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Category Archives: The family

Why childbirth should be on the feminist agenda in Ireland

Guest post by Sylda Dwyer

The day before Mother’s Day in an emergency Saturday sitting, a High Court judge was asked to compel a pregnant woman to undergo a Caesarean section. According to an affidavit presented in court, Waterford Regional Hospital believed that because the woman was 13 days overdue by their calculations, had a scar on her uterus from a previous C-section and the position of the baby’s head was high, a Caesarean was required. As the woman was refusing to consent to the procedure, the hospital sought an order to enforce the C-section immediately.

The judge heard evidence from the locum consultant obstetrician attending the woman and one other consultant obstetrician from the same hospital who gave his evidence over the phone. No independent or third party opinions were heard. The woman was represented in court by a solicitor paid for by the hospital. Her voice – undisputedly the most important in this potentially precedent-setting case – was absent. We do not know her reasoning for refusing the section except that it was not on religious grounds as the judge sought clarification on this.

We do know the following:

- she believed the hospital had miscalculated her due date and was in fact due on 18 March

- her husband was overseas and therefore unable to support her

- she has a son who was born in 2010 by Caesarean section

- she wanted to deliver this baby naturally

- she was prepared to undergo a C-section if an emergency arose or if the surgery took place on the Sunday or Monday when her husband would be back in the country.

Just minutes before the judge was due to make his ruling, word arrived from the hospital that the woman had consented and that a spinal anaesthetic had been administered. It is unlikely that we will ever know how the judge would have ruled. Either decision would have been a significant landmark in human rights in childbirth in Ireland.

A ruling in favour of the enforced C-section could have potentially opened up the floodgates to medical professionals turning to the courts when coming up against resistance from women who disagreed with hospital policies such as induction and active labour management. Such a ruling would essentially take the decision making power of a pregnant woman out of her hands and in the process remove her right to body autonomy in contravention of her human rights, a situation not unfamiliar to Irish women.

A ruling in favour of the mother would have been a boost to the recognition of a woman’s right to bodily integrity and to make informed decisions about her healthcare during pregnancy, something that is sorely needed in Ireland at the moment.

Either way, this emergency sitting had huge implications for maternity care and women’s human rights in this country.

It is also worth noting that the absence of a ruling meant that no woman in this country has yet been subjected to a court-enforced Caesarean birth against her will and this is cause for celebration. Although it is a dark day for pregnant women’s rights that the situation arose at all, we should be thankful that the horrors that might unfold in a forced C-section have not been realised. One can only imagination the long term negative implications such a birth would have on the baby and its traumatised mother.

So what happened next?

Outside of a couple of articles from the Irish Times, who initially broke the story on Saturday, an excellent opinion piece from Victoria White in the Examiner and some cursory pieces in a smattering of online and print outlets, the media has been deafeningly silent on this case. Apart from reporting the facts that presented themselves in court, no analysis or questioning of the case has been published. No one has asked why an independent expert opinion wasn’t sought, no one has asked why the woman was insistent on refusing consent, no one has queried the fact that one of the consultants claimed that Caesarean sections are “almost risk free”. It would appear that we’re all relieved that this messy business has been neatly swept under the carpet.

There has been no public outcry or a rallying of the troops to support this woman who played such a strong hand to defend her bodily integrity and human rights when most would have conceded to the pressures. In fact, rather than the sound of supporting voices, the loudest noise has been the feverish tapping on keyboards and smartphones as boards, forums and social media have lit up with other women condemning this new mother for daring to question her medical advice, calling her a reckless, selfish, stupid, dangerous, incense-burning hippy who deserves to have her child taken from her.

Rather than an outpouring of sympathy for a woman who felt she knew her own body and her baby best, many believe that the medical opinion was sacrosanct and beyond reproach and therefore the court should have ruled that she be subject to a forced Caesarean. By all accounts, the majority of the female online community have judged that the pregnant woman was fully entitled to bodily integrity and to make decisions about her body and her baby, just as long as they were the “correct’ decisions as deemed by her doctor.

Is seems that as a nation we are happy to accept that there is only one truth to birth and that is the medical system’s truth. Rather than question the policy practices of the Irish maternity system, which prioritises managing as many women through the system as it can, as fast as it can, over the health and wellbeing of mothers and their babies, we are happy to accept routine interventions which often directly lead to complications and traumatic birth experiences with long term health consequences, both physical and psychological.

We have a birth culture in Ireland where women accept that their birth process can be decided on by a medical practitioner. Hospitals dictate when a woman’s labour starts, how is starts, and whether its going fast enough according to a one-size-fits-all policy. Inductions convenient to hospital diaries, but not to a woman whose body simply isn’t quite ready to give birth yet, often fail leading to Caesarean sections that could have been completely avoided if the woman had been given a few extra days for her body to be ready to give birth.

Women already in labour who are deemed not to be progressing sufficiently fast enough to hospital policy, although their body is going at a pace that is working for both mother and baby, have their labour speeded up which can lead to both maternal and foetal distress. Episiotomies, surgically planned incisions of the perineum, are often performed without seeking a woman’s consent and in some cases in spite of her refusal. There is a time and a place for all of these interventions where they are positive and useful tools in successful birth outcomes. The issue is that they have become standard practice without medical indication.

In recent years a whole industry has developed around dealing with the fall out of women’s – and babies – negative birth experiences. Traumatic birth counsellors with expertise in post natal depression and post traumatic stress disorder, cranio-sacral osteopaths, women’s health physiotherapists and perineal specialists are part of mainstream healthcare. These practitioners provide a necessary and important service but surely there are questions to be asked about why so many women and their babies will require these services in the first instance?

Why is it that when the vast majority of pregnancies in Ireland are considered low risk, do we have such a high incidence of intervention and medicalised birth? Why do we accept that giving birth is something horrific that has to be endured as long as we end up with a healthy mother and baby? Who decides what the definition of healthy is? It would appear that we set that standard as simply still being alive, and to hell with the immediate and long term consequences of trauma caused by a medical interventionalist model. It is a low bar.

We unquestionably go along with hospital policies that are put in place to manage the number of women passing through maternity hospital doors and to protect medical professionals against litigation rather than for the best interest of mothers and babies. Rather than allowing labours to begin spontaneously and to progress at a natural pace for the comfort and safety of both mother and baby, hospitals hold full control over the birth process. This model of maternity care is the only example in the healthcare sector of maintaining such control. In any other medical situation, the patient has full control in the decision making process and can walk away without consequence if they don’t consent to medical recommendations. In this same context, it’s worth noting that pregnancy is not an illness, rather a natural physiological process, until medical complications arise.

Given that there are so many births in Ireland every year and child bearing is experienced by so many women, why is childbirth completely ignored by the feminist movement? . We rally to defend the rights of women in early pregnancy to choose how they want their pregnancy to proceed, as we should. Yet there is something about the birth process itself that we have marginalised and dismissed.

When uninterrupted, pregnancy and birth can be a life-affirming, empowering, peaceful and private experience that can result in positive outcomes for both mother and child, including in the post-partum bonding and healing process. So why do we allow it to be taken from us and controlled? The current system of maternity care, while populated with many excellent medical professionals, has administration, logistics and litigation management as its focus rather than mother-led care. Until freedom of choice in childbirth is put front and centre as a priority of the feminist movement in Ireland, alongside pro-choice and equality policies, cases like this High Court sitting will become de rigour and women’s rights in childbirth will continue to be eroded.

Related articles:

Woman agrees to Caesarean after hospital goes to court – Irish Times

Sadly, Ireland doesn’t know best in Ireland’s rigid childbirth regime – Victoria White, Irish Examiner

Caesarean Section Refusal in Ireland – Human Rights in Ireland

No country for pregnant women – AIMS Ireland

Giving birth is a feminist issue – Mind the Baby

Irish hospital prepared to forcibly perform C-section on non consenting woman – Allergic to Patriarchy

NHS NICE Caesarean Guidelines

Sylda Dwyer blogs at http://www.mindthebaby.ie

Children’s rights must not mean women’s wrongs

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Last month the Irish Minister for Children, Frances Fitzgerald, announced that the long-promised referendum on the rights of children would finally be held this year.

The background to this lies in the following provisions of the Irish Constitution:

Article 41
1. 1° The State recognises the Family as the natural primary and fundamental unit group of Society, and as a moral institution possessing inalienable and imprescriptible rights, antecedent and superior to all positive law.
2° The State, therefore, guarantees to protect the Family in its constitution and authority, as the necessary basis of social order and as indispensable to the welfare of the Nation and the State.

3. 1° The State pledges itself to guard with special care the institution of Marriage, on which the Family is founded, and to protect it against attack.

Article 42
1. The State acknowledges that the primary and natural educator of the child is the Family and guarantees to respect the inalienable right and duty of parents to provide, according to their means, for the religious and moral, intellectual, physical and social education of their children.

5. In exceptional cases, where the parents for physical or moral reasons fail in their duty towards their children, the State as guardian of the common good, by appropriate means shall endeavour to supply the place of the parents, but always with due regard for the natural and imprescriptible rights of the child.

The proposed referendum, as agreed by an all-party parliamentary committee, would leave Article 41 intact but remove those two subsections of Article 42. The replacement text is rather lengthy so I’ll just provide a link rather than post it all here.

The impetus for this change comes from a series of judicial and policy decisions, which have been seen as making it so difficult to interfere with the sacred institution of The Family (and more particularly the marital family) as to effectively tie the State’s hands when it comes to child protection and welfare. A few examples:

  • The 2001 case Northwestern Health Board v HW, where the Supreme Court upheld the right of parents to refuse to allow their child undergo the PKU test, a totally safe procedure to detect a disorder that leads to brain damage if untreated.
  • An unspeakably horrible case of familial abuse in County Roscommon, revealed a little over a year ago. You can Google it yourself, I don’t have the stomach for it. The mother had obtained an injunction preventing the children being removed from the family home; her affidavit cited the rights that she and her husband, as a married couple, had over their children. Social workers on the case confirmed that Article 42 had a sort of chilling effect on their efforts to protect the children, as it led them to believe they would need to prove a nearly impossible threshold of neglect.
  • The 2006 “Baby Ann” case (N v Health Service Executive), in which a two-year-old girl was ordered returned to her birth parents. They had consented to her adoption, but changed their minds and subsequently married – at which point, according to Justice McGuinness, the rights of the family took over from the best interests of the child as the “central issue”. (Actually, on the peculiar facts of this case the birth parents would have had a decent argument even without the constitutional imperative, but there are obvious reasons to be concerned about the court’s emphasis on the primacy of the marital family.)

So you can see why there’s widespread support for amending the Constitution to specifically enshrine the rights of children. What little opposition there is is mainly coming from two of the most repellent groups in Irish society: the xenophobes, who fear the amendment being used to prevent deportation of Africans with minor children; and the uber-Catholics for whom any interference with the marital family is anathema. (It hasn’t gone unnoticed that the list of amendment opponents reads like a Who’s Who of the Irish anti-abortion movement – whose concern for the rights of children clearly ends at birth.) Ironically, although the latter group is far more organised and politically powerful than the former, it is the deportation issue that is actually holding the referendum up. I was present at a private meeting a couple years ago where a then-Cabinet Minister, a current Cabinet Minister and a backbench member of the other current government party all agreed that the wording would have to be changed to assuage those fears.

Irish feminism, on the other hand, seems to be pretty much entirely behdind the amendment, and that’s fairly understandable. After all, the primacy of the marital (read: patriarchal nuclear) family hasn’t exactly done us many favours; and while the amendment won’t remove Article 41.1, it clearly will narrow its scope. But while I wouldn’t argue that we should vote “no”, I do think some important issues have been overlooked in the debate. Consider the following:

  • In 2006, the High Court ordered that a Jehovah’s Witness be given a blood transfusion (subscription required) contrary to her express wishes, the first time this was done to a competent adult. Counsel argued and the Judge accepted that her child’s need for a parent overrode her right to refuse medical treatment.
  • In the US, women have lost custody of their children for working outside the home, being lesbians and even reporting domestic abuse.
  • According to a representative of the fabulous Association for Improvements in the Maternity Services Ireland who I was speaking to recently, some Irish women have been threatened with prosecution – yes, prosecution – if they insisted on giving birth at home rather than under the full control of the professional (and strongly male-dominated, and extremely paternalistic) medical industry.

What these cases all have in common is that they’re examples of the “best interests of the child” being used to further a patriarchal agenda, in which motherhood automatically strips women of their autonomy. Make no mistake about it, this isn’t just the standard assumption of self-sacrifice that having children always entails; it’s the quite deliberate channeling of women with children – whose primary identity is now “mother” – into tightly prescribed roles, with the legal system there to act as enforcer.

I’m being a bit deliberately melodramatic here and I’m not suggesting that passage of this amendment will actually turn us all into Stepford wives. But I don’t think we should be complacent about the risk of “children’s rights” becoming another tool of state misogyny. Let’s not forget that this is a state where woman’s primary role as housewife and mother is actually enshrined in the Constitution (Article 41.2, for readers abroad). Do you trust all of our judges to read the new amendment in a way that protects children’s rights without trampling on women’s? I don’t.

I’m also uneasy about the way this amendment could be read in juxtaposition with Article 40.3.3, on the right to life of the “unborn”. Judging by some of the cases coming out of the US at the moment, it seems that pregnant women in some states might be only a few years away from being forcibly institutionalised to prevent them doing anything that might possibly lead to the birth of a less-than-perfectly-healthy baby, such as having the odd glass of wine or eating too much junk food. It’s a strange sort of logic that allows women to be penalised for “neglecting” foetuses that they have every right (at least on paper) to abort, which I suspect is why those laws aren’t more widespread throughout the US than they are. Here, of course, the constitutional position on abortion is no impediment to such laws – and with a mandate to protect both the rights of (actual) children and the rights of the “unborn”, there is, I think, a worrying possibility that this American trend could catch on here.

Again, and just to be perfectly clear, I’m not saying that feminists should oppose the amendment. In all likelihood I will vote for it myself, on a simple cost-benefit analysis (as in, I think overall it will probably do more good than harm). And I don’t have any suggestions as to how it could be worded to avoid these nightmare outcomes, especially while the odious Articles 40.3.3 and 41.1-2 remain. But we shouldn’t be leaving it to the racists and religious fanatics to highlight its possible unintended consequences. We should be putting the State on notice that although we want to see better protection for Irish children, we are not going to tolerate it becoming yet another tool to oppress Irish women.

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