By Ivana Bacik
Public debate on maternity care is currently focused on the tragic deaths of babies in certain hospitals like Portlaoise, and inadequacies in care provision that may have contributed to those awful outcomes. However, any assessment of the legal framework for maternity services in Ireland more generally would indicate the need for a much wider change agenda if women are to have real choices in childbirth.
A major review of services available to pregnant women and their babies is required. This must take into account the preferences of women regarding place and type of birth, including both home births and hospital births. The key considerations must be to provide women with a safe service and to ensure choice in this key life event. Ultimately, any such review should lead to an effective set of’ ‘pregnancy pathways’ for women in Ireland.
Maternity care in Ireland is a consultant-led, hospital-based service. This is legislated for in the Health Act 1953. There has been no review of this model since that time. The current position differs dramatically from the routine practice at the beginning of the twentieth century, when most midwifery throughout Ireland was practised in the community. Nowadays, with the exception of a small number of midwifery-led units, maternity care in Ireland is generally provided in hospitals.
There have been particular legal implications arising from the sidelining of midwifery in the maternity care system. In particular, women’s choices in childbirth have been curtailed within the medical setting. The option of homebirth has become effectively inaccessible for many, as the recent case of the midwife Philomena Canning has shown.
Maternity care practices are unduly dependent on a medicalised model of childbirth. Yet this medicalised model has not necessarily brought about safer outcomes for women or babies. The Association for Improvements in Maternity Services (AIMS) has called for a review of maternity services generally.
When viewed in an historical context, it appears that cultural attitudes, and, in particular, religious ethical codes, have influenced the development of maternal healthcare and have restricted women’s choices. Healthcare in Ireland has traditionally been controlled by the Catholic Church and the Church’s influence on health services still persists.
The lack of discernible national direction from the Irish healthcare system until recent years may be a legacy of the handing over of control for hospitals to a number of religious orders, all of which brought different management styles to bear. What many of these have in common was the Catholic ethical code. This in turn influenced, and limited, the types of services made available to patients.
Ethics committees still operate in many hospitals, and many still refer to an underlying Catholic doctrine informing their policy. Religious influence is also highly visible in a more practical way. Many hospitals continue to use religious iconography throughout their premises, including maternity wards with crucifixes, statues, and wards named in honour of individual saints.
Apart from the enduring visibility of religious imagery in maternity hospitals, many more serious historical examples exist of the adverse influence of religious doctrine on maternity care in Ireland. These include the barbaric practice of symphysiotomy, carried out in some Irish maternity hospitals right into the 1980s for so-called ethical reasons. Performed during childbirth, it involved sawing through the pelvis.
Many of the women upon whom it was performed have suffered life-long physical and psychological effects as a result. How this barbaric practice could have persisted so late, when caesarean section offered a better alternative for women, is a question that remains unanswered.
Well before the extent of this barbaric practice came to light, revelations had emerged about unjustified numbers of peripartum hysterectomies performed upon women in the Lourdes Hospital, Drogheda. Over a 25-year period, obstetrician Michael Neary had continued practising unnecessary surgery upon vulnerable women, until finally the practices were exposed by a whistleblower.
The ‘Catholic ethos’” dominant within the hospital was one of the factors alluded to critically in the 2006 report of Judge Maureen Harding Clark into the Neary case.
These are not the only examples of problematic practices in Ireland around childbirth and maternity. The history of the incarceration of young women and children in religious-run Magdalen laundries, and other institutions, has now been well-documented. Reports of disturbingly high infant mortality rates in the “Mother and Baby homes” have led to the establishment of a commission of investigation chaired by Judge Yvonne Murphy. Once completed, its report may reveal further detail about these problematic practices and our shameful past. •