Friday, 2 December 2016

Additional Information regarding Fact Check: Ireland's safety record on maternal health

AIMS Ireland were contacted with regards to the Factcheck on a leaflet used by anti-choice campaigners highlighting an excellent record of safety in Irish maternity services.

The Factcheck can be read here:

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.

We have not had a response from Factcheck (2 weeks) so are publishing the additional information provided to Factcheck into the public domain.

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.

Hi Dan,

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.

AIMS Ireland is a maternity rights organisation which also provides advocacy to women within the continuum of maternity services.

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.

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.

Ireland is ranked joint 6th in WHO data.

This ranking is made up of a 31 year average
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.

Australia 6 Germany 6 Norway 5

Austria 4 Greece 3 Poland 3

Belarus 4 Iceland 3 Slovakia 6

Belgium 7 Italy 4 Spain 5

Canada 7 Japan 5 Sweden 4

Cyprus 7 Israel 5 Switzerland 5

Czech Rep 4 Kuwait 4 United Arab Emirates 6

Denmark 6 Montenegro 7

Finland 3 Netherlands 7

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.

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.

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.

Maternal Morbidities MAMMI Study Ireland 2016

1/7 women in Ireland who die, die from suicide
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.
Ireland has the highest rates of postnatal depression in the OECD
4/10 women who give birth in Ireland are readmitted to hospital for their own health.
10% of maternal deaths in Ireland are due to maternal haemorrhage
Major Obstetric Haemorrhage (MOH) has increased from 1.5% to 4.1% in Ireland from 2001-2011
24% of MOH in Ireland are admitted to the UCU (near misses)
11.2% of MOH have hysterectomy
The National rate of MOH is 2.6 per 1000
Almost 2/3 of women report sexual health problems post birth. 1 in 5 women reported painful sex a year following birth.
Anal incontinence 12% of women who gave birth in Ireland

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.

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.


Jene and Sinéad

** In addition, AIMS Ireland would like to reiterate that Ireland's ranking in WHO documentation is based on a 31 year average. 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 only since 2009. 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.

Additional information on MDE Ireland ia available to read here:

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.

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.

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.
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.

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.

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.

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. 

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.

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.

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.

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.

There is no valid reason for the fact that though symphysiotomy was dropped and even banned as a procedure in other Western countries, it  continued to be used in Ireland as late as the 1980’s, no matter how frequent its use was.  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.

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”.

Women should not be suffering either emotionally or physically after childbirth in Ireland.