Savita dies due to refusal to terminate an unviable foetus.*Mod warning Post #1*

awec

This post has been deleted.

partyatmygaff

MrCreosote wrote: »

We'll never know for sure obviously, but I would say that if she had a termination/ERPC on the Monday, she would never have developed septicaemia.

There's not a lot of evidence to support that view. The initial infection almost certainly took hold on Monday and quite likely took hold earlier than that. For all we know, she could have been in a painless miscarriage for some time until the back pain alerted her. The back pain could well have been as a result of the infection.

Either way, at this stage, it's next to impossible to find out when exactly the initial infection was picked up let alone when it passed in to systemic circulation. All we can do is say what probably happened.

However it's the religious overtones that turn it from a case of possible medical mismanagement, to the hugs issue it has become.

What religious overtones? It's medical mismanagement (A forced hand thanks to the lack of clarity of the law) from start to finish. If the law was clear about therapeutic abortion in the case where the mother's life is in danger and the foetus is not viable no comments would have been made and they would have been able to induce on Monday or Tuesday. It wouldn't necessarily have effected the final outcome but nevertheless it would have been better to have that facility.

poeticseraphim wrote: »

What is REALLY annoying me is the way pro-lifers KEEP saying this is NOT about the wider issue of abortion.

If this is not about abortion what is this about???

What it's about is the law and very specifically therapeutic abortion. There's really no link between this case and "Abortion up until such and such an arbitrarily chosen number of weeks".

I have no idea whether the Doctors could have predicted her death..infact I highly doubt they would have refused a termination if they KNEW she would die.

I think this will come out , the fact that they DID NOT expect her life to be in danger.

Another thing disturbs me...they seem to be suggesting that if she had been given antibiotics then she would have lived .....so thats ok then.

The thing about antibiotic therapy and empirical prescribing is that it's hit and miss until they know the exact nature of the species responsible for the infection. Even if she had an abortion on Monday evening and was discharged with painkillers and antibiotics she still very probably would have suffered the same pain and ultimate fate. For one, I doubt they would have prescribed antibiotics for discharge from what appeared to be an uncomplicated miscarriage and even if they did there's no guarantee they would have prescribed an effective antibiotic.

poeticseraphim wrote: »

I don't like the idea of a Doctor deciding rather than advising. If a woman feels her best interests are an abortion then they are.

If a woman felt her best interests was to have a dose of morphine to calm her and ease the pain, she could definitely make a request for that form of treatment but the doctor isn't under any obligation to follow through with that request.

Surely the only way of providing a safety net for any situation is legalizing abortion.

That's a bit disingenuous. All that needs to be done is to clarify the law on therapeutic abortion to prevent doctors having to go for sub-optimal treatment plans in fear of becoming involved in a world of legal problems.

Yes I am pro-choice but i really believe it is the easiest way to legislate.

Easiest? I don't see how. It won't have as much support as legislation specific to therapeutic abortion. This woman's case has absolutely nothing to do with elective abortion and it's shocking the amount of people who've used her tragedy to shoe-horn in their campaign for pro-choice on the hope to appeal to people's emotions and incorrect belief that an abortion would have definitely saved her life.

Oryx

@partyatmygaff You seem to be coming at this from a medical background or at least with medical knowledge. Though you do use a lot of probablys, when in fact not you, nor I nor anyone actually know whether this lady would still be alive today if a different medical route had been taken.

And that is what it boils down to. What could the doctors have done differently? In another hospital not subject to our laws, would a medical termination have been the first action when presented with this case? That is the crux of this. Are our laws preventing doctors from administering what they feel is the required treatment?

Das Kitty

Stheno wrote: »

It's illegal to perform an abortion if the mothers health is in danger, it must be that their life is in danger, sorry for being pedantic. Of course there comes a point where a deterioration in health can be life threatening which must be a very grey area for any medic.

There was an article I read today that stated that standard practice if someone is having a miscarriage and the cervix is fully dilated for more than 24 hours is to focus on evacuation of the foetus via the most appropriate method.

The big question here seems to be why it took three days for this to happen and did that lead to an advancement of septicemia that may not have happened if it had been dealt with sooner?

See I think that assumes a viable foetus. Was it stated in the article?

When I was giving birth I know when it was getting near the end, the midwife was in bits checking her watch to check was it coming up to 24 hours since my cervix dialated. I was already dosed with antibiotics at this stage.

partyatmygaff

Oryx wrote: »

@partyatmygaff You seem to be coming at this from a medical background or at least with medical knowledge. Though you do use a lot of probablys, when in fact not you, nor I nor anyone actually know whether this lady would still be alive today if a different medical route had been taken.

I use probably a lot in my posts because it's impossible to say for certain what would have happened. For one, we don't have all the technical information and even if we did there are far too many unknowns and variables to make any concrete predictions. All we can really say is what would most likely have occurred if option X or Y was taken.

And that is what it boils down to. What could the doctors have done differently? In another hospital not subject to our laws, would a medical termination have been the first action when presented with this case?
That is the crux of this. Are our laws preventing doctors from administering what they feel is the required treatment?

Termination definitely wouldn't be an appropriate first line treatment for an uncomplicated miscarriage (Which is all that it appeared to be at first). Expectant care is usually the best way to manage a case like this with intervention either by drugs or surgery being reserved if complications arise.

This case in particular could definitely have been handled better had the doctors not been so focused on avoiding legal trouble. To my mind, the absolute best way of handling this situation would have been:

1. Expectant management for the first 24 hours with monitoring for complications
2. If it hasn't resolved itself or complications are present, resort to pharmaceutical/surgical treatment to induce.
3. Check for symptoms of infection. If there are symptoms of infection, immediately start a course of antibiotics based on the most likely pathogen and in the meantime send a sample for analysis.
4. Once a species has been identified, adjust the choice of antibiotic if necessary, keep going with the course and try and keep things under control.

Step 2 is the problem. The law just isn't clear enough on whether or not that's legal in the event of a miscarriage. Now, even if that was clearly legal and they went ahead with it there's no guarantee it would have changed the outcome. What's key to all this is when she picked up the infection and at what point did it cross in to the bloodstream.



If it occurred and started progressing from very early on, I don't think an abortion would have made a huge difference to the final outcome as septicaemia has a high mortality rate. If it occurred later on in her hospital stay (Say late Monday/Tuesday) then it's quite difficult to say what would have happened. If the abortion removed enough of the bacteria and only very little had entered the blood stream and her immune system was up to scratch she would have survived. They're all very big and uncertain "ifs" too as I don't think someone who has just suffered a miscarriage would be in the best physical or mental condition. Not only that but with the timeframe of when she started showing symptoms of septicaemia, it would appear that the infection crossed the bloodstream early on. Even with an abortion, if the infection had already crossed the bloodstream in large numbers and and she was given an ineffective antibiotic (Or nothing at all) the infection would have still progressed to septicaemia.

Stheno

Das Kitty wrote: »

See I think that assumes a viable foetus. Was it stated in the article?

When I was giving birth I know when it was getting near the end, the midwife was in bits checking her watch to check was it coming up to 24 hours since my cervix dialated. I was already dosed with antibiotics at this stage.

What do you think assumes a viable foetus, sorry, am confused

Ah I think I get you now, do you mean that after 24 hours of the cervix being dilated they proceed to induce etc on the basis of a viable foetus and not when it's clear it's not viable?

eviltwin

I see this as a women's health issue moreso than an abortion issue.

People hear the word "abortion" and those who are against it or don't feel they would ever make that decision themselves don't feel its really applies to them. And sure why would they? When most people think of "abortion" they think of the women who travel to the UK. I'm as guilty as that as anyone, I never think of women like Savita.

Any one of us who gets pregnant could be in a similar situation. Now we have to wait and see what the reports say but if it turns out that lack of action from the doctors put this woman in danger WE all should be outraged.

Remember this family wanted this baby, it was a normal pregnancy but some thing went wrong, the baby was dying, it was never going to live, she was in the process of having a miscarriage and she should have been dealt with quickly and not left for days over a legal ambiguity that has been in existance for 20 feckin years

Sadly I can see prolife people I know back away from this because they hear the word abortion and think "that will never be me".

Its first and foremost, for me at least, an issue of womens health that affects us all.

Das Kitty

Stheno wrote: »

What do you think assumes a viable foetus, sorry, am confused

Ah I think I get you now, do you mean that after 24 hours of the cervix being dilated they proceed to induce etc on the basis of a viable foetus and not when it's clear it's not viable?

Yeah, I think so.

They're really quick to induce after 30 weeks, reticent between 24 and 30 in the experience of my friends. But if your cervix is dialated at all (and the circulature stitch doesn't work) they'll induce labour.

Just wondering if the article you read specified the policy extended to non-viable foetuses?

sambuka41

eviltwin wrote: »

Its first and foremost, for me at least, an issue of womens health that affects us all.

This is so important and has been missed in the debate. The foetus was not viable, the doctors left Savita in pain for days, ignoring her decisions and input, she had no voice in this whole ordeal.

gozunda

Oryx wrote: »

@partyatmygaff You seem to be coming at this from a medical background or at least with medical knowledge. Though you do use a lot of probablys, when in fact not you, nor I nor anyone actually know whether this lady would still be alive today if a different medical route had been taken.

And that is what it boils down to. What could the doctors have done differently? In another hospital not subject to our laws, would a medical termination have been the first action when presented with this case? That is the crux of this. Are our laws preventing doctors from administering what they feel is the required treatment?

See LINK - payg is a Pharmacutical student

Sorcha16

This woman was having a miscarriage. Therefore the baby was already being lost naturally. This is not about abortion because there was never a healthy baby to abort. The baby was already lost.

Given this fact, it is not logical to allow a healthy adult to die by virtue of prioritising a baby that was never going to live

gozunda

partyatmygaff wrote: »

I use probably a lot in my posts because it's impossible to say for certain what would have happened. For one, we don't have all the technical information and even if we did there are far too many unknowns and variables to make any concrete predictions. All we can really say is what would most likely have occurred if option X or Y was taken.

Termination definitely wouldn't be an appropriate first line treatment for an uncomplicated miscarriage (Which is all that it appeared to be at first). Expectant care is usually the best way to manage a case like this with intervention either by drugs or surgery being reserved if complications arise.

This case in particular could definitely have been handled better had the doctors not been so focused on avoiding legal trouble. To my mind, the absolute best way of handling this situation would have been:

1. Expectant management for the first 24 hours with monitoring for complications
2. If it hasn't resolved itself or complications are present, resort to pharmaceutical/surgical treatment to induce.
3. Check for symptoms of infection. If there are symptoms of infection, immediately start a course of antibiotics based on the most likely pathogen and in the meantime send a sample for analysis.
4. Once a species has been identified, adjust the choice of antibiotic if necessary, keep going with the course and try and keep things under control.

Step 2 is the problem. The law just isn't clear enough on whether or not that's legal in the event of a miscarriage. Now, even if that was clearly legal and they went ahead with it there's no guarantee it would have changed the outcome. What's key to all this is when she picked up the infection and at what point did it cross in to the bloodstream.
If it occurred and started progressing from very early on, I don't think an abortion would have made a huge difference to the final outcome as septicaemia has a high mortality rate. If it occurred later on in her hospital stay (Say late Monday/Tuesday) then it's quite difficult to say what would have happened. If the abortion removed enough of the bacteria and only very little had entered the blood stream and her immune system was up to scratch she would have survived. They're all very big and uncertain "ifs" too as I don't think someone who has just suffered a miscarriage would be in the best physical or mental condition. Not only that but with the timeframe of when she started showing symptoms of septicaemia, it would appear that the infection crossed the bloodstream early on. Even with an abortion, if the infection had already crossed the bloodstream in large numbers and and she was given an ineffective antibiotic (Or nothing at all) the infection would have still progressed to septicaemia.

pamg - your opinion on this womans best options for treatment are are direct odds with at least one respected obstetrician.

At 17 weeks - it would not have been classed as "straight forward miscarriage" and "Expectant Care" or as I have seen it put "watchful Wait" (sic) is not the best practice in such a scenario as explained by this obstetrician

LINK

iguana

ASVM wrote: »

One of the nurses at the hospital told me I should have taken Panadol as a pain killer while I was miscarrying and was surprised that I hadn't. I found this a shocking suggestion from a member of the medical profession as I believed it to be wrong to take any drug during a miscarriage; in case the baby might stand a chance of surviving.I got the feeling that it was common practice to give women pain killers while miscarrying which would then be a form of termination, would it not?

Panadol is paracetamol which is perfectly safe to take during pregnancy as it does not pose a risk to the embryo/foetus.

Wibbs

gozunda I'm afraid I had to delete your quoted text from an external source. Since Minister Sherlocks vague legislation came out we have to be very careful about linking to such sources. PITA though this is.

iguana

I sent the National Women's Council emails to my TDs last week before I heard about this case. I received two replies immediately after, one from my SF TD who voted in favour of C Daly's legislation at the start of the year and one from a Labour TD's assistant basically saying he'd get back to me. After reading about Savita on Wednesday I emailed him and the other two who didn't respond again with a personal, very angry email. (I gave birth on Saturday morning in dangerous circumstances so was feeling very emotional about it.) I got back one reply so far.

As part of the negotiated Programme for a National Government, agreement was achieved to establish an expert group to address the issues arising from the established ruling of the Irish Supreme Court on the X case and the subsequent ruling of the European Court of Human Rights.

The expert group consulted with appropriate medical and legal expertise with a view to making recommendations to Government on how this matter should be properly addressed.

This report is now with the Minister for Health and it is expected to come before the Cabinet next week.

I believe that legislation is required to clarify the difficulties arising from the X case.

Politicians have for years lacked the courage to deal with this issue. We can no longer avoid our responsibility.

Stheno

Das Kitty wrote: »

Yeah, I think so.

They're really quick to induce after 30 weeks, reticent between 24 and 30 in the experience of my friends. But if your cervix is dialated at all (and the circulature stitch doesn't work) they'll induce labour.

Just wondering if the article you read specified the policy extended to non-viable foetuses?

No it was a general, "if the cervix is dilated for more than 24 hours" then intervention is necessary, I'm still trying to find it, but a few of the posts following mine suggest it too if I've read them correctly.

cch

iguana wrote: »

Panadol is paracetamol which is perfectly safe to take during pregnancy as it does not pose a risk to the embryo/foetus.

And was most likely the only painkiller offered to her over the 3 days (given my own experience of second trimester miscarriage)

Penny Dreadful

iguana wrote: »

Panadol is paracetamol which is perfectly safe to take during pregnancy as it does not pose a risk to the embryo/foetus.

This is true. My sister developed meningitis while pregnant and was told by the doctor to take paracetamol and that it was pefectly safe to do so.

cch wrote: »

And was most likely the only painkiller offered to her over the 3 days (given my own experience of second trimester miscarriage)

:eek: I'm really shocked at that. Paracetamol is well and good for a (mild enough) headache but when it is widely known that it doesn't even do anything for period pain never mind the pain this woman was enduring I am flabbergasted that she was left in such pain.
It seemed clear to everyone that the baby was being miscarried and there was no hope of survival for it. Why on earth was she not given some decent level of pain relief then.
Its just another thing to be angry, sad, upset and sorry about in this whole tragic story.

Das Kitty

Penny Dreadful wrote: »

:eek: I'm really shocked at that. Paracetamol is well and good for a (mild enough) headache but when it is widely known that it doesn't even do anything for period pain never mind the pain this woman was enduring I am flabbergasted that she was left in such pain.

Paracetemol was all I was given after a c-section. Which is abdominal surgery. And they were religious with the 'every 4 hours' thing. No matter how many times I asked. Some people get solpadeine or morphine. I had to get my GP to prescribe it when I was discharged (codeine)

Penny Dreadful

Das Kitty wrote: »

Paracetemol was all I was given after a c-section. Which is abdominal surgery. And they were religious with the 'every 4 hours' thing. No matter how many times I asked. Some people get solpadeine or morphine. I had to get my GP to prescribe it when I was discharged (codeine)

I understand that long term use of solpadeine (or similar) is not without its ill affects and all that business but really after major surgery being told to deal with the pain with paracetemol is just wrong. Its all well and good if you don't require anything stronger but if you do then bloody hell how is it any skin off the doctor's nose what you get

username123

Das Kitty wrote: »

Paracetemol was all I was given after a c-section. Which is abdominal surgery. And they were religious with the 'every 4 hours' thing. No matter how many times I asked. Some people get solpadeine or morphine. I had to get my GP to prescribe it when I was discharged (codeine)

Is that anything to do with breastfeeding?

It would seem to make no sense that Savita was offered nothing stronger than paracetemol considering she was not going to have a baby at all much less be breastfeeding one.

Mind you I had surgery in June for something completely unpregnancy related and I was only offered paracetemol as well.

Das Kitty

username123 wrote: »

Is that anything to do with breastfeeding?

Nope. If they can't tell a smoker not to smoke when breastfeeding they can't tell a mother not to take a low codiene dose for pain.

It doesn't pass into breastmilk in a large a volume as it does via the placenta anyway.

In the case here, we really don't know what sort of painkillers she was given. All we know is that she was in pain. Pain management is not an exact science at the best of times.

cch

username123 wrote: »

It would seem to make no sense that Savita was offered nothing stronger than paracetemol considering she was not going to have a baby at all much less be breastfeeding one.

But if there was still a heartbeat... which is the whole reason for this debacle...

I don't know for certain how the three days were managed as I don't think details of that have come out yet, but (and that was my point above) I wouldn't be surprised if it was just paracetemol she was given...

username123

cch wrote: »

I don't know for certain how the three days were managed as I don't think details of that have come out yet, but (and that was my point above) I wouldn't be surprised if it was just paracetemol she was given...

Yes, I appreciate its just conjecture, I wouldnt be surprised myself either if it turned out to be the case.

I also wouldnt be surprised if we begin to hear of other cases similar to Savitas that had not gone public.

Lingua Franca

We wouldn't have heard of this case at all if she had survived.

gozunda

Wibbs wrote: »

gozunda I'm afraid I had to delete your quoted text from an external source. Since Minister Sherlocks vague legislation came out we have to be very careful about linking to such sources. PITA though this is.

Erh no worries - do you have a link to that so I can take a read by an chance?

Thanks

LeeHoffmann

We can no longer avoid our responsibility.

The right attitude to take here IMO.
Congrats iguana btw

ts first and foremost, for me at least, an issue of womens health that affects us all.

exactly.

Lucyfur

Could she not have been given pethidine?

Edit; That sounds very blunt, sorry. Surely pethidine would've been ok for her?

I really feel for her husband

Iguana, huge congrats to you and himself, sorry to hear it was difficult but I'm delighted your baba is here xx

Neyite

Das Kitty wrote: »

Paracetemol was all I was given after a c-section. Which is abdominal surgery. And they were religious with the 'every 4 hours' thing. No matter how many times I asked. Some people get solpadeine or morphine. I had to get my GP to prescribe it when I was discharged (codeine)

Yep. Me too. Well, I got Diefene and paracetemol with my C-Section, for 5 days. And if I didnt specifically hobble up to the nurses station at the allotted time to ask for more pain relief they often forgot to give it to me. After I was discharged the only thing the pharmacist would give me without prescription was paracetamol. And I was doubled up and breathless with pain at the counter.

username123 wrote: »

Is that anything to do with breastfeeding?.

Nope dont think so, I was given a total of 17 different types of medication during my labour and C-section, but in my experience they are just very tight with the pain relief.

I was lucky - its my first baby and my partner took time off work for 2 weeks so I pretty much stayed in bed and just concentrated on feeding baby and resting. I dread to think how a woman with a C-section and a toddler and maybe a partner who couldn't get time off managed on panadol.

Lucyfur

I was given enough morphine to comatose a horse after my ectopic surgery!

It's insane how it differs.