optimum care. Nor should women's care vary depending on the opinion/ routine practice of the care provider they see.<br />
<br />
Women should be able to put trust in their maternity care and care providers.<br />
<br />
There are very many extremely overworked and exhausted midwives and HCPs - stressed because they are unable to provide the care they know is evidence based and safe. There is much attention placed on the faults of our maternity system, to which there are many. However, AIMS Ireland fully recognises the very many wonderful care providers, who strive to bring the best practice and evidence based care to those they care for. There are pockets of amazing, supportive care in Ireland and these individuals are the backbone of these stories! <br />
<br />
AIMS Ireland hope that maybe, someday, positive stories, such as the one here and others from 42 weeks campaign will be the norm for ALL. <br />
<br />
Until then, all the negative experiences and feedback received from women must be carefully scrutinised and recognised as powerful tools of change. Lessons to learn from. A mirror to show us where we are - and where we must go. It is not an 'either/or' situation and we need the support of the media and Government to recognise this. ALL experiences are part of the system. ALL are worthy and should be heard. Only when we are able to be accepting and acknowledging of this - by highlighting what needs to be changed and what can be achieved - will women, babies and families get the optimum care and treatment they deserve and need.<br />
<br />
This woman's story shows it can be done. <br />
Here is the bar. <br />
RISE to it!<br />
<br />
#moreofthisplease<br />
<br />
Irish Times: Maternity services: ‘I felt safe in the hands of the professionals’ <a href="http://www.irishtimes.com/life-and-style/health-family/parenting/maternity-services-i-felt-safe-in-the-hands-of-the-professionals-1.2168618">http://www.irishtimes.com/life-and-style/health-family/parenting/maternity-services-i-felt-safe-in-the-hands-of-the-professionals-1.2168618</a><br />
<a class="_58cn" data-ft="{"tn":"*N","type":104}" href="https://www.facebook.com/hashtag/moreofthisplease?source=feed_text&story_id=878366652223059" saprocessedanchor="true"><span aria-label="hashtag" class="_58cl"></span><span class="_58cm"></span></a>Anonymoushttp://www.blogger.com/profile/05874066401296452492noreply@blogger.com1tag:blogger.com,1999:blog-9022711156100944101.post-68770422171739423332015-04-01T11:03:00.002+01:002015-04-01T12:36:44.271+01:00Compensation costs, accountability, and listening to women.<span data-ft="{"tn":"K"}" data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body"><span class="UFICommentBody" data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.0"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.0.$end:0:$0:0">On Monday, March 30th 2015, the Irish Times ran an article "Childbirth malpractice cost HSE €67m over five years" by Ciarán D'Arcy in which new figures were revealed from the HSE that nearly €67 million has been paid out to families in compensation for medical malpractice for birth procedures in the past 5 years.</span></span></span></span><br />
<span data-ft="{"tn":"K"}" data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body"><span class="UFICommentBody" data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.0"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.0.$end:0:$0:0"></span></span></span></span><br />
<span data-ft="{"tn":"K"}" data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body"><span class="UFICommentBody" data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.0"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.0.$end:0:$0:0">The article states: "The increase in birth-specific payouts in 2013 reflects an overall spike that year, in which HSE hospitals spent over €50 million compensating patients and members of the public. This compares to €26 million in 2012, and €32 million last year, according to figures obtained through Freedom of Information legislation. As an organisation, the HSE has spent about €367 million in compensation payments for more than 2,000 cases over the last decade."<br />
<br />
What is omitted from this discussion is the human voice of those touched by these cases. The experiences and lives of families affected.The people behind the HSE's compensation figures.</span></span></span></span><br />
<span data-ft="{"tn":"K"}" data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body"><span class="UFICommentBody" data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.0"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.0.$end:0:$0:0"><br />
</span></span></span></span><span data-ft="{"tn":"K"}" data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body"><span class="UFICommentBody" data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.0"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.0.$end:0:$0:0"><br />
One woman provided a powerful comment following the posting of this article:</span></span></span></span><br />
<span data-ft="{"tn":"K"}" data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body"><span class="UFICommentBody" data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.0"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.0.$end:0:$0:0"><br />
</span></span></span></span><span data-ft="{"tn":"K"}" data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body"><span class="UFICommentBody" data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0"><em><strong><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.0"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.0.$end:0:$0:0">"If these so called 'medical professionals' did their jobs properly in the first place then there wouldn't be babies born with severe brain damage which is life changing for them and their families! If these so called midwives and doctors were held acco</span></span><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.3"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.3.0"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.3.0.$end:0:$0:0">untable for their actions and were not let free to do it again there would be less children born with brain damage. We as parents have not come in for some kind of 'windfall' as is quoted in the article and also said at a medical conference by the head of the States Claims Agency! It is NOT about money. Our children's lives have been ruined. Do these people have children? Do they know what they are going to say at their childs funeral? I do."</span></span></span></strong></em></span></span><br />
<strong><em></em></strong><br />
This woman and others, should be at the very heart of this conversation. Her experience. Her child. They are not a number on a list of pay-outs nor the words in a court brief. <br />
<em></em><br />
Another notable absence in this discussion is recognition of a culture within our maternity services which fails to deliver accountability and best practice standards to women and babies.<br />
<br />
<span data-ft="{"tn":"K"}" data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body"><span class="UFICommentBody" data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.3"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.3.0"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.3.0.$end:0:$0:0">Have individual clinician's practices been reviewed following these cases? </span></span></span></span></span><br />
<span data-ft="{"tn":"K"}" data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body"><span class="UFICommentBody" data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.3"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.3.0"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.3.0.$end:0:$0:0">Have any clinicians been suspended or required to re-train as a result of adverse outcomes?</span></span></span></span></span><br />
Are these cases open and transparent so that women can make informed decisions?<br />
H<span data-ft="{"tn":"K"}" data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body"><span class="UFICommentBody" data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.3"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.3.0"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.3.0.$end:0:$0:0">ave there been investigations into routine clinical practices which do not meet best practice standards?</span></span></span></span></span><br />
<br />
The reader quoted above also posted on the AIMS Ireland page, that she,<br />
<br />
<em><strong> "would love to see a change but unless a legal duty of candour is brought in nothing will."</strong></em> <br />
<br />
The reluctance of medical professionals a<span data-reactid=".12x.1:3:1:$comment329617437237229_329639320568374:0.0.$right.0.$left.0.0.1.$comment-body.0.3"><span data-reactid=".12x.1:3:1:$comment329617437237229_329639320568374:0.0.$right.0.$left.0.0.1.$comment-body.0.3.0"><span data-reactid=".12x.1:3:1:$comment329617437237229_329639320568374:0.0.$right.0.$left.0.0.1.$comment-body.0.3.0.$end:0:$0:0">nd the State Claims Agency (in spite of their media spin) to bring in 'open disclosure' in the case of adverse events means no apologies and no clear and helpful information for those who have suffered, and continue to be profoundly affected, by these significant events.</span></span></span><br />
<span data-ft="{"tn":"K"}" data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body"><span class="UFICommentBody" data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0"><em><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.3"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.3.0"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.3.0.$end:0:$0:0"></span></span></span></em></span></span><br />
<span data-ft="{"tn":"K"}" data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body"><span class="UFICommentBody" data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.3"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.3.0"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.3.0.$end:0:$0:0"><strong><u>Accountability</u></strong></span></span></span></span></span><br />
<span data-ft="{"tn":"K"}" data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body"><span class="UFICommentBody" data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.3"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.3.0"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.3.0.$end:0:$0:0"></span></span></span></span></span><br />
<span data-ft="{"tn":"K"}" data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body"><span class="UFICommentBody" data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.3"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.3.0"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.3.0.$end:0:$0:0">What is a grave concern to AIMS Ireland is the number of failures at national level identified in numerous reports which include timely access to maternity services, inadequate staffing levels for safe care, a maternity care model that hasn’t been revised in 59 years despite numerous national and international reports and recommendations, a lack of accountability and governance, and a strategic review of maternity services in which women's voices have not been included in the consultation process.</span></span></span></span></span><br />
<span data-ft="{"tn":"K"}" data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body"><span class="UFICommentBody" data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.3"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.3.0"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.3.0.$end:0:$0:0"></span></span></span></span></span><br />
<span data-ft="{"tn":"K"}" data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body"><span class="UFICommentBody" data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.3"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.3.0"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.3.0.$end:0:$0:0"></span></span></span></span></span><span data-ft="{"tn":"K"}" data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body"><span class="UFICommentBody" data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.3"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.3.0"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.3.0.$end:0:$0:0">Ireland is a nation of numerous reports and recommendations. Report , after report, after report come to the same conclusions with absolutely no preventative action from the HSE or Department of Health to implement best practice standards and individualised care in Irish maternity care options. There is a fundamental failing to identify and act on local and individual clinical practice; all necessary to ensure full accountability.</span></span></span></span></span><br />
<br />
<br />
<strong><u>Silencing Experiences</u></strong><br />
<br />
As a nation, we have a comprehensive failure to listen to women and those at the centre of the issue. The HSE have claimed 'unverified accounts' within the most recent HIQA report. How can our Irish health services be accountable when a woman's/family's first person account is considered 'unverified' in the eyes of the HSE?<br />
<br />
This is a reoccurring complaint to AIMS Ireland – women do not feel their experiences, concerns, and the implications of their birth are acknowledged or listened to. <br />
<br />
Women are told what their experiences were, rather than being asked. <br />
Women are spoken for by politicians, health care providers, and other 'experts'.<br />
Women are told what they are feeling.<br />
Women's stories, choices, and concerns are silenced.<br />
<br />
Women also referenced 'not being listened to' in the AIMS Ireland 2014 survey, "What Matters to You" in which nearly 3,ooo women took part who had birthed in Ireland over the past 5 years. This trend is highlighted in the following graph including women's comments.<br />
<br />
<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiDZ1T9BkQpNPkrOd6ZsBAHO1ZNjIC0aDiwVW5H9s2VgSCMYp1RuYPdUx7l9idmvnUb3Om2V8dZ6Ic4fSBRKDKMW6B65i7uWo4g4dqiMXvnRuEc3JsuzZdEJ7VpDkop82QRykgPfQTVV1c/s1600/blog+listened+to.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiDZ1T9BkQpNPkrOd6ZsBAHO1ZNjIC0aDiwVW5H9s2VgSCMYp1RuYPdUx7l9idmvnUb3Om2V8dZ6Ic4fSBRKDKMW6B65i7uWo4g4dqiMXvnRuEc3JsuzZdEJ7VpDkop82QRykgPfQTVV1c/s1600/blog+listened+to.jpg" height="240" width="320" /></a></div>
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#WMTY2014<br />
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<br />
<strong><u>Change of Culture</u></strong><br />
<br />
A change of culture is desperately needed from the top to the bottom in Irish maternity services with a focus on high quality, evidenced clinical practice and accountability for failures in clinical safety. The experiences and voices of those using the services, those living with the consequences of their birth, those at the very centre of the issue, must be consulted as equal and worthy partners in the process. #listentowomen<br />
<br />
<br />
Full article on compensation costs here: <a href="http://www.irishtimes.com/news/health/childbirth-malpractice-cost-hse-67m-over-five-years-1.2157876">http://www.irishtimes.com/news/health/childbirth-malpractice-cost-hse-67m-over-five-years-1.2157876</a><br />
<br />
What Matters to YOU 2014 - AIMS Ireland survey available to read here - next batch of results due out in April: <a href="http://aimsireland.ie/what-matters-to-you-survey-2015/">http://aimsireland.ie/what-matters-to-you-survey-2015/</a><br />
<span data-ft="{"tn":"K"}" data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body"><span class="UFICommentBody" data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.3"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.3.0"><span data-reactid=".w.1:3:1:$comment867878676605190_867904479935943:0.0.$right.0.$left.0.0.1.$comment-body.0.3.0.$end:0:$0:0"></span></span></span></span></span><br />Anonymoushttp://www.blogger.com/profile/05874066401296452492noreply@blogger.com0tag:blogger.com,1999:blog-9022711156100944101.post-86410999492791516652015-03-29T16:24:00.000+01:002015-03-29T16:56:41.451+01:00The Coombe, Portlaoise, The Report and Managing the Media<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhBFYRP4DjFSk9l1vOqd29FZKsBNhu5PTanFAgozgZFf-a_9jSU8ySAPC9jKZBK7z7yzckiqPE-jFNVSf2vPSHU953kFjX1iX_piNOgmNLuCa69SL8DrFexWtdeEvJPHe6NqmY6_1UzHJk/s1600/portlaoise.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhBFYRP4DjFSk9l1vOqd29FZKsBNhu5PTanFAgozgZFf-a_9jSU8ySAPC9jKZBK7z7yzckiqPE-jFNVSf2vPSHU953kFjX1iX_piNOgmNLuCa69SL8DrFexWtdeEvJPHe6NqmY6_1UzHJk/s1600/portlaoise.jpg" height="240" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Portlaoise Hospital www. Midlandsradio.fm</td></tr>
</tbody></table>
<br />
AIMSI was doing a media interview yesterday and we were asked by the radio presenter what our opinion was of the Minister of Health's response to the issues with Portlaoise, in particular with reference to the overtaking of services in Portlaoise by The Coombe Women's and Infants University Hospital.<br />
<br />
Three days ago (25th March 2015) the Minister for Health, Mr Leo Varadkar appeared on the Pat Kenny show on Newstalk national radio and made the following statements re the as yet unpublished draft HIQA report on Portlaoise hospital.<br />
<blockquote class="tr_bq">
"It is a draft report. It's not a draft report that I've seen yet"<br />
"The draft report hasn't yet been put to the board of HIQA. Like any draft report, on any matter, it needs to be fact checked and that's the process that's now underway. I do expect to see it in a couple of weeks and it will be published."<br />
"The draft report casts the net very wide, not just making findings against senior management in HSE at national level but also front line staff at local level."<br />
"The HSE would take the view that it has to defend the reputation and good name of its staff on the frontline."<br />
"I don't want to see government agencies suing each other. I think it's not appropriate, it's a waste of money."<br />
"I haven't seen the report yet so I'm not going to come down on any side until I have."</blockquote>
<blockquote class="tr_bq">
Minister Varadkar on Newstalk Radio with Pat Kenny </blockquote>
The next day, Thursday March 26th we hear that a memorandum of understanding has been signed between the Coombe Women's and Infants University Hospital and Portlaoise Hospital to transfer governance as part of a "managed maternity network", The implied message is that this a direct response from the Department of Health to the HIQA (as yet draft and unpublished) report. How could this possibly have happened in direct response to the HIQA report when the day before the Minister of Health admitted on national radio that he had not even read the report?<br />
<br />
The logistics required to make it such a response could not possibly have been implemented in 24 hours. Rather than a direct response to the HIQA report this was a cynically managed media response to divert attention away from the spat between HIQA and the HSE, and the abhorrent failures within Portloaise itself. In fact this response coming in the first quarter of 2015, highlights another HSE failure, as these measures were recommended to have been in place by the second quarter of 2014.<br />
<br />
<span style="color: #38761d;"><b>The transfer of governance to the Coombe Women's and Infants University Hospital was recommended on the 24th February by the Chief Medial Officer based on the fact that it was ALREADY agreed government policy that this would happen based on the hospital trust policy. </b></span><a href="http://health.gov.ie/wp-content/uploads/2014/03/IndHospTrusts.pdf">http://health.gov.ie/wp-content/uploads/2014/03/IndHospTrusts.pdf</a><br />
<br />
The process was initiated on the 28th February 2014, when staff from the Coombe were initially transferred to Portlaoise Regional Maternity Hospital<br />
<blockquote class="tr_bq">
"In a statement, the HSE said a new management team has been appointed on an interim basis in order to run the service from today.<br />
The new team consists of Michael Knowles who is currently General Manager in Naas Hospital and Angela Dunne, currently the Assistant Director of the Coombe Women and Infant University Hospital.<br />
The National Director for Acute Hospitals, Ian Carter, said “the new governance arrangements will bring the appropriate vigour to maternity services in Portlaoise Hospital.”"<br />
<a href="http://www.thejournal.ie/portlaoise-management-hse-1338134-Feb2014/">http://www.thejournal.ie/portlaoise-management-hse-1338134-Feb2014/</a></blockquote>
This new management team wa a result of the preliminary report to the Minister for Health relating to he issues that arose following a Primetime Investigates programme relating to Portlaoise Hospital Maternity Services on 30th January 2014.<br />
<br />
<div>
The Interim Report to the Minister for Health Dr James Reilly TD From Dr Tony Holohan Chief Medical Officer on the 24 February 2014 on "HSE Midland Regional Hospital, Portlaoise Perinatal Deaths (2006-date)"stated that<br />
<blockquote class="tr_bq">
"The overall conclusions in the Report are as follows: 1. Families and patients were treated in a poor and, at times, appalling manner with limited respect, kindness, courtesy and consideration. 2. Information that should have been given to families was withheld for no justifiable reason. 3. Poor outcomes that could likely have been prevented were identified and known by the hospital but not adequately and satisfactorily acted upon. 4. The PHMS service cannot be regarded as safe and sustainable within its current governance arrangements as it lacks many of the important criteria required to deliver, on a stand-alone basis, a safe and sustainable maternity service. (See Overall Recommendation 3). 5. Many organisations, including PHMS, had partial information regarding the safety of PHMS that could have led to earlier intervention had it been brought together. 6. The external support and oversight from HSE should have been stronger and more proactive, given the issues identified in 2007. " p. 10<br />
<a href="http://cdn.thejournal.ie/media/2014/02/portlaoise_perinatal_deaths.pdf">http://cdn.thejournal.ie/media/2014/02/portlaoise_perinatal_deaths.pdf</a></blockquote>
The recommendations of this report included the following<br />
<blockquote class="tr_bq">
"Recommendation O.R.3: A team should be appointed to run the PHMS pending implementation of
Recommendation O.R.4 below.
Recommendation O.R.4: PHMS should become part of a Managed Clinical Network under a singular
governance model with the Coombe Women & Infant University Hospital.
Recommendation O.R.5: Other small maternity services should be incorporated into managed clinical
networks within the relevant hospital group." p. 10 <a href="http://cdn.thejournal.ie/media/2014/02/portlaoise_perinatal_deaths.pdf">http://cdn.thejournal.ie/media/2014/02/portlaoise_perinatal_deaths.pdf</a></blockquote>
Overall recommendation 3 was expanded on:<br />
<blockquote class="tr_bq">
"In this regard the HSE should immediately put in place a transition team to take control of the
service at PHMS and to oversee the planning and execution of the orderly implementation of the
managed clinical network recommended below. The transition team should consist of appropriate
clinical and managerial expertise". p. 69 <a href="http://cdn.thejournal.ie/media/2014/02/portlaoise_perinatal_deaths.pdf">http://cdn.thejournal.ie/media/2014/02/portlaoise_perinatal_deaths.pdf</a></blockquote>
Overall recommendation 4 was expanded on, and the report recommends implementation of this in the second quarter of 2014<br />
<blockquote class="tr_bq">
"The number of births at PHMS shows that there is and will continue to be a need to have a
maternity service at Portlaoise Hospital which meets the requirement of good safety, patientcentred
and sustainable care. A decision to close the service would not be appropriate given the
scale of activity. Neither is it an option to maintain and develop the service under its current
governance arrangements given the findings and conclusions in this report.
Portlaoise Hospital is a constituent hospital of the Dublin Midlands Hospital Group. This Group also
includes the Coombe Women & Infant University Hospital. The development of a managed clinical
network within the Dublin Midlands Hospital Group, initially comprising the PHMS and the Coombe
Women & Infant University Hospital provides a sustainable solution to the leadership, staffing,
training, quality assurance, clinical standard and risk management issues identified in this report.
The implementation of the Establishment of Hospital Groups34 will ensure that the future service
needs of the whole population of each hospital group will be quantified and planned in a more
integrated fashion. The overarching system of clinical governance and enhanced communication
and cooperation between hospitals within the hospital group setting, will underpin the provision of
quality and safe healthcare.
The managed clinical network should consist of the following features: A single clinical service under the governance, direction and authority of the Master of
the Coombe. Capacity for medical, midwifery and other staff to be appointed to the network and to
rotate as required by service and training needs between sites. Training for junior doctors and midwives to happen on both sites. Common system of clinical governance i.e. policies, audit meetings, quality assurance,
incident reporting, incident management etc. with pooling of all data to ensure that all
quality assurance is on the basis of one single service- albeit operating on two sites. Risk stratification of patients attending PHMS to ensure that higher risk pregnancies
are dealt with at the Coombe site". p.69 <a href="http://cdn.thejournal.ie/media/2014/02/portlaoise_perinatal_deaths.pdf">http://cdn.thejournal.ie/media/2014/02/portlaoise_perinatal_deaths.pdf</a></blockquote>
<br />
Overall recommendation 5 was also expanded on and the report recommended implementation of this at the end of the second quarter of 2014<br />
<blockquote class="tr_bq">
"This Report recommends the urgent transition of Portlaoise Hospital as the first smaller hospital to
become part of a managed clinical network under the clinical governance of a larger hospital, in this
case, the Coombe Women & Infant University Hospital. A managed clinical network with the
features described above would provide a number of advantages for smaller units. It can provide
clinical governance, leadership, shared clinical guidance, shared training and processes for rapid
referral. In these circumstances, other small maternity services in the country should be
incorporated into a managed clinical network within the relevant hospital group. Given the findings
of this Report which are in part the result of small size and the challenge of sustaining services by
attracting and retaining staff, it is considered reasonable that work commence on integrating
smaller maternity units into systems of common governance in line with the planned hospital
networks. It should not await the outcome of further analysis by HIQA which is recommended
below." p. 70<br />
<a href="http://cdn.thejournal.ie/media/2014/02/portlaoise_perinatal_deaths.pdf">http://cdn.thejournal.ie/media/2014/02/portlaoise_perinatal_deaths.pdf</a> </blockquote>
The report also made these observations<br />
<blockquote class="tr_bq" style="background-color: white; border: 0px; margin-top: 15px; padding: 0px; vertical-align: baseline;">
"In the preparation of this Report a number of issues of concern emerged through meetings with
families and others. There were clear descriptions where patients felt backs were being turned; honest
accounts were not given; and unprofessional behaviours and language were frequent. Insensitivity and
a lack of empathy were common themes. Younger patients were not so much spoken to directly as
through their mothers and had the feeling of being “judged” by staff. There were even accounts of
senior clinical staff (more than one) inviting families to “sue”. There was also a lack of cultural
sensitivity. These accounts were not just applicable to the PHMS but also to the paediatric unit." <a href="http://cdn.thejournal.ie/media/2014/02/portlaoise_perinatal_deaths.pdf">http://cdn.thejournal.ie/media/2014/02/portlaoise_perinatal_deaths.pdf</a> </blockquote>
AIMSI are used to hearing these types of descriptions from service users of the Irish Maternity Services. Most health professionals prefer to keep their ears closed and believe that such reports are grossly over exaggerated. In fact many health care professionals feel that patients airing grievances with the maternity services should not happen in the media at all. Without the media, the alarming events at Portlaoise would never have come to light. We know that internal inquiries were carried out in Portlaoise with appallingly long time lags; averaging three years from incident to report. In one case the incident took six years to reach report stage. AIMSI will continue to liaise with the HSE whenever our input is welcome and appreciated. When it is not, we will continue to highlight lapses in care and safety in the media.<br />
<br />
Our press release in response to the HIQA report is here <a href="http://aimsireland.ie/hse-response-to-hiqa-report-on-portlaoise-hospital/">http://aimsireland.ie/hse-response-to-hiqa-report-on-portlaoise-hospital/</a><br />
<br />
To answer the question; what is AIMSI s response to the managed maternity network between the Coombe and Portlaoise (as recommended in 2014). Our response is that this can only be a good thing. Our hope is that this will ensure adherence to the National obstetric guidelines, primarily with respect to CTG, and to the new guideline for the use of syntocinin in labour. We also hope that the ethos of The Coombe as a forward thinking hospital, looking to encourage midwifery led options for low risk women will also transfer to Portlaoise. Recent developments in the Coombe have included water births, DOMINO, early transfer home and midwife led antenatal clinics. They are also the first hospital to have initiated a doula policy in Ireland. On May 7th they will be hosting the 8th Essence of Midwifery Care Conference looking at Changes, Choices, Childbirth in which many of these changes will be highlighted. AIMSI will be speaking at the conference.Or more information on the conference see <a href="http://www.nursingboard.ie/en/events-article.aspx?article=c19af0c9-a4f4-4361-9675-0d9552b5e5c6" target="_blank">.http://www.nursingboard.ie/en/events-article.aspx?article=c19af0c9-a4f4-4361-9675-0d9552b5e5c6</a><br />
<br /></div>
Anonymoushttp://www.blogger.com/profile/15102063693461334158noreply@blogger.com0tag:blogger.com,1999:blog-9022711156100944101.post-31892397503923476182015-03-19T16:26:00.004+00:002015-03-19T17:53:46.593+00:00Draft Clinical Guidelines for Maternity Care skirt around the issue of informed consent... Again.<h2>
Draft Clinical Guidelines for Maternity Care skirt around the issue of informed consent...Again.</h2>
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<span lang="EN-US" style="color: green; font-size: 16pt;"><span style="color: black;"><span style="background-color: white; color: #38761d;"><strong></strong></span></span></span> </div>
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<span lang="EN-US" style="color: green; font-size: 16pt;"><span style="color: black;"><span style="background-color: white; color: #38761d;"><strong>Today's Medical Independent ran a piece by Catherine Reilly, <em>"SCA concerned over Executive’s draft clinical oxytocin guideline"</em> in which a survey by the State's Claims Agency expressed concern that draft Irish clinical guidelines, on the use of syntocinon (oxytocin) in maternity services, have no reference to obtaining informed consent</strong></span><span style="font-size: small;"><span style="background-color: white; color: #38761d;"><strong>.</strong></span> </span></span></span></div>
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<span lang="EN-US" style="color: green; font-size: 16pt;"><span style="color: black; font-size: small;"><em>“There is no reference to obtaining informed consent in the draft guideline under development. Clearly, this is an area that must be addressed,” it stated. “In Ireland, a “substantial number” of claims suggest oxytocin as a causative/contributory factor, it also reported."</em></span></span></div>
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<span lang="EN-US" style="color: green; font-size: 16pt;"><em><span style="font-size: small;"></span></em></span> </div>
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<span lang="EN-US" style="color: green; font-size: 16pt;"><span style="color: black; font-size: small;"><span style="color: #38761d;"><strong>Further, the article references<em> </em>claims by a HSE spokesperson who said</strong></span> <em>"at present it is not aware of any national or international guidelines to guide practice on oxytocin augmentation in labour." </em></span></span></div>
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<span lang="EN-US" style="color: green; font-size: 16pt;"><span style="color: #38761d; font-size: small;"><strong>A claim that AIMS Ireland have previously refuted on this blog, here: </strong></span></span><span lang="EN-US" style="color: green; font-size: 16pt;"><span style="color: black; font-size: small;">"FAO: HSE - A helpful synopsis of well respected Clinical Guidelines on the use of Synthetic Oxytocin" </span></span></div>
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<span lang="EN-US" style="color: green; font-size: 16pt;"><span style="color: black; font-size: small;"><a href="http://nocountryforpregnantwomen.blogspot.ie/2014/12/hse-unaware-of-international-guidelines.html">http://nocountryforpregnantwomen.blogspot.ie/2014/12/hse-unaware-of-international-guidelines.html</a></span></span></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: green; font-size: 16pt;"><em><span style="color: black;">Irish National Clinical Guidelines - Informed Decision Making</span></em></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: green; font-size: 16pt;">In the past, AIMS Ireland provided recommendations to Irish draft clinical guidelines - for the VBAC guidelines and Pregnancy and Obesity guideline (2011).</span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: green; font-size: 16pt;">In both instances, AIMS Ireland commented on how guidelines failed to acknowledge informed consent / informed refusal; a key principal of patient centred care. AIMS Ireland recommended that each guideline reference informed decision making, suggesting wording from NICE Clinical Guidelines as a high quality resource. In neither instance were these recommendations implemented. </span></b></div>
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<span lang="EN-US"><strong><span style="color: black; font-size: large;">AIMS Ireland Recommendations to draft clinical guidelines (2011):</span></strong> </span><br />
<span lang="EN-US"></span><br />
<span lang="EN-US" style="color: green; font-size: large;"><o:p><strong>Below is our recommendation following consultation for the Pregnancy and Obesity draft guideline, submitted in 2011, in which we clearly reference this issue.</strong></o:p></span></div>
<br />
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<span lang="EN-US"><span style="color: #38761d;"><strong>"1.
There is no reference for women’s right to informed consent and/or informed
refusal or women-centred care on recommendations made within the Guideline.
AIMS Ireland would like to see the inclusion of women’s rights to informed
consent/refusal and an outline of women-centred care principals within <u>each</u>
of Ireland’s Guidelines as per NICE Guideline 55, Intrapartum Care. NICE have
used the following introductory forward for their Guideline which we feel is
excellent:</strong></span> "<o:p></o:p></span></div>
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<i style="mso-bidi-font-style: normal;"><span lang="EN-US" style="color: green; font-family: "Times New Roman",serif;"><o:p> </o:p></span></i></div>
<i style="mso-bidi-font-style: normal;"><span lang="EN-US" style="font-family: "Times New Roman",serif;">"Women and their families should
always be treated with kindness, respect and dignity. The views, beliefs and
values of the woman, her partner and her family in relation to her care and
that of her baby should be sought and respected at all times. The woman should
be fully involved in planning her birth setting so that care is flexible and
tailored to meet her needs and those of her baby. <o:p></o:p></span></i><br />
<br />
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<i style="mso-bidi-font-style: normal;"><span lang="EN-US" style="font-family: "Times New Roman",serif;"><o:p> </o:p></span></i></div>
<i style="mso-bidi-font-style: normal;"><span lang="EN-US" style="font-family: "Times New Roman",serif;">Women should have the opportunity
to make informed decisions about their care and any treatment needed. If a
woman does not have the capacity to make decisions, healthcare professionals
should follow the Department of Health guidelines ‘Reference guide to consent for
examination or treatment’ (2001) (available from <u>www.dh.gov.uk</u>). </span></i><br />
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<i style="mso-bidi-font-style: normal;"><span lang="EN-US" style="font-family: "Times New Roman",serif;"><o:p> </o:p></span></i></div>
<i style="mso-bidi-font-style: normal;"><span lang="EN-US">Good
communication between healthcare professionals and the woman and her family is
essential. It should be supported by the provision of evidence-based written
information tailored to the needs of the individual woman. Care and information
should be appropriate to the woman, and her cultural practices should be taken
into account. All information given should also be accessible to women, their
partners and families, taking into account any additional needs such as
physical, cognitive or sensory disabilities and inability to speak or read
English."</span></i><br />
<i style="mso-bidi-font-style: normal;"><span lang="EN-US"></span></i><br />
<span lang="EN-US"><span style="font-size: large;"><strong>#WMTY14 Survey - Consent</strong></span></span><br />
<i style="mso-bidi-font-style: normal;"><span lang="EN-US"></span></i><br />
<strong>
</strong><span style="color: #38761d;"><strong>In the 2014 AIMS Ireland survey, of nearly 3,000 women whom have given birth in Ireland from 2010-2014, <u>What Matters to YOU? 2014</u>, the issue of informed decision making (informed consent and informed refusal) was looked at in depth. </strong></span><br />
<span style="color: #38761d;"><strong></strong></span><br />
<span style="color: #38761d;"><strong>The survey found that informed consent and informed refusal remain an issue of concern in Irish Maternity Services, with the use of Syntocinon / Oxytocin referenced in comments from women as a specific issue. </strong></span><br />
<span style="color: #38761d;"><strong></strong></span><br />
<span style="color: #38761d;"><strong>Many women expressed that while basic consent was sought, they felt they did not have a choice. Results also showed a failure to have full benefits, risks, and potential implications for having and not having a test, treatment or procedure explained to them.</strong> </span><br />
<br />
<em><span style="font-size: x-small;">"I repeatedly impressed my wish not to have oxytocin and this was disregarded and I was treated like I was being silly. I reluctantly agreed but I felt badgered into submission rather than consenting.”</span></em><br />
<em><span style="font-size: x-small;"></span></em><br />
<em><span style="font-size: x-small;">“Formally yes (consent was obtained), but I wasn’t in favour of being induced, it was never presented as an option but rather as a decision made on my behalf.”</span></em><br />
<em><span style="font-size: x-small;"></span></em><br />
<span style="color: #38761d;">The Full #WMTY14 survey results on Consent can be read here:</span> <a href="http://aimsireland.ie/what-matters-to-you-survey-2015/womens-experiences-of-consent-in-the-irish-maternity-services/">http://aimsireland.ie/what-matters-to-you-survey-2015/womens-experiences-of-consent-in-the-irish-maternity-services/</a><br />
<br />
<span style="color: #38761d;"><strong>In the same survey, 44.6% of first time mothers surveyed said they received Syntocinon / Oxytocin in the first stage of labour, while 20.4% of first time mothers surveyed said they received Syntocinon / Oxytocin during the second stage (pushing). <span style="font-size: large;">*</span> </strong></span><br />
<span style="color: #38761d;"><strong></strong></span><br />
<span style="color: #38761d;"><strong>These figures are worryingly high and suggest an inappropriate use of synthetic oxytocin outside of evidence based recommendations. </strong></span><br />
<strong><span style="color: #38761d;"></span></strong><br />
<strong><span style="color: #38761d;">All women should be fully informed of the benefits and risks of synthetic oxytocin in order to facilitate women in informed choice. </span></strong><br />
<strong><span style="color: #38761d;"></span></strong><br />
<br />
<span style="color: #38761d;">Syntocinon/ Pitocin /Oxytocin is a synthetic version of a hormone present in labour which stimulates contractions. Synthetic Oxytocin is routinely used in Irish maternity units to synthetically start (induce) or speed up labour. It is a common component of Active Management of Labour, in which a woman's labour is managed by health care providers, using intervention and drugs, to 'speed up' process. Synthetic Oxytocin is linked to an increase of adverse effects for women. A recent study has also suggested that synthetic oxytocin is an independent risk factor for adverse effects in full term newborns. <br />
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<br />
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* Syntocinon/Oxytocin is a common drug used in maternity units to either induce labour or to accelerate labour. <br />
* ACOG have cited Sytocinon/oxytocin is an independent risk factor to adverse effects on babies and also is shown to increase adverse effects in birthing women. <br />
* Syntocinon is an independent risk factor for unexpected admission to NICU for fullterm infants lasting more than 24 hours and lower APGAR scores. <br />
* Syntocinon/Oxytocin is an active agent used in Irish units to manage how long women labour. <br />
* In hospitals with a strong Active Management of Labour ethos, half of women will have Syntocinon/Oxytocin in the first stage of labour. <br />
* Sytocinon is routinely used in Irish units by injection to manage the birth of the placenta (3rd stage of labour). The majority of women in Ireland have a managed 3rd stage and many local units have it as policy that the 3rd stage should be managed.<br />
* The makers of syntometrine (syntocinon) specifically state it is not safe to give to women who are breastfeeding/planning to breastfeed their babies</span><br />
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<strong><span style="color: #38761d;"></span></strong><br />
<span style="color: #38761d;"><strong>* </strong>Note, these figures are total figures for all first time mothers surveyed, inclusive of those using midwife led units and homebirth where syntocinon is not used.</span><br />
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<span style="color: black; font-size: large;"><strong>AIMS Ireland Recommendations </strong></span><br />
<strong><span style="font-size: large;"></span></strong><br />
<span style="color: #38761d;"><strong>It is inconceivable that a health system can stand over guidelines which fail to protect the basic rights of those using the service. Women make good decisions. Provisions must be in place to ensure that each woman is supported to make the best decision for her and her baby in her specific circumstances.</strong></span><br />
<span style="color: #38761d;"><strong></strong></span><br />
<span style="color: #38761d;"><strong>AIMSI would recommend that the issue of consent and provision of unbiased, complete information become areas of importance with Irish maternity units. “Hospital Policy” should not over-ride or give illusion of consent and individual choice for care options, admission, and opting in or out of procedures, tests and treatments. Consent policies should be revisited and printed material become available for every woman booking into maternity units.</strong></span><br />
<span style="color: #38761d;"><strong></strong></span><br />
<span style="color: #38761d;"><strong>Women should be informed of all the benefits, risks, and potential implications for themselves and their baby to have or not have procedures, tests, treatments, and interventions in order to make the best decisions in their circumstances. Women cannot truly give consent unless they understand what it is they are consenting to and are supported in these decisions by health care providers.</strong></span><br />
<strong><span style="color: #38761d;"></span></strong><br />
<span style="color: #38761d;"><strong>AIMS Ireland recommend strongly that a National clinical guideline is implemented to support the principals of informed decision making in Irish maternity services. To facilitate guidance of this, obstetric units should be under obligation to implement already existing National clinical guidelines for evidence based care rather than routine policy which relies heavily on medical management.</strong></span><br />
<strong><span style="color: #38761d;"></span></strong><br />
<strong><span style="color: #38761d;"></span></strong><br />
Full article in Medical Independent here: <a href="http://www.medicalindependent.ie/61652/sca_concerned_over_executives_draft_clinical_oxytocin_guideline">http://www.medicalindependent.ie/61652/sca_concerned_over_executives_draft_clinical_oxytocin_guideline</a>Anonymoushttp://www.blogger.com/profile/05874066401296452492noreply@blogger.com0tag:blogger.com,1999:blog-9022711156100944101.post-45545090192036583032015-03-13T18:22:00.004+00:002015-03-13T18:22:46.756+00:00Guest Blog by Jo Murphy Lawless: National Healthcare Charter for Maternity Care - "An 'opportunity to contribute' ????? <div style="text-align: left;">
<strong>Guest Blog post by Jo Murphy Lawless, Trinity College Dublin: </strong></div>
<div style="text-align: left;">
<strong>National Healthcare Charter for Maternity Care - "An 'opportunity to contribute' ?????</strong> </div>
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<br />
<div>
'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. ' Irish Times, 2 March, 2015</div>
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Sounds useful doesn't it?</div>
<div>
</div>
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The reality is this:</div>
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</div>
<div>
1. We have had a so-called 'Patients Charter' in this godforsaken jurisdiction since 1992, published then by the Department of Health, and it made not a jot of difference to the long-suffering Irish public (one of the clauses in that original 1992 Charter is that everyone is entitled to a specified individual appointment time in all outpatients sections of all our hospitals.; so that was a great success as a policy, wasn't it? Ask women in our antenatal clinics around the conutry, let alone women in breast clinics and so on how long they wait in cattle mart conditions?</div>
<div>
</div>
<div>
2. The whole notion of 'patients charters' was a very suspect emollient to broken health services from the late 1980s in the UK, when the first steps were taken in the NHS and elsewhere to privatise. Its focus was the individual as a 'consumer' concerned only with her own needs and not with the needs of the community as a whole. They were designed to limit patient dissatisfaction to a menu of complaints and not to investigating how and why</div>
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</div>
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3. That 1992 Department of Health Charter here drew on what was already a politically bankrupt approach to the problems of health services.</div>
<div>
</div>
<div>
4. What women wanted for their maternity services was thoroughly canvassed in the run up to the publication of the 1997 A Plan for Women's Health; workshops were held round the country. to no avail. Nothing changed. Women's voices in that kind of empty exercise decorated with the word' consultation' were all too readily sidestepped.</div>
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</div>
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5. And the HSE is reviving this tattered and useless set of approaches now?</div>
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</div>
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And the NWCI is signing up to this paper exercise??</div>
<div>
</div>
<div>
Such disheartening news for International Women's Day, given all we have endured of scandals which have cost women their lives, their babies’ lives, and families’ well-being since Tania McCabe’s tragic death in 2007.</div>
<div>
</div>
<div>
We need much tougher and realistic engagements, at the very least the setting up of a maternity services committee, integrated directly into local policymaking and chaired by women who have used our maternity services. One such is now in place in Saolta University Healthcare Group in the west, where policies can be interrogated by women users of the maternity services, using a solid evidence base, and then getting those policies reformed, monitoring that reform process.</div>
<div>
</div>
<div>
The scope needs to be much wider. Human rights in patients care is a far more appropriate frame of reference - see <a href="http://www.hhrjournal.org/2013/12/10/human-rights-in-patient-care-a-theoretical-and-practical-framework/" saprocessedanchor="true" target="_blank"><span style="color: #1155cc;">http://www.hhrjournal.org/<wbr></wbr></span><span style="color: #2288bb;">2013/12/10/human-rights-in-<wbr></wbr></span><span style="color: #2288bb;">patient-care-a-theoretical-<wbr></wbr></span><span style="color: #2288bb;">and-practical-framework/</span></a></div>
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</div>
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<span style="color: #555555;"> Jo Murphy-Lawless, TCD, 8 March 2015,</span> </div>
Anonymoushttp://www.blogger.com/profile/05874066401296452492noreply@blogger.com1tag:blogger.com,1999:blog-9022711156100944101.post-66522324734066947922015-03-13T18:07:00.002+00:002015-03-13T18:10:28.158+00:00Guest Blog by Jo Murphy Lawless: National Healthcare Charter for Maternity Care - "An 'opportunity to contribute' ????? <strong>National Healthcare Charter for Maternity Care - "An 'opportunity to contribute' ?????</strong> <br />
<br />
'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. ' Irish Times, 2 March, 2015<br />
<br />
Sounds useful doesn't it?<br />
<br />
The reality is this:<br />
<br />
1. We have had a so-called 'Patients Charter' in this godforsaken jurisdiction since 1992, published then by the Department of Health, and it made not a jot of difference to the long-suffering Irish public (one of the clauses in that original 1992 Charter is that everyone is entitled to a specified individual appointment time in all outpatients sections of all our hospitals.; so that was a great success as a policy, wasn't it? Ask women in our antenatal clinics around the conutry, let alone women in breast clinics and so on how long they wait in cattle mart conditions?<br />
<br />
2. The whole notion of 'patients charters' was a very suspect emollient to broken health services from the late 1980s in the UK, when the first steps were taken in the NHS and elsewhere to privatise. Its focus was the individual as a 'consumer' concerned only with her own needs and not with the needs of the community as a whole. They were designed to limit patient dissatisfaction to a menu of complaints and not to investigating how and why<br />
<br />
3. That 1992 Department of Health Charter here drew on what was already a politically bankrupt approach to the problems of health services.<br />
<br />
4. What women wanted for their maternity services was thoroughly canvassed in the run up to the publication of the 1997 A Plan for Women's Health; workshops were held round the country. to no avail. Nothing changed. Women's voices in that kind of empty exercise decorated with the word' consultation' were all too readily sidestepped.<br />
<br />
5. And the HSE is reviving this tattered and useless set of approaches now?<br />
<br />
And the NWCI is signing up to this paper exercise??<br />
<br />
Such disheartening news for International Women's Day, given all we have endured of scandals which have cost women their lives, their babies’ lives, and families’ well-being since Tania McCabe’s tragic death in 2007.<br />
<br />
We need much tougher and realistic engagements, at the very least the setting up of a maternity services committee, integrated directly into local policymaking and chaired by women who have used our maternity services. One such is now in place in Saolta University Healthcare Group in the west, where policies can be interrogated by women users of the maternity services, using a solid evidence base, and then getting those policies reformed, monitoring that reform process.<br />
<br />
The scope needs to be much wider. Human rights in patients care is a far more appropriate frame of reference - see <a href="http://www.hhrjournal.org/2013/12/10/human-rights-in-patient-care-a-theoretical-and-practical-framework/" saprocessedanchor="true" target="_blank"><span style="color: #1155cc;">http://www.hhrjournal.org/<wbr></wbr></span>2013/12/10/human-rights-in-<wbr></wbr>patient-care-a-theoretical-<wbr></wbr>and-practical-framework/</a><br />
<br />
<br />
<span style="color: #555555;"> Jo Murphy-Lawless, TCD, 8 March 2015,</span>Anonymoushttp://www.blogger.com/profile/05874066401296452492noreply@blogger.com0