Media and Politicians please make informed decisons. Review of Maternity Services is an opportunity for change & reform - not more of the same.

PLEASE READ AND SHARE to media and politicians: 

 

AIMS Ireland published a press release following the HIQA report yesterday. We note it was printed in several media outlets, thank you! However, we are dismayed to see that in ALL instances, bar the blog of Clare Daly, the need for reform of Ireland's maternity care model has been left out. We have heard numerous reports from obstetricians and politicians in the past 24 hrs using this report to call for more obstetricians. This presents a big problem - its a reactionary plaster which in the long run, WILL fail. More obstetricians will not save mothers or babies. It will cost more. This is an opportunity for CHANGE. The maternity services need REFORM away from an obstetric care model.

Here's why:

The obstetric led care model is NOT evidence based. It is shown time and time again to cost MORE and to be LESS SAFE for the majority of mothers and babies.

Pregnancy is not an illness. The majority of pregnancies and births are healthy and low risk - these women do NOT need surgical health care providers who specialise in high risk pregnancy/birth looking after them (obstetric care model). In fact, research shows that when healthy women in healthy pregnancies and birth are attended by an obstetrician, risk INCREASES. This leads to a DOMINO effect - increasing demands on our services and introduces risks to women and babies.

EXAMPLES:
 
1)Adverse affects from interventions and surgical births mean that MORE women will require medical aftercare for physical and mental health reasons.

2) More interventions and surgical births means that MORE women will NEED specialized care in future pregnancies = requiring more specialists on specialist wages, more surgeries, more postnatal beds as women stay for longer durations, and more NICU funding.

 3) Increase in surgical births significantly increases risks for WOMEN in current birth AND for future pregnancies. Surgical birth makes women more likely to suffer a severe maternal morbidity and require admission for high dependency units. Many interventions and surgical birth leads to an increase in NICU admission for babies.

Obstetricians are surgeons and experts in high risk complications. Having a maternity system that requires ALL women to see a specialist surgeon/obstetricians takes specialist surgeons/obstetricians AWAY from the very women who genuinely need this specialized expert care.

Midwives are the experts of healthy pregnancy and birth. Not obstetricians. Obstetricians are highly skilled and play and important role in maternity services - but they are NOT QUALIFIED to provide care or create policy for the majority of healthy women enjoying healthy pregnancies and births.

 Midwife led care models have been shown time and time again to be of MORE benefit to women, have less adverse affects, and are more cost efficient. Midwife led care is the RECOMMENDED care model for the large majority of women - backed by HIGH QUALITY and robust research.

The medical (obstetric) care model is not working. We have hired the wrong person for the job and it is having a negative affect on the physical and psychological health of women and babies.

We need REFORM - not more of the same.

The media and politicians hold incredible power - they control what information is presented to the public and create policies that directly affect the care women receive in maternity care. Please be INFORMED. Make INFORMED DECISONS.

Information:

Midwives, not medicine, promote healthier pregnancies and births in Sweden: http://www.examiner.com/article/midwives-not-medicine-promote-healthier-pregnancies-and-births-sweden

Midwife led care delivers best outcomes, Cochrane review finds: http://www.bmj.com/content/347/bmj.f5321

Midwife-led versus other models of care for childbearing
women (Review): http://apps.who.int/rhl/reviews/CD004667.pdf

An evaluation of midwifery-led care -The Report of the MID-U Study (HSE): http://www.hse.ie/eng/services/Publications/services/Hospitals/midwifery%20north%20east.pdf

Who should provide routine antenatal care for low-risk women, and how often? A systematic review of randomised controlled trials: http://onlinelibrary.wiley.com/doi/10.1046/j.1365-3016.12.s2.6.x/full

AIMS Ireland welcomes HIQA Savita report and recommendations: Condemning Irish Maternity Services as being 'outdated', 'patently unsafe', and a 'geographic lottery.'

PRESS STATEMENT

 

AIMS Ireland welcomes HIQA Savita report and recommendations: Condemning Irish maternity services as being 'outdated', 'patently unsafe', and a 'geographic lottery'. 

 

(Wednesday 9 October 2013) The Association for Improvements in the Maternity Services Ireland (AIMS Ireland) today welcomed the HIQA report into the safety, quality and standards of care of Savita Halappanavar and called for the HSE to immediately conduct a full review of maternity services as recommended in the report.

 

 Commenting on the report, Krysia Lynch, Co-chair of AIMS Ireland said:  "The findings of the HIQA report indicate a failure at all strata of responsibility to provide basic levels of adequate and appropriate care to Savita Halappanavar which would have saved her life. What is also of grave concern to AIMS Ireland is the number of failures at national level identified in the report including 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, an absence of reviews of clinical practices in units and the lack of a national maternity services strategy, all of which we have seen recommended on previous inquests without reform. "

 

The 2007 Safer Childbirth Document recommends that midwife to woman staffing levels are never to exceed 1:28 for low risk women and 1:25 for high risk women, in order to ensure that women are safely looked after and not left alone in labour.  Irish ratios drastically exceed these recommendations and were seen to be contributing factors into the deaths of Tania McCabe, Bimbo Onanuga, and now, Savita Halappanavar.   Recent research in Ireland has shown that there is are marked regional variations in obstetrical intervention for hospital birth, therefore, it is difficult to determine how and where interventions are more or less frequently adhered to within maternity services. Regional variations in obstetric interventions across Ireland essentially present women with a ‘geographic lottery’ in terms of their maternity care. There is no standardized care.

 

Krysia Lynch "The HSE and Department of Health have seen numerous recommendations and reports of unsafe practice in Irish maternity services in the recent decade, all of which have fallen on deaf ears. Ireland purports to be one of the safest Countries to have a baby... yet these incidents of gross neglect continue. The current midwife to woman ratio is patently unsafe. Maternity units have reported midwife to woman ratios of 1:43, failing not only international recommendations but those resulting from previous investigations following the deaths of Tania McCabe and Bimbo Onanuga." Lynch continues, "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." 

 

AIMS Ireland strongly refutes the calls today to increase the number of obstetricians in the Irish maternity services as a reactionary measure to this report. AIMS Ireland states, "We need an over-haul of the maternity care model in Ireland. Our maternity services are 90% obstetric-led and lack continuity of carer. Outdated practices are of no benefit to the majority of women. High quality robust evidence, including the recently published Cochrane Review on midwife-led care, shows that the large majority of women benefit from a Midwifery-Led care model, not obstetric. Obstetric-led care has a very important place in Irish maternity services and should be available for women who want or need this type of maternity care, however, in failing to provide evidence based care options, valuable resources are being over-utilized as women have no option but birth in under-staffed and over-crowded consultant led units."

 

 

AIMS Ireland stresses, "Today we  have heard repeated calls for yet more of the same - an increase in obstetricians. Where are the midwife led units and birth centres? Ireland needs to wake up and listen to the evidence. This is an opportunity to review our maternity care model and provide women with evidence based midwife led care models in every Irish unit."

 ENDS 

 

For further information:

Krysia Lynch

087 754 3751   

 

About AIMS Ireland

AIMS Ireland is a consumer-led voluntary organisation dedicated to improvement in maternity services in Ireland. Our mission is to highlight normal birth practices, which are supported by evidence-based research and international best practices, and campaign for recognition of maternal autonomy and issues surrounding informed choice and informed refusal for women in all aspects of the maternity services and maternal health.  

AIMS Ireland campaigns on the grounds that birth choice is a basic human right as declared at the International Conference of Human Rights and Childbirth.

AIMS Ireland offer independent, confidential, non-judgemental support and information on maternity choices and care to women and their families. We assist in complaints and run a closed online Birth Healing support group for women following difficult and/or traumatic birth.

Our day-to-day contact with service users, consumer interest groups and healthcare practitioners helps us stay informed of key issues in maternity care and services which we can directly feedback to service providers, media, HSE and Government in an effort to improve maternity services on a local and national level.

AIMS Ireland is run solely by volunteers and funded through donations and fundraising. Volunteers cover their own costs (travel to meetings, parking, childminding, phone costs). All money donated to AIMS Ireland goes directly back to women and support.

For more information please visit our website, www.aimsireland.com 

ÁGNES GERÉB 3RD ANNIVERSARY IN CONFINEMENT: Statement from Campaign for Justice for Dr. Ágnes Geréb.

http://www.szuleteshaz.hu/agnes-gereb-3rd-anniversary-in-confinement/?lang=en

ÁGNES GERÉB 3RD ANNIVERSARY IN CONFINEMENT:

 

Three years is a long time. Three years in confinement is a very long time. Three years in confinement when you have done nothing wrong is a very, very long time. Through prison and house arrest, she has retained her strength, her dignity, her reputation and she has remained true to herself and her beliefs. And so many in Hungary and around the world have remained true to her. Women everywhere see her as someone who has responded to the wishes of birthing mothers. In doing so she has had to face mistreatment and injustice. But the birthing mothers in Hungary who want midwifery-led-care, whether in hospital or at home, are still there and their wishes will not go away. 

On this third anniversary of her arrest on 5 October 2010, we recognise some signs of improvement. She is now allowed out of her home for one hour each day. Recently, the UN Working Group on Arbitrary Detention spent 3 hours at her home, listening to her story. In their preliminary report, issued on 2nd October, they condemn the 'excessive use of preliminary detention' in Hungary, and point to the excessive zeal of prosecutors, and the weakness of judges in standing up to them - all features, we believe, of the gross abuse to which she has been subjected. And they recognise that house arrest, too, is a deprivation of liberty. The Government appears to be grudgingly aware of the capacity of the judicial system to inflict injustice. They have faced a constant stream of support for Ágnes, for birthing mothers and for midwives from the day she was imprisoned. And they know this support is not going away. We have secured great attention and backing from so many influential and esteemed persons and organisations worldwide who fully believe in the right of birthing mothers to choose the type of birth experience that suits them best and who see that Ágnes has been shamefully mistreated in her own efforts to respond to those wishes.

In the months ahead Ágnes will continue to defend her actions and her reputation in the courts. Birth right supporters here remain determined and, amongst many other actions, will soon bring cases to the EU and to the UN on these matters. We believe in the end, regardless of the time it takes, that birthing rights will be secured for future Hungarian mothers and that personal and professional rights will be secured for all the midwives like Ágnes who serve the needs of birth mothers.

 

http://www.szuleteshaz.hu/agnes-gereb-3rd-anniversary-in-confinement/?lang=en

Donal Kerry
International Spokesperson
Campaign for Justice for Dr. Ágnes Geréb.

mobile:  0036309242190

 

 

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: http://www.aimsireland.com/news/?topic=newsBulletin#_nbItem6

 

*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 chair@aimsireland.com or leave a reply on this blog post.

 

Thank You,

 

AIMS Ireland Team

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: http://www.hse.ie/eng/services/list/3/nas/news/National_Consent_Policy.pdf


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

 

References: 

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

AIMS Ireland response to the 'home versus hospital' debate

PRESS STATEMENT

 

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.

 

ENDS

 

For further information:

Krysia Lynch

087 754 3751