Ire­land treats women so badly dur­ing preg­nancy and child­birth.

The Irish Times - Tuesday - Health - - Front Page - Jacky Jones

Re­cent dis­clo­sures by women about sex­ual abuse show the ex­tent of the per­va­sive, phys­i­cal, sex­ual, and psy­cho­log­i­cal vi­o­lence against women that ex­ists ev­ery­where in society.

This abuse is per­pe­trated by men from all walks of life.

The vol­ume of dis­clo­sures shows that abuse of, and vi­o­lence against women, is rou­tine, par for the course, a de­fault po­si­tion for many men. As has been pointed out by sev­eral com­men­ta­tors, abuse of, and vi­o­lence against women is not about sex but about the abuse of power.

The Coun­cil of Europe Con­ven­tion on pre­vent­ing and com­bat­ing vi­o­lence against women notes that “vi­o­lence against women is a man­i­fes­ta­tion of his­tor­i­cally un­equal power re­la­tions be­tween women and men, which have led to dom­i­na­tion over, and dis­crim­i­na­tion against, women by men and to the preven­tion of the full ad­vance­ment of women”.

Homes and work­places are not the only places where women ex­pe­ri­ence abuse. Power is mis­used and abused on a daily ba­sis in Ire­land’s ma­ter­nity care sys­tem.

Ear­lier this year the UN Com­mit­tee on the Elim­i­na­tion of Dis­crim­i­na­tion against Women found that “the State party has a pol­icy of hav­ing three births per 24 hours for ev­ery bed in ma­ter­nity wards, which does not re­spect the nor­mal birth process”.

The com­mit­tee was par­tic­u­larly con­cerned that “child de­liv­ery is highly med­i­calised and de­pen­dent on ar­ti­fi­cial meth­ods to ac­cel­er­ate the process”.

Forc­ing women to give birth within a spec­i­fied time­frame is abuse. There is no other word for it. The Na­tional Ma­ter­nity Strat­egy – Cre­at­ing a Bet­ter Fu­ture To­gether 2016-2026 – was sup­posed to change all this by “recog­nis­ing that preg­nancy is a nor­mal phys­i­o­log­i­cal process” and en­sur­ing that women “are front and cen­tre in all de­ci­sions about their care”.

Since its pub­li­ca­tion out­comes for preg­nant women have ac­tu­ally wors­ened. More births are in­duced now than ever be­fore with in­duc­tion rates for first-time mothers rang­ing be­tween 29 and 48 per cent in the State’s 19 ma­ter­nity hos­pi­tals/units. Cae­sarean sec­tion rates have also in­creased with a rate as high as 56 per cent in one hos­pi­tal for first-time mothers and 11 ma­ter­nity hos­pi­tals/units have rates three times that rec­om­mended by the World Health Or­gan­i­sa­tion.

Re­tain power

Un­for­tu­nately, the Na­tional Ma­ter­nity Strat­egy Im­ple­men­ta­tion Plan, launched in Oc­to­ber by the Min­is­ter for Health Si­mon Har­ris, shows that treat­ing preg­nancy and child­birth as nor­mal phys­i­o­log­i­cal pro­cesses is not go­ing to hap­pen any time soon. Ma­ter­nity ser­vices must be the only health ser­vice left where best prac­tice does not ap­ply.

Although the strat­egy con­cluded that “mid­wifery-led care is as safe as con­sul­tant-led care for low-risk women; women are more likely to be sat­is­fied with their care if led and de­liv­ered by a mid­wife; mid­wifery-led care is cost ef­fec­tive; and mid­wifery led care re­sults in fewer in­ter­ven­tions”, this will not hap­pen.

Ob­ste­tri­cians want to re­tain their power over child­birth and will not al­low mid­wives to lead un­less they do it as part of a mul­ti­dis­ci­plinary team. There is over­whelm­ing ev­i­dence that mid­wife-led care is best for 80 per cent of women, but in Ire­land ob­ste­tri­cians are in charge.

This is an abuse of power. What else is new?

The three care path­ways de­scribed in the strat­egy – sup­ported care (mid­wife-led), as­sisted care (ob­ste­tri­cian-led), and spe­cialised care (ob­ste­tri­cian-led) – are to be of­fered in just one hos­pi­tal in each net­work by 2018. Only 20 per cent of women, ris­ing to 30 per cent by 2019, are to be of­fered the sup­ported care path­way. Lack of re­sources and a mid­wife short­age means women who want mid­wife-led care will be un­able to avail of it. Women in ru­ral Ire­land will be par­tic­u­larly dis­crim­i­nated against.

For most women it will be busi­ness as usual. Their labours will be speeded up whether they like it or not. They will be in­duced whether they like it or not.

Fair game

Ire­land is not the only coun­try that treats women badly dur­ing preg­nancy and child­birth. Preg­nant women ex­pe­ri­ence dis­re­spect­ful, abu­sive, and ne­glect­ful treat­ment in health fa­cil­i­ties around the world. A re­cent anal­y­sis of 65 stud­ies from 34 coun­tries con­cluded that mis­treat­ment oc­curs at the level of in­ter­ac­tion be­tween women and health pro­fes­sion­als as well as sys­tem­i­cally. Ex­am­ples of abuse in­cluded us­ing re­straints such as stir­rups, us­ing co­er­cive lan­guage to en­sure women com­ply with hos­pi­tal birth pol­icy, no in­formed con­sent for many pro­ce­dures in­clud­ing epi­siotomies, un­nec­es­sary and fre­quent phys­i­cal ex­am­i­na­tions, and loss of au­ton­omy.

Sys­temic abuses, such as lack of pri­vacy and speedy labour poli­cies, oc­cur be­cause of staff short­ages and in­ad­e­quate fa­cil­i­ties.

These abuses hap­pen be­cause only women be­come preg­nant and women are fair game for abuse ev­ery­where.

Homes and work­places are not the only places where women ex­pe­ri­ence abuse. Power is mis­used and abused on a daily ba­sis in Ire­land’s ma­ter­nity care sys­tem

PHO­TO­GRAPH: ISTOCK

More births are in­duced now than ever be­fore with in­duc­tion rates for first-time mothers rang­ing be­tween 29 and 48 per cent in the State’s 19 ma­ter­nity hos­pi­tals/units.

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