The Fight For Bodily Autonomy – Are You Listening?

My heart is sore. I’ve just finished listening to an incredibly brave woman, Siobhan Whelan, talk about her pregnancy in an interview on Prime Time. Prime Time never gets the good news stories from maternity wards, and this interview was no different. Siobhan, who was pregnant at the same time as I was in 2013/2014, was treated in Cavan General Hospital. This hospital has been in the news quite a bit over the past few years, home to numerous tragedies caused by medical misadventure. Pregnant women have entered and left empty handed, mourning the loss of their babies, believing in many cases that it was their fault. This isn’t the first Prime Time interview I’ve watched with women who were treated there, not the first I’ve welled up to. It draws little surprise, even though the topic is heart-wrenching. The lack of shock about the conditions is what hurts my heart most of all. It’s not exactly the only example of pregnant women losing their voices in the course of pregnancy as far as the medical profession is concerned. Bodily autonomy isn’t something afforded to those with child here.

Siobhan spoke about her scan in March 2014 which seemed to show an issue with her placenta, and which was followed up by other scans but never dealt with. The problem was later denied by doctors and midwives, and she was even made to feel like she was “still going on about it”. In fact, they failed to diagnose vasa previa, a condition which causes the foetal blood vessels to block the entrance to the birth canal. Siobhan went into labour on May 13th, the day before her induction date. Upon reaching hospital, she felt what she thought were her waters breaking, but indeed turned out to be blood. On examination, she was told in the maternity unit that everything was fine. Despite this, the couple’s worry for their baby remained, but their requests for a c-section to speed up the delivery of their son to ensure his safety were repeatedly denied. A vaginal exam led to more bleeding, which caused more worry to the couple, but the medics seemed unphased.

“I was pleading ‘no more instruments up me…please give me a section’ but she (the gynaecologists) wanted to rupture my membranes. Ann (the nurse) said to her ‘before you rupture membranes, would you not consider doing a test on the baby’s head to see how the baby is doing’. Siobhan says “The doctor went ahead and broke my waters. ‘There, waters are broken now’ she said and discarded the instrument used abruptly behind her.” Despite her begging to not have her waters broken, ARM (Artificial Rupture of Membranes) was performed without her consent. After a quick word outside the ward between nurse and doctor, things started moving quickly. In a panic, there was a rush to theatre, even with a nurse was knocked to the ground by the trolley.

In court, Siobhan alleged: “Dr Rita cut me open without me being fully under sedation. I was told this by the nurse Ann Arnott in the ICU after. She told me that Dr Rory Paige was very distressed that Dr Rita was only thinking of the baby now and not the mother. According to Ann he was roaring and shouting at Dr Rita to stop, that they must wait for the patient to be fully sedated and that he literally threw himself across me to stop her.”

At 1.49pm weighing eight pounds, Conor was born. He had to be revived. Mrs Whelan was given life-saving surgery. Conor was rushed to the Rotunda, but died 17 hours later on the morning of the 14th of May. Mrs Whelan told the court that she was told a few days later by another medic that Conor had died because her membranes had been ruptured. When she told this medic(Dr Finan) – that Dr Rita had performed the procedure, he was “so shocked that he staggered back into the wall”.

This is just another tale of maternity woe in Ireland. Our little country, the best country in the world to have a baby, if our government is to be believed, has seen too many tragedies. Most of them are completely preventable, if provision of maternity care is adequate and involves listening to the pregnant woman. You’d think that we would learn from our mistakes, but it seems like every time we are made aware of these flaws, we shout, we cry, we are ignored. Women plead for bodily autonomy – the right to choose what happens to their bodies – and we are denied, talked down to, ignored. There seems to be a gap in areas of the maternity healthcare sector in listening to patients who know their own bodies better than a doctor who sees them for two minutes. By far it isn’t the majority of midwives and obstetricians, but those who do work like this cause utterly preventable tragedies, and even when they don’t, lead to women being left traumatised by their birth experiences. The sentence “Dignity left at the door” is one spoken in many conversations about maternity care. This shouldn’t be the case. Just because you’re in labour, or carrying a baby, doesn’t mean you lose the right to dignity or respect. Each maternity patient is a person, not a number.

Aside from medical misadventure, the legal definition for the cause of many of these tragedies, lack of bodily autonomy in pregnancy is a bigger issue in modern Ireland. The 8th Amendment of the Irish Constitution states “The State acknowledges the right to life of the unborn and, with due regard to the equal right to life of the mother, guarantees in its laws to respect, and, as far as practicable, by its laws to defend and vindicate that right.” Referred to as Article 40.3.3, this amendment prevents any medical intervention which would potentially end the life of the unborn foetus. It has in recent years been amended to allow for termination in the most life threatening of circumstances for the mother, but does not allow for intervention which threatens the health of the mother until it becomes a proper threat to life. It does not allow for termination or early induction of pregnancy in the case of fatal foetal abnormality. It does not allow for women who have been raped, who are the victims of incest, who do not want to be pregnant to end their pregnancy. Those who suffer suicidal ideation as a result of being pregnant can gain the right to end their pregnancy only after a group of experts deem them enough of a risk to themselves. As a result, 10 women every day travel to the UK and other European countries to obtain legal abortions there. We export our problem so that Catholic Ireland does not have to own up to it. Our constitution does not afford women the right to choose what happens to our bodies. Bodily autonomy is not on the table.

As Louise O’Neill says “is it enough to call for a referendum @endakennytd ” #repealthe8th

A photo posted by Repeal Project (@repealproject) on

We are fighting back, and we are not alone in our fight. On Saturday 24th September, thousands of men, women and children marched through Dublin in the rain, despite the weather and the bus strike, to show the government public demand for a referendum to Repeal the 8th Amendment. Similar shows of solidarity (in smaller numbers) were seen from places around the world, all asking the government to give women the right to choose. This week, Polish women went on an all out strike to protest their government’s proposal to make all abortion for any reason illegal and punishable by 5 years in prison for both the woman and the medical professional involved. Currently, Poland have restrictive abortion laws, but ones which allow for abortion in cases of risk to the mothers life, the fetus is irreparably damaged or the pregnancy results from rape or incest. While this allows for more than Ireland’s current legislation, many women have to travel outside of Poland to obtain the procedure. Dressed in black to mourn the loss of their already limited rights, this boycott of all forms of work by half the workforce shut down government and education buildings. It was a powerful protest with images standing out around the world. Their message was clear. Women are an important part of society – do not treat them like they are an afterthought.

The 8th Amendment allows for the requests of the mother to be ignored. Her dignity, and her bodily autonomy, are left at the door, if not back in the bathroom stall where she took her pregnancy test.

My experience of maternity services in Ireland is one where I consider myself lucky. I was a patient of CUMH (Cork University Maternity Hospital) during my 2013/2014 pregnancy. I was pregnant at the same time as Siobhan Whelan. Like her, I did not receive an anomaly scan at 20 weeks. I was advised that they were not the norm in CUMH at that stage. At my 22 week appointment, I received a two minute scan which showed the heartbeat. The doctor told us  “I don’t see anything, it must be a girl”. A few days later, I was involved in a road traffic accident, and from this point on my unborn son (who I found out was a boy at our 31 week 4d scan) became a regularly photographed being. This wasn’t down to the car accident, though this definitely made me a whole lot more nervous about my baby, but rather to my hypertension which became pre-eclampsia.

I was kept as an inpatient from 32 weeks until delivery at 37+3, and for the most part felt vastly uninformed about why I was there. For someone who had sky high blood pressure, having to consult Google to be given a proper answer for what pre-eclampsia entailed instead of being told the blunt basics by my doctor was very frustrating. At all times, the midwives, in particular the student midwives who worked tirelessly, were incredible. However, the communication between them and the doctors was not consistent, and many times it felt like their concerns were not being listened to. A comment made upon my moving to the High Dependency Unit during my induction from one midwife to another stated that she (the midwife who had been treating me for the past four weeks) had told the doctors I “needed to be brought down a week ago”. I had spent that same week questioning my doctors at every rounds as to what the plan was with regard to delivering my baby. Much as I did not wish to have a premature baby who would be facing health difficulties unnecessarily, having seen so many news reports during my pregnancy about mismanagement of difficulties in pregnancy, I was scared. I was taking the highest doses of blood pressure medication and still watching it soar. At one stage I was banned from playing cards with my visitors, as my excitement at potential of winning pushed it up further. Google and Downton Abbey were my only frames of reference for pre-eclampsia. At the time, the 42 weeks campaign was happening in tandem with my pregnancy. I learned about other women’s experiences with losing bodily autonomy crossing the threshold of the maternity hospital. I hoped my case would be different.

My induction experience isn’t one I would ever seek to relive. At 37+3, I wasn’t favourable. I’d done my research in all that bed rest time. I knew this was more likely to end in a c-section. I had made my piece with it. So, when at 24 hours into gels being applied nothing was happening, I asked to be placed on “the list”, added to the next morning’s c-section queue. I was laughed at and made to feel stupid for asking. Told it would be something I’d regret, and that it would affect any other pregnancies. My comments reflecting my reluctance to have another after my experience during this pregnancy were met with laughs and disbelief, which made me feel spoken down to. I was instead told they would break my waters. I agreed to this, having been told I wasn’t allowed to put myself on the list. It all happened quickly from there. They started me on a Syntocinon drip – I asked not to but was told I had to in order to progress. I’d seen reports of several cases of foetal distress caused by the Syntocinon which had led to tragedy and was concerned. As it turned out, my fears were grounded – the foetal heartbeat monitor and my blood pressure both went mad, and we wound up having an emergency c-section. The epidural, the only thing I remember signing for, didn’t take. It just made me shaky, but able to feel everything. Not ideal when they’re cutting into you. I shouted to tell them this and was told “discomfort is normal” – thankfully my next shouts that it was pain, not discomfort were listened to and I was put under general anaesthetic.

I am lucky. My requests may not have been listened to by those in charge. I was laughed at. I was not listened to when I was in distress. I was made to feel little and stupid when I was at my most vulnerable. But. My baby was healthy. I was healthy. We left the hospital six days later and two and a half years later, I have a loud tantrum throwing hug giving toddler. My baby came home with me. I am one of the lucky ones.

We need maternity care to listen to women in this country. Occupation of a womb does not mean that our brain checks out. We know more about our bodies in a lot of cases than we are given credit for, and we should have the ability to make informed decisions about what happens to it. Bodily autonomy should be a right not a privilege. If we continue to make the same mistakes we have been making without changing things, further tragedies will continue to happen. Further tears will continue to fall and we will continue to look for answers.

Tonight when my son wakes in the middle of the night, I will hug him a little closer, for a little longer than I normally do. I will continue to hope that when he gets to the age where he will have children of his own, that the woman giving birth to his child will have her body respected, her views listened to and her experience untainted. It’s really not that much to ask.

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Let me know what thoughts you have on this topic – either in the comments below, or on Facebook or Twitter. It’s a conversation we need to keep having out loud – let me know what you think!

 

 

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4 comments / Add your comment below

  1. Speaking as a midwife I want to say I’m sorry you weren’t listened to, every woman has a right to compassionate and respectful care. As midwives we need to listen to women and advocate for them. We do practise in a very hierarchical setting, we are not listened to either a lot of the time. I’m glad you were lucky and came home with your lovely boy and I’m so desperately sad for Siobhan Whelan and her loss, I commend her courage in telling her story…

  2. That story is so heartbreaking. We have a similar issue in the US, with doctors not listening to pregnant women and talking down to them. They rush to induce, and rush to perform c-sections.

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