Above: Paul Reynolds caught this very telling photograph at last year’s Rally For Life.
Since its introduction in 1983 the 8th amendment has created an environment where responsibility of control for the pregnant woman is in the hands of the Health Care Provider. For practicing midwives, this is a scary position to be in. Polly Molotov is a registered midwife and general nurse and takes us through the problems it creates.
It is a form of power, that is not warranted, and should not be wanted. It can lead to an environment of fear for both the pregnant woman and her midwife by creating an unbalanced dynamic that is not collaborative, as it should be. This immediately ameliorates when the authority and responsibility is placed where it belongs – with the pregnant woman – in an informed setting where she can make choices in her own best interests with the support of her midwife.
It’s useful to explore first what human rights in healthcare actually means, how they apply during pregnancy, and during childbirth. Bodily autonomy is key to a human rights’ framework for healthcare. It allows each of us to make decisions about what is best for our own wellbeing, based on information provided to us by our healthcare providers. For midwives, it allows us to do our job. Midwifery means ‘with woman’: we are there to assist her, to inform her, to advocate for her for the good of her and her baby.
The basic rights that should be afforded to every person are detailed in the United Nations Universal Declaration of Human Rights. Ireland has obligations to women under this declaration that are not being fulfilled, and cannot be fulfilled as long as the Eighth Amendment prevails. Adopting a human rights framework in maternity healthcare allows dignity, respect and safety for every woman during her pregnancy, and, importantly, allows for legal recourse in the event that this does not happen.
In pregnancy, it includes all women and seeks to accommodate all choices – those who do go into hospital, and those who are turning away from hospital or obstetric-based services towards alternatives such as home birth, Midwifery Led Units, or birth centres – the former of which there are only two in Ireland, the latter of which there are none.
A woman cannot be told that, regardless of her birth experience, the only thing that really matters is that she and her baby are alive. Any environment where this happens is one where disrespectful, and potentially abusive care towards women in pregnancy and childbirth are also possible. While the Eighth Amendment remains a part of its constitution, Ireland, unfortunately, creates such an environment.
A human rights framework for pregnancy and birth means that a pregnant woman is not just seen as a vessel. She remains a person in her own right and not a means to the production of her baby, whose interests can be subordinate of the needs of the foetus.
Human rights are predicated on respect for the decisions a person makes, because only upon respecting each other’s free will can we respect one another as human beings. During pregnancy and childbirth as in elsewhere, this means respecting a woman’s decisions. This is incredibly important because research has shown that the two things that really matter to women during pregnancy and childbirth are a supportive respectful relationship with their midwife or doctor and a sense of control. This doesn’t mean that things can’t deviate from a plan; it means the woman has been consulted, and continues to be a decision-maker in their care as events unfold.
Once you become pregnant in Ireland, the state has regard to the right to life of the unborn. This means that from the moment of conception, a pregnant woman is a different class of person in Ireland. Pregnant women are subject to a different form of state intervention – in continued pregnancy just as in abortion.
As a nation, we are aware of the impact of the Eighth Amendment on access to abortion services. But we remain largely blissfully ignorant of the impact of the Eighth amendment in continued pregnancy. This includes the very significant possibility of forced medical intervention; the foetal right to life empowers medical staff to override women’s informed choices, with or without a court order.
During Ireland’s human rights examination in February 2017 in Geneva, the UN Women’s Committee, CEDAW, called on the government to ensure that women can access maternity services that do not use artificial methods to accelerate labour and that respect the normal birth process, describing Ireland’s system of maternity care as one that transformed the most important experience of a lifetime for women and their partners into a production-line process.
The commissioner of the Council of Europe in his review of Irish maternity services stressed that pregnant women and adolescent girls are entitled to receive care that is respectful of their human rights, dignity and autonomy. Expressing concern about the consequences for women in childbirth of protecting the right to life of the unborn on an equal basis with the right to life of the pregnant woman, the Commissioner highlighted the “common practice by hospitals of invoking the Eighth Amendment – with threat of, or actual, court order – to force women to comply with medical decision-making about their care and treatment with which they do not agree.”
Interventions can include post-date induction, where a woman’s knowledge of her dates is dis-regarded and she is compelled to be induced even if she does not wish to or agree with the assessment of date. Testimony from women surveyed both by AIMSI and MFC has shown that women often feel coerced, threatened, or bullied into compliance. Importantly, under the Eighth Amendment they have no option for legal recourse.
Outside of continued pregnancy, the Eighth amendment impacts on a woman’s entitlement to abortion, and to abortion aftercare – an area that also falls within the remit of midwifery. At a clinical level, it creates an environment of fear for women, who for instance may have taken the abortion pill and are afraid to turn up to the emergency room for care. Similarly, it also creates an environment of fear and non-disclosure in women who have returned from having an abortion abroad, and may require medical care.
The referendum about the Eighth Amendment isn’t just about abortion. It’s about making sure that future generations of Irish women will not become second class citizens by becoming pregnant. It is about untying the hands of the Health Care Professionals who want to care for the population entire and want to provide the best evidence based care for this population in their own country. Trust people, Trust Doctors, Trust Midwives and Nurses, Repeal for better birth.
Photo by Paul Reynolds.