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All your wombs belong to us – The State, Ms. B and Forced C Sections

The High Court decision in HSE v B has been made public today (I’ll edit to add a link once it’s available). A month ago, a woman who wished to undergo a vaginal birth after three c-sections found herself in the High Court as the HSE attempted to have her compelled to undergo a fourth c-section against her consent. The HSE case was based on the notion that the Eighth Amendment rendered them more appropriate to decide what was best for her pregnancy than she was. This is a landmark decision, because for once, it’s a maternity rights case where the resulting decision hasn’t been completely terrible.

The judgment is long and make no mistake, there is no judicial feminism in here; the Court is at pains to point out throughout the judgment that they have no idea why this woman would possibly want a vaginal birth. But ultimately it goes on to state (at Paragraph 21):

“The court concludes that it is a step too far to order the forced caesarean section of a woman against her will even though not making that order increases the risk of injury and death to both Ms. B and her unborn child.”

Essentially this means that the Court recognises the right of the HSE to pursue a case against a heavily pregnant woman on the basis of the Eighth Amendment, but the idea of legally compelling a woman to undergo a caesarean including the sedation, anaesthetic, the surgery, the pain, the recovery….and all that goes with it, was a little bit too much even by an Irish High Court’s standards.

Maternity rights activists in AIMS have been pointing out for years that the Eighth Amendment is not just a tool of coercion for women who want to access abortion services, but that it is used just as regularly against women who are continuing their pregnancies. They report that women are regularly told the guards will come to get them if they don’t turn up for their scheduled inductions. Being threatened with the guards coming to your door when you’re in the full of your health and not in a vulnerable pregnant state is one thing, but threatening a woman on the brink of her due date is quite another – it is beyond bullying, it is obstetric violence. And as AIMS have pointed out, it usually ensures that women will go along with whatever is being forced upon them by the HSE. The prospect of being brought to court, like Ms. B was, is too much for most.

The ruling is not completely terrible in that it finds that the risk to the “unborn” is not so great that it warrants overriding Ms. B’s rights to have a c-section forcibly performed on her, however as is the practice with Irish judgments there is no sense of what might constitute a *risk* to the unborn that is sufficient that a woman may have some other form of medical intervention performed on her against her will. We are not out of the woods yet. As long as the Eighth Amendment remains in the Constitution, this will not be the last Court case on the matter.

While this was a case concerning a woman who fully intended to carry her pregnancy to term, it has important implications for the tiny number of women who may find themselves before panels of doctors in an attempt to access abortions under the Protection of Life During Pregnancy Act. In the Ms. Y case a young asylum seeker, pregnant as a result of rape was deemed by a number of doctors to be suicidal. However, the HSE also felt that the way in which to avert the risk of suicide would be to perform a cesarean section on her at 24 weeks gestation instead of the abortion she requested as soon as she found out she was pregnant at 8 weeks. When Ms. Y went on hunger and thirst strike, the HSE sought and received a court order to forcibly hydrate her. The threats of court were uttered in relation to the c-section, and Ms. Y gave birth against her wishes by c-section as a result. We now wonder whether the Ms. B judgment had been delivered earlier and Ms. Y’s counsel fought the HSE at the outset of a c-section being mentioned, would the outcome have been different? Ms. B is yet another judgment to add to the mounting stacks of obstetric violence entering the courts that don’t really give us clarity one way or the other.

What is clear though is how the Eighth Amendment does not just impact those seeking abortions, but on the broader spectrum of reproductive justice. The Eighth Amendment along with a warped mentality of maternity care that infantilises women leads medical practitioners to coerce women into interventions out of a fear that they will be found to have not protected the “right to life of the unborn.” Criminalising those accessing abortions, threatening women who want natural births with garda interventions or dragging women like Ms. Y and Ms. B into the courts is obstetric violence. It demonstrates that regardless of the circumstance or your wishes in pregnancy, the State via the HSE will treat you as a vessel with no competence to make your own choice. There is no autonomy within maternity “care” and doulas are viewed with at best suspicion and at worst, contempt. There is a separate system of medical consent for pregnant women that mean effectively forced c-sections happen every day. They don’t enter the courts, but when the decision to agree to a c-section you don’t really want is made because you can’t take the bullying from medical practitioners or because you believe they will take you to court, is it really not forced?

Any kind of surgery against your will would be unpleasant to say the least. I can’t imagine getting a tooth out without having given full consent. But a forced c-section is a whole other level of violence. It is misogynist and it is degrading, and it is the State sponsored infliction of terror on pregnant women. There is no way you can undergo surgery you have been coerced into and not feel a profound blow to your sense of bodily autonomy and integrity, and those conditions are ripe for birth trauma and postpartum post-traumatic stress disorder. Women are gaslit and told their ideas about what should happen during birth are simply “baby brain” and the parallels with domestic violence are striking; indeed many women first experience violence in a relationship when they become pregnant. This is gender based violence, and if anyone objects to that analysis, then please, show me the judgment where the HSE attempted to compel a non-pregnant person undergo major invasive surgery, then colluded with the courts to make sure it happened.

What exactly will it take to ensure women are afforded autonomy over their pregnancies? Obstetric violence and coercion of pregnant women is abuse, and it is a major public healthcare problem in Ireland. Having an unwanted vaginal exam performed on you without consent is a form of violence against women that is no less real than violence against women in the home. We need to start addressing it as such so that the structural and systemic aspect of it can be picked apart and broken and so that no more Ms. Y’s or Ms. B’s find themselves before the Courts. We need to repeal the Eighth Amendment.

@stephie08

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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