Monday, 30 September 2013

AIMS Ireland - why we marched for choice on Sept 28th

AIMS Ireland - why we marched for choice on Sept 28th


AIMS Ireland are an organization committed to supporting all women in all choices in maternal health, autonomy for women, and evidence based care practices in issues surrounding maternity services. Maternal health/maternity services covers a wide spectrum of care and care options - from fertility, reproductive health, pregnancy, labour, birth, postpartum and beyond - some queries extending into physical complaints as the result of childbirth decades following the birth experience.  
AIMS Ireland accept that there are times in which to maintain this commitment of support to women, some may feel disconnect. We also accept that taking a stand on a particular position, practice, incident can and will cause some fallout in some areas of support. However, AIMSI firmly believe that in order offer full support to women and campaign for improvements in maternity services, we must recognize all women in the right to autonomy of choice.  The 8th Amendment affects all pregnant women - your birth choices, your right to accept or refuse a test or treatment, your right to individual assessment, your right to be pregnant or not.

* The issues of abortion and the 8th Amendment are intertwined with Irish maternity services. Immediately following the death of Savita Halappanavar , AIMSI held an emergency meeting to discuss our position. The majority felt that AIMSI must continue to support all women in choice and autonomy, not only in planned healthy pregnancies, but also where there are fatal foetal abnormalities, risk to life and health, and in terms of unplanned pregnancy, to continuing a pregnancy or  to have access to safe legal abortion without travel.
* In spring, our position became heightened when a HSE draft consent policy was circulated the day before a vbac woman, Mother A, was brought before an emergency sitting of the High Court to force a Caesarean Section. The Consent Policy for pregnant women directly cited the 8th amendment and deemed the High Court and Protective Services as appropriate action for pregnant women whom refuse medical recommendations. AIMSI have since had 5 more mothers come forward whom have been threatened with High Court or child protective services over their birth choices. In more than one instance, these threats have been carried out. The consent policy illustrates how the 8th Amendment takes away the rights of women to decide how or where they given birth - where they feel safest, what they decide to be best for themselves and their baby.
* AIMSI have spoke with other women who were left in limbo during miscarriage of an unviable pregnancy. One woman, in the same unit as Savita, was left over 2 weeks and eventually travelled to Spain to have a D&C.
* Informed consent continues to be an issue in Irish Maternity services - many women are cited 'risk to baby' as a reason why their right to informed choice/consent/refusal has not been respected.
AIMS Ireland have been fully transparent in our position.
* AIMSI have submitted two submissions to Oireachtas following the death of Savita Halappanavar.

- The first was made in January 2013 to the Joint Oireachtas Committee for Health on the expert group. 

- The second was made in May 2013 to the Oireachtas committee on the Protection of Life Bill 2013.

To aid transparency, AIMSI's submissions were immediately published on AIMSI facebook , twitter, and were available on the Oireachtas website which we linked on numerous occasions through social media. These submissions are also available on our website to read here:
*AIMSI made a presentation to the Home Birth Association Conference discussion the 8th Amendment and autonomy/choice
* AIMSI have regularly discussed the 8th Amendment and Consent Policy in blog posts, on social media, and in articles.
* AIMS Ireland have also signed our name to several letters on the topic.
Other Queries on AIMS Ireland social media and membership:
AIMS Ireland Facebook:
There have been queries with regards to Censorship - that AIMS Ireland will remove comments from Facebook discussion:
Regular Users of the AIMSI facebook page will know that AIMSI do not delete nor censor posts in discussion/debate.
AIMSI welcomes all discussion and debate from all positions from members and users of our FB page.
Users should feel free to express themselves, their opinions safely.
The only posts which are deleted are those which are advertising a product/course/class to women for profit.
Membership and voting rights:
There are 1800+ followers on the AIMS Ireland facebook page. Membership is separate and vital in order to maintain the services AIMS Ireland offers to women. Paid membership is €20, or €10 for students. Paid members  may avail of a closed member's group and have a vote for committee roles and positions. Anyone who is currently paid to date has been added to the member group.  Any new members who feel strongly about this issue and no longer wish to be AIMS Ireland members, please contact us for a refund.
Any further queries on this issue please contact or leave a reply on this blog post.
Thank You,
AIMS Ireland Team

Friday, 27 September 2013

National Consent Policy - section 7.7.1 - Refusal of Treatment in Pregnancy

National Consent Policy has been fully implemented.
This is the most current wording.

National Consent Policy:

Page 41: 7.7.1 Refusal of Treatment in Pregnancy

The consent of a pregnant woman is required for all health and social care interventions.
However, because of the constitutional provisions on the right to life of the "unborn" (12), there is significant legal uncertainty regarding the extent of a pregnant woman's right to refuse treatment in circumstances in which the refusal would put the life of a viable foetus at serious risk. In such circumstances, legal advice should be sought as to whether an application to the High Court is necessary.

Citation: (12) Article 40.3.3 of the Irish Constitution (1937)

Relevant factors to be considered in this context may include whether the risk to the life of the unborn is established with a reasonable degree of medical certainty, and whether the imposition of treatment would place a disproportionate burden or risk of harm on the pregnant woman.

Beverley Beech Responds to Daily Mail article "Giving Birth at Home isn't Bad per se"

While on a visit to Dublin I read your article ‘Giving birth at home isn’t bad per se.  What’s bad is being miles from the ER if anything goes wrong
Your article opens with the comment from a coroner that midwives should go to home births in pairs.  While it may be tempting to think that two midwives are better than one, there is no research evidence at all to support that view.  Indeed, this recommendation was first adopted in the UK when it was realised that home births were cheaper than hospital deliveries and in order to increase the costs this recommendation was made.
When deciding whether or not to birth at home the parents need to balance the risks of home birth with the risks of hospital deliveries.  The chances of a baby dying at a home birth is exceedingly small and that risk is far too often the focus of warnings about the dangers.  For first babies it is slightly more risky than in hospital (but not significantly different) but for subsequent babies it is far safer to birth at home or in a free-standing midwifery unit.  While transfer to hospital in labour is often painful and very stressful, particularly if there is concern about the baby or the mother, the majority of women who do transfer from a home birth to hospital are not doing so because there is an emergency, but because circumstances may have changed and the midwife is recommending the hospital – just in case.  Furthermore, every women booked for a hospital delivery transfers to hospital in labour, and no-one has assessed the risks of doing that.   Those babies born at the roadside are held up in the press as something wonderful, no-one suggests that the mother and baby would have been far safer not moving but giving birth at home instead.
Very few journalists write articles about the risks of hospital deliveries, particularly for the mother, or about babies who are induced far too soon and end up spending time in special care units.  You mentioned the rising caesarean section rates.  I would suggest that if there was a similar rise in major abdominal surgery in the rest of the population there would be a parliamentary enquiry and public outrage yet, because it is childbirth this often unnecessary and avoidable major surgery is accepted and rarely questioned.
In the  Confidential Enquiry into Maternal Death suicide was the leading cause following childbirth, and in the latest edition it is still a major problem.  AIMS had persuaded the Enquiry to look at maternal death following childbirth up to three years after the birth, but the statistics are only gathered up to one year; and, of course, Irish statistics are barely worth the paper upon which they are written.  We believe that many more deaths would be recorded were the enquiry period extended.  From our records postnatal depression and post traumatic stress features in far too many of the appeals to our help line.
While I acknowledge that a hospital is the place to be if a woman has a problem pregnancy or birth but for low-risk women a large centralised hospital is the last place she should be.  The Birthplace Study revealed that, and now a recent study from Australia has shown that one-to-one midwifery care produces the best outcomes with fewer caesareans, 30% fewer inductions, less severe blood loss and the women were more likely to breastfeed their babies.
It is time that articles in the press drew women’s attention to the risks they are taking booking into a hospital for the birth.
Yours, Beverley Lawrence Beech
Hon Chair Association for Improvements in the Maternity Services
Birthplace in England Collaborative Group (2011)  Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study, British Medical Journal, 343:d7400 doi: 10.1136/bmj.d7400
Tracy Prof SK et al.  Caseload midwifery care versus standard maternity care for women of any risk: M@NGO, a randomised controlled trial, The Lancet, 17 Sept 2013, doi:10.1016/S0140-6736(13)61406-3

Tuesday, 17 September 2013

AIMS Ireland response to the 'home versus hospital' debate

AIMS Ireland response to the ‘home versus hospital birth’ debate
(Tuesday, 17 September 2013) AIMS Ireland today expressed their continued support of women making informed decisions on where and how they give birth in Ireland. In recent weeks, the media have given the topic of ‘home versus hospital birth’ extensive coverage. The conclusions drawn by most commentators is that there must be an expansion in health infrastructure to support women in making informed birth choices.
The public attention given to the landmark High Court case taken by Aja Teehan and the coverage of the recent Coroner’s inquest in the tragic death of baby Kai David Heneghan in Mayo have dominated the debate and have detracted from the real issues of: (i) Ireland’s maternity care system being almost solely obstetric led and (ii) a woman’s right to make responsible, informed choices in pregnancy and childbirth.

The HSE are currently not offering midwifery-led care options to the majority of women; either at home or in hospital. Yet we know from repeated high quality, robust research that midwifery-led care options (as opposed to midwife attended care in obstetric-led units) is the safest model of care for 85% of women. In the limited locations where such care is available the criteria for accessibility has become increasingly restrictive since the introduction of the Nurses and Midwives Act 2011. This restrictive criteria is not evidence-based and these women are denied midwifery-led care without individual assessment. For many women, a traumatic primary experience in an obstetric led unit is one of the main reasons for choosing midwifery-led care or home birth in a subsequent pregnancy. Yet the physical consequences of a an obstetric led birth often forces a woman back into the same care model irrespective of an informed choice.
In addition to the restrictive criteria, a recently published National Consent Policy document clearly states that the HSE has the authority to deny a pregnant woman her inalienable right to refuse medical treatment due to the legal uncertainty inherent in Article 40.3.3 of the Irish Constitution, whereby the life of the unborn is equal to that of the mother. Women are unaware of the fact that their basic maternal and reproductive rights are qualified by Irish law and the impact this has on their right to choose how and where they birth.
Obstetric-led care has its place in all maternity services and must be available for women who need or want this type of care. However midwifery-led and home birth care must also be provided as an option to all women in Ireland. These care options must be supported by an infrastructure which enables a seamless maternity service for women. 

Failing to provide appropriate care options affects all women. Our current two tiered obstetric base system means that:
  1. No choice is afforded to women who prefer to birth under a midwifery-led continuity of care model 
  2. Women who do not need or want obstetric-led care are using valuable resources and are taking up time and beds from women who need or want a obstetric-led care model
  3. Women who choose midwifery-led care and home birth may have difficulty accessing these services in the first place, and if they do secure the service face numerous other administrative obstacles that the HSE needs to resolve..
If the maternity services are to be more equitable, there has to be more weight given to what women and families want in their maternity services. Many women are satisfied with the care they are receiving but this does not, and should not, silence the many women who are extremely unhappy with their maternity experience. These women’s voices are integral to the development of a fair and equitable maternity service that listens to and collaborates with women on their birth choices.

AIMS Ireland believes that maternity services should be based on robust and up-to-date medical evidence that provides women and families with choices in how and where they give birth. The safety and health of both mother and baby are always the priority, however, good governance should never replace the right to informed consent and informed refusal of any consumer of the health services in Ireland.
For further information:
Krysia Lynch
087 754 3751

Friday, 6 September 2013

Press Statement: AIMS Ireland response to court decision on costs in relation to Aja Teehan vs HSE

AIMS Ireland response to court decision on costs in relation to Aja Teehan vs HSE
(Friday, 6 September 2013) AIMS Ireland today welcomed the decision of Ms Justice Iseult O’Malley to not award costs against Aja Teehan in her High Court case for individual assessment by the HSE in her care pathway for the birth of her baby. This was a public interest case with significant repercussions for women seeking evidence-based maternity care in Ireland.
The public attention of this case has been solely focused on homebirth and has detracted from the real issue of women’s rights to make responsible, informed choices in pregnancy and childbirth. Best practice clearly states that patients should be assessed on an individual basis on their current health, current medical conditions, as well as their previous history. The HSE are not providing women with individual assessment, a fundamental principle in evidence based care.
AIMS Ireland is a volunteer run charity relying solely on the donations of members of the public to fund our work. Our financial situation currently stands at less than €500 to continue to support women and we would like to express our deepest gratitude to the men, women and families who have freely given their time to come out and support Aja Teehan and AIMS Ireland in this landmark case.
AIMSI would like to express our gratitude to Aja Teehan and Charles Brand for taking this landmark case. We wish them the very best in the future and on their upcoming birth.
For further information:
Krysia Lynch
AIMS Ireland
Tel: 087 754 3751