‘It was like watching someone artificially inseminate a cow’.
This is how my husband described my induction to my sister and brother-in-law, when I was giving them a blow-by-blow account of my labour and delivery while they enjoyed their first cuddles with their niece, whom I had given birth to 18 hours previously. I had had a fabulous labour and delivery experience, being very well-taken care of by the staff in Holles Street, with one glaring exception – the moment I had been induced. My waters had broken ten hours before but I had had no contractions in that time, and there was meconium present in the amniotic fluid, which is associated with an increase in risk to the baby in the unlikely event that the baby aspirates (breathes in amniotic fluid while being born).(1) The doctors told me they were going to examine me to check whether I had dilated at all, to ascertain the extent of the meconium, and to decide whether I needed to be induced. One horrifying never-ending minute later, I was induced – the doctor inserted the gels then and there, without my prior knowledge or consent.
In the weeks and months after the birth, I realised I was not getting over this aspect of my birth experience like I should. As I spoke to healthcare professionals and spent time on internet groups, I learned I was not alone – many women experience similar difficulties in labour and delivery, including undergoing procedures to which they did not consent. We don’t know how many women have this experience, as the HSE collects no data on maternal satisfaction in pregnancy and delivery, but there are numerous charities that support women through these experiences and have first-hand knowledge of the impact these decisions can have on women and their families.
For a prolife woman, however, reaching out to these charities poses a major problem. These charities are, to my knowledge, universally in favour of removing the current legal protection offered to the babies they are pregnant with. This prochoice stance stems from the HSE’s National Consent Policy,(2) which states in article 7.7.1:
‘… because of the constitutional provisions on the right to life of the “unborn”, 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’.
The HSE has repeatedly used article 40.3.3 of the constitution to force or attempt to force women to undergo medical procedures to which they do not consent, often with little to no evidence of any risk to the foetus, let alone a serious risk. In HSE vs B,(3) for example, the HSE took Mother B to court in an attempt to prevent her from having a vaginal delivery when she had previously had a c-section. Such a delivery scenario is associated with a higher risk of uterine rupture, or where the wall of the uterus separates at the site of the previous c-section. In an Irish study published in 2006,(4) the risk of uterine rupture after c-section was found to be 2 in 1000, while in a normal delivery it is 1 in 1000. The High Court agreed with Mother B that the HSE’s concerns did not amount to a serious risk to the foetus, and found in her favour.
As I researched this issue, I found that Active Management of Labour (AML), whereby women are given medical or surgical interventions in order to speed up labour, actually originated in Holles Street before spreading worldwide.(5) The original recommendations were made in the absence of asking women how it actually affected their experience of labour, and the practise has more recently been questioned.(6) I also found cases almost identical to Mother B’s case in other jurisdictions where abortion is freely available and the unborn has no right to life (7)(8). I found that in countries where abortion is freely available women are not even allowed to eat during labour,(9) despite there being no evidence of any benefit from this practise.(10) The abuse of women in labour became clearer, but the link with the right to life of the baby became less and less clear. I began to become very suspicious of the claims that if only 40.3.3 were repealed, Ireland would abandon its historical links to AML and would suddenly become a world leader in maternal autonomy during labour. This argument seemed hopelessly naive given the international evidence.
It should seem obvious to anyone, prolife, prochoice or in between, that the HSE is abusing article 40.3.3 and forcing women to undergo procedures for which there is little to no evidence. The clear response should be to challenge the HSE in these situations, campaign to change the National Consent Policy, and advocate for evidence-based maternity care. However, the only people advocating change in this area are campaigning to remove article 40.3.3 altogether. This means they implicitly agree with the HSE – that protecting the unborn means forcing women to undergo sometimes barbaric treatment in labour and delivery, and so the unborn’s protection must go. Prolife women are left between a rock and a hard place – we are told we can have our right to autonomy protected, or our baby’s right to life protected, but not both. Some choice.
I am happy to say that I am booked in to have my second labour and delivery with the Community Midwives in Holles Street as their care was exemplary and I look forward to the experience. However, when it comes to how the HSE, AIMS Ireland, Parents for Choice, Midwives for Choice, Amnesty Ireland and many other bodies interpret 40.3.3 and how it applies in the labour ward, I want better for myself and I want better for my baby. I refuse to be bullied into accepting that my rights and my baby’s rights are in conflict, and that in order to protect my baby I must be treated, literally, like a cow. I will learn from my experience and ensure that no procedure be carried out without my knowledge and consent. I will demand evidence-based care for myself and my baby in labour and delivery. I will not allow my baby’s right to life to be compromised. And I encourage any other women who have been put in a similar situation by our maternity services to do the same.
Our babies’ right to life is not the enemy and it is not where we should bring this fight.
Muireann Lynch is a graduate of TSM Mathematics and Economics. She lives with her husband and daughter in Dublin.
9. https://www.ncbi.nlm.nih.gov/pubmed/26580836 – Maternal satisfaction did not feature as a criterion in making this recommendation