Aja Teehan take court case over right to home birth.

Morag

So the HSE has changed the guidelines for home birth, restricting further the few choices women have.

Aja Teehan has a court date tomorrow to challenge those new restrictions.
How this will go, no matter either way will be a landmark ruling for women in this country.

http://www.independent.ie/irish-news/mumtobe-takes-case-over-refusal-to-allow-home-birth-29419767.html

The couple have been giving interviews and have kept a blog as they fight for the right to have the birthing experience they want.

http://www.ajateehan.com/

Women have had vaginal births after a c section and women have had successful home births after having a c section but the HSE has changed it's guidelines to rule out home births completely for such women.

LegacyUser

I'm all for people being given a choice, but I also think that in some cases, people need to be protected from themselves!
A pal of mine works in a maternity hospital. Lady came in recently, 42 years old, first pregnancy, IVF baby. Consultant advised that she be induced. She refused- "I have decided". Ended up having an emergency C-section as babys' heart rate was dropping quickly Mum& baby both survived what could have potentially been a fatal outcome. Her comment to the medical team the following day? A surly "I wish you'd given me more time to push"!!! Ego/childs' life?

pwurple

Just to be a total capitalist about it, but how much does a home birth followed by emergency tranfser to hospital cost the taxpayer, vs the standard hospital birth?

People can give birth in a tent by their favourite lighthouse for all I care, as long as I'm not footing an extra tax bill for that particular whim.

Tigger99

The case will be very interesting, especially considering how much active management is pushed in hospitals and I suspect many women would like the choice of being at home?

Hgffc don't know how your story or that ego comment is relevant to home births?

Chattastrophe!

Makes sense to me. While it is of course possible to have a successful natural birth after a section, there is a higher risk of complications, which is why it makes sense to have the birth in a hospital - where the mother and baby can be monitored much more closely, and any medical intervention necessary can be done much faster. It wouldn't seem fair to leave a midwife responsible for a home birth where there's an increased risk of complications, as she wouldn't have the necessary equipment and resources immediately available should things go wrong.

Offering midwives for home births is a nice luxury, but I wouldn't see it as am automatic right of expectant mothers, and I'd agree that it should only be considered in the most straightforward uncomplicated pregnancies.

Rosy Posy

I think that so much depends on the midwife. I trust my midwife completely so I know if she said we had to transfer then we would transfer. Ditto any intervention- I would know if she said it had to be done it really did. I think a lot of the scare stats are made up from incompetent or zealous midwives.

lazygal

I'm considering my options after an elective c section last time. At my first appointment with my consultant the risks of trying for a vaginal delivery vs having another elective section were outlined, and have been weighed up as my pregnancy has progressed. I would have loved to have had a more 'natural' experience last time, but my health and that of my baby were paramount. I'd have been in serious trouble if I'd attempted a vaginal delivery. I knew before I had my c section that the chances of future vaginal deliveries were smaller than if I'd had a vaginal birth - you've a one in four or three chance (depending on age, hospital policy and other factors) of a c section birth even if everything goes perfectly. I know a woman who was ten cm dilated, no drugs up to that point, and ended up with an emergency section.

Thing is, you don't know how straightforward or uncomplicated a pregnancy will be at any stage. I had issues present at 20 and 34 weeks last time, and a few issues present this time. I'm very healthy, at the younger end of the age scale, got pregnant naturally both times and have no indications that I would have any issues. Even during labour you don't know what might go wrong, like a malformed uterus that wasn't picked up in scans or a large baby that looked a normal weight in scans. I have my own issues with the medicalisation of birth, but I don't think its always a case that natural is best or that pointing out the risks of homebirths is scaremongering.

hickory99

Hgffc did you even research what the risks of a vbac delivery are before you posted? No mother and I mean no mother wants a natural birth at any cost, this case is about the right to choice. If you go by EVIDENCE BASED research it shows a vbac is safer for mum and baby. The extra 'risk' assossciated with vbac is scar rupture which is a risk of less then 1%. The other fact is if you have a hospital birth you are much more likely to end up with un-needed intervention that is done more to suit the hospital's busy schedule and overcrowding problems. Why on earth people think that being in hospital is guarantee of a safer birth is beyond me. It has been proven that homebirth is just as safe as a hospital delivery, it's cheaper on the tax payer and it's free up hospital beds.

I'm all for individual evaluation as too wether there are any likely complications but a blanket NO to all vbac mums is uncalled for. I had a vbac last month in hospital because I had no choice. No complication, not so much as a stitch. There was no specific reason why I couldn't have my baby at home except that less then 1%. The reason for my section first time round was because the hospital consultant LIED to me about a number of things that I only found out afterwards and was admitted too by the hospital. Can you imagine how hard it was for me to be denied a homebirth because they forced me into a section and then to have absolutely no choice but to put my body into their care again this time round? I should not of been put in that position, I should of had a choice. I hope to god this woman gets what she wants and for those people who are ignorant enough to say she "should be in hospital for a safe delivery" without doing any bloody research on the matter stay out of the arguement

Das Kitty

I firmly believe that every woman should have the right of informed choice on how and where to give birth. If I were denied my choice of birth this time I know I would be massively distressed.

If this woman is willing to pay all the costs associated with the home birth, and knows the risks and challenges that might occur, I don't see why the HSE should bar self-employed midwives from partaking in cases like this.

Irish hospitals are overcrowded, noisy and uncomfortable. This is not the ideal situation for progression of labour, far from it. To be honest I'd like to see more birthing centres available to labour in, where you have the security of being in a medical enviornment without the conveyor belt feeling of being in a hospital. Wishful thinking at the moment though!

Rosy Posy

hickory99 wrote: »

The reason for my section first time round was because the hospital consultant LIED to me about a number of things that I only found out afterwards and was admitted too by the hospital. Can you imagine how hard it was for me to be denied a homebirth because they forced me into a section and then to have absolutely no choice but to put my body into their care again this time round? I should not of been put in that position, I should of had a choice. I hope to god this woman gets what she wants and for those people who are ignorant enough to say she "should be in hospital for a safe delivery" without doing any bloody research on the matter stay out of the arguement

I'm so sorry to hear of your experience. It's shocking and such a huge violation of your rights and your body.

With my second child I was trying for a homebirth but transferred to hospital fully dialated but with an anterior lip. The registrar who was on pushed for a section. My OH worked in the hospital at the time and we knew the girl and that she had only moved up from being a house officer two weeks previously so I refused to let her perform the surgery. She called the consultant who didn't want to get out of bed and told her to call him back in an hour if the baby wasn't born...baby was born naturally half an hour later! If I hadn't had my husband and midwife advocating for me I might have had a totally unnecessary surgery which could have prevented me from delivering my next baby at home.

I think there's a lot to be said for midwife led care across the board. Here in NZ all ante and post natal care is done by independent midwives and you only see a doctor if there's a problem. There's continuity of care and it works out a lot cheaper on the taxpayer.

ash23

If she is willing to pay the costs, find a midwife who is willing to take to risk and sign something to say she won't sue the HSE if something does go wrong which was related to complications caused by VBAC, then let her have her home birth at her own risk.

But if she wants any costs or insurance paid by the HSE, then I would say that they are within their rights to refuse the risk.

Personally I had a c-section and can have a VBAC but I wouldn't choose to have a home birth now in case of rupture combined with being quite a distance from the hospital. I would have liked a home birth but I'm not a risk taker by nature.

Das Kitty

ash23 wrote: »

If she is willing to pay the costs, find a midwife who is willing to take to risk and sign something to say she won't sue the HSE if something does go wrong which was related to complications caused by VBAC, then let her have her home birth at her own risk.

But if she wants any costs or insurance paid by the HSE, then I would say that they are within their rights to refuse the risk.

Personally I had a c-section and can have a VBAC but I wouldn't choose to have a home birth now in case of rupture combined with being quite a distance from the hospital. I would have liked a home birth but I'm not a risk taker by nature.

See the thing is, to operate as a midwife in Ireland, you need to be indemnified by the HSE. Even if you're self-employed.

So even if a midwife were willing to do this and the woman incurred the cost, and worked out a legal waiver, they can't.

lazygal

I can't stress how important it is for women to have a serious chat with their partners or whomever will be in the room with them during labour. Even though I had an elective section my husband had to insist on a few things that would have been done without my knowledge. Because we'd chatted about dos and don'ts beforehand he was able to fight my corner when I wasn't able to. I'm not very into birth plans, but I am into birth preferences - and your birth partner should be fully aquainted with them because when you're in the throes of having a baby you are tired, emotional and vulnerable. You need someone who's able to fight on your behalf and who won't be pushed into making decisions which might be regretted later on.

If people want midwife led care, they should be able to have it. I'm happy with consultant led care - but I'm in the lucky position of being able to pay for it and I feel I have more options because I've an ongoing relationship and care plan with one doctor who is able to talk through things with me and knows all about what happened last time.

ash23

Das Kitty wrote: »

See the thing is, to operate as a midwife in Ireland, you need to be indemnified by the HSE. Even if you're self-employed.

So even if a midwife were willing to do this and the woman incurred the cost, and worked out a legal waiver, they can't.

Well then that should be changed. If the self employed midwife is being paid privately, has their own insurance to cover them which is no way costing the HSE anything, then the HSE shouldn't be involved.
However, if the HSE are going to end up liable, then they are well within their rights to draw the line in terms of the risk they are willing to take.

meeeeh

ash23 wrote: »

Well then that should be changed. If the self employed midwife is being paid privately, has their own insurance to cover them which is no way costing the HSE anything, then the HSE shouldn't be involved.
However, if the HSE are going to end up liable, then they are well within their rights to draw the line in terms of the risk they are willing to take.

If something goes wrong HSE/state will end up paying for it. Parents foot a big bill for kids with special needs but state still offers some treatments, equipment, special needs school assistance. Somebody (woman or baby) could need lifelong assistance from the state and should we stop providing it if the midwifes insurance doesn't cover all the cost?

ash23

meeeeh wrote: »

If something goes wrong HSE/state will end up paying for it. Parents foot a big bill for kids with special needs but state still offers some treatments, equipment, special needs school assistance. Somebody (woman or baby) could need lifelong assistance from the state and should we stop providing it if the midwifes insurance doesn't cover all the cost?

Well in that case then the HSE are right to minimise their risk. I'd actually not thought about it in terms of ongoing assistance for the child and was more thinking about it in terms of an immediate payout for the mismanagement of the birth.

So therefore if they want to minimise risk, I think they should be able to do so.

eviltwin

She can have a home birth if she wants it but the HSE are protecting themselves and tbh I can understand their point of view on this.

As much as I think all women should have the option of a home birth if they want its just not possible. Birth does carry risks and while they are small they are still significant.

I've never been able to have exactly the kinds of births I want due to my health issues, I often think I could have been okay if they hadn't been so cautious in the hospital but now, with the benefit of hindsight, I think they were right. The most important thing has to be a healthy outcome for mum and baby even if that means mum doesn't always get what she wants.

meeeeh

ash23 wrote: »

Well in that case then the HSE are right to minimise their risk. I'd actually not thought about it in terms of ongoing assistance for the child and was more thinking about it in terms of an immediate payout for the mismanagement of the birth.

So therefore if they want to minimise risk, I think they should be able to do so.

Plus whatever we think of HSE they are probably better qualified to evaluate someones abilities and work practices than insurance companies. I would be even surprised if insurance companies actually insure people without HSE indemnity. It just seems too risky.

ash23

meeeeh wrote: »

Plus whatever we think of HSE they are probably better qualified to evaluate someones abilities and work practices than insurance companies. I would be even surprised if insurance companies actually insure people without HSE indemnity. It just seems too risky.

I'd say the premiums would be insanely high, the cost would have to be passed to the person paying the private midwife and therefore a home birth would become totally unaffordable for the majority of people.

LittleBook

Hgffc wrote: »

I'm all for people being given a choice, but I also think that in some cases, people need to be protected from themselves!

For anyone who's interested, it might be worthwhile having a read of this recent thread which discussed a hospital who forced a woman to have a C-section ... it was a bit of an eye-opener (for me anyway) in terms of the treatment of pregnant women by our health service.

The HSE MOU on home births is not available at the moment on their website so it's not possible to judge the criteria, but I understand the latest edition has led to a situation where even women who have had successful home births in the past would no longer be eligible.

There's no doubt that the circumstances of a home birth after a caesarean need careful consideration, but I wouldn't be too quick to assume that the HSE is working in the interest of the woman or the baby. The woman in this case is challenging a "blanket policy" which was considered a bit dubious by many at the time it was introduced.

To quote myself from that thread which applies here also:

LittleBook wrote:

I must admit, at the beginning of this thread I was of the "why wouldn't she (the woman in question) listen to the experts?" mindset, whereas now I'm more than dubious about the situation.

Edit: HSE home births section is back up

eviltwin

Its hard enough to get a VBAC when you plan to have your baby in a hospital so its not a bit surprising she was refused a home birth.

Its worth thinking about the midwife in all this as well, as much as she might be experienced etc its a lot of responsibility on her in a situation where she has no back up, no intervention available, is relying solely on her own judgement to decide what to do and when to do it and if something went wrong she is the one who takes the rap. Its a lot to ask of someone.

um7y1h83ge06nx

It's going to turn into a crusade:

http://www.independent.ie/incoming/babies-show-their-support-for-mum-in-high-court-battle-29462261.html

As most people said she should be able to do what she wants but if she goes against HSE advice the HSE should be covered from legal action if something goes wrong.

Could she take out her own indemnity insurance for the mid-wife?

LittleBook

eviltwin wrote: »

Its hard enough to get a VBAC when you plan to have your baby in a hospital so its not a bit surprising she was refused a home birth

Why is that I wonder? Ireland's rate of caesarean section is nearly 30% which seems quite high.

eviltwin wrote: »

Its worth thinking about the midwife in all this as well, as much as she might be experienced etc

If she didn't have a midwife who was prepared to do it, I doubt this case would have gotten out of the blocks. Apparently a very experienced midwife called Philomena Canning is supporting her in this.

ash23

LittleBook wrote: »

If she didn't have a midwife who was prepared to do it, I doubt this case would have gotten out of the blocks. Apparently a very experienced midwife called Philomena Canning is supporting her in this.

A midwife who is expecting the HSE to indemnify her should something go wrong. Is this midwife willing to fly solo and leave herself open to litigation if something does go wrong? Has she insurance lined up for herself which will cover any needs the mother and child may/will have if something goes wrong?
Will the HSE have absolutely no obligation to this woman or her child?

Highly unlikely.

So the midwife basically wants her "employer" to allow her to do something that they feel leaves them at risk. Truthfully I don't think they have a leg to stand on. I don't think a court could dismiss the right of the HSE to minimise the risk to themselves unless they also absolve them of any obligation. And I'm not sure that is possible.

meeeeh

LittleBook wrote: »

Why is that I wonder? Ireland's rate of caesarean section is nearly 30% which seems quite high.

Of over 11,000 women surveyed, 26.7 per cent had C-sections. Slightly over half of these were emergencies but 48.2 per cent were elective.
Despite expressions of official concern, C-sections rates have been rising in Ireland for some years. At 26.7 per cent, the Irish rate is higher than the UK rate (23 per cent) and the European average of 19 per cent. The World Health Organisation recommends a rate of between 10 and 15 per cent.

http://www.irishtimes.com/news/health/caesarean-rate-higher-in-private-care-1.1403506

I think there is an impression that women are forced into caesarean but stats show that there is a very high level of elective procedures. I'd say it is very complicated issue, Ireland has also higher birth rate and as far as I know C section is more common after multiple births and like for like comparisons are hard. I think there is possibility that there are unnecessary c-sections performed because it suits doctors or hospital but I also think that the issue is far from straightforward and depends on a lot of other factors like age, general stamina, number of children, cultural influences...

In the same way is also hard to compare home birth stst because only low risk mothers living in certain proximity of the hospital (if I'm not mistaken) are allowed to have one.

lazygal

I can only go on anecdotes and its no way medically indicative of anything, but I'm not aware of anyone in my pregnancy cohort (I'm in some online and RL mums groups) who had c-sections for anything other than medical reasons. These might be failure to progress, breech presentation, failed induction, baby measuring very large for a woman who has a small pelvis, gestational diabetes or pre-eclampisa. I don't like the perception that women 'choose' to have a section with the use of the term 'elective'. I had an elective section but it wasn't my choice. I got comments about how right I was to chose a section because for whatever reason its seen as a choice rather than being medically necessary. I've stopped trying to explain that my section was for medical, not any other, reasons, and I won't bother if I end up having another.

There's also other reasons for the higher rate of sections, such as being older. You're a geriatric mum after the age of 35! And there's far more overweight/obese women who would be at risk of complications.

LittleBook

ash23 wrote: »

A midwife who is expecting the HSE to indemnify her should something go wrong. Is this midwife willing to fly solo and leave herself open to litigation if something does go wrong? Has she insurance lined up for herself which will cover any needs the mother and child may/will have if something goes wrong?

Do you mean professional insurance? Any midwife in the INMO has professional indemnity insurance. Isn't this about the difference between what a public and a private patient are entitled to? Sorry if I've misunderstood that.

ash23 wrote: »

So the midwife basically wants her "employer" to allow her to do something that they feel leaves them at risk. Truthfully I don't think they have a leg to stand on. I don't think a court could dismiss the right of the HSE to minimise the risk to themselves unless they also absolve them of any obligation. And I'm not sure that is possible.

Again, I thought this was more to do with public versus private and what the HSE will cover for the patient, not what the midwife expects from the HSE.

meeeeh

lazygal wrote: »

There's also other reasons for the higher rate of sections, such as being older. You're a geriatric mum after the age of 35! And there's far more overweight/obese women who would be at risk of complications.

That was my point. There are multiple factors why someone would have a C-section, I just don't like the impression that evil hospitals force C-sections on women. The fact is that women here have more children than in comparable countries, I don't have date for age but I almost certain that they are a bit older and also a bit heavier than EU average. Higher rate of C sections among private patients does imply that some are deciding for private care because C-section would not be available otherwise (it could also imply that pregnant women in riskier category will opt for private care).

There is no denying though that C-section stats in Ireland are high. Just to make it clear I'm not one of the natural birth advocates and I would have no issues with c-section if it was needed or perceived to be needed.

LittleBook

lazygal wrote: »

I can only go on anecdotes and its no way medically indicative of anything, but I'm not aware of anyone in my pregnancy cohort (I'm in some online and RL mums groups) who had c-sections for anything other than medical reasons.

No doubt LG (and sorry, I know this is going OT but) I googled "growing number of c-sections in Ireland" and found these articles:

http://www.irishhealth.com/article.html?id=2472

In 1990, there were 4,706 Caesarean sections performed. A decade on however this figure had increased to 10,413, despite a modest increase in the overall number of births.

One of the reasons suggested for the increase in the rate of C-sections is an increased tendency among patients to resort to litigation.

http://www.irishexaminer.com/archives/2004/0309/ireland/c-sections-up-mothersapos-infection-risk-595962877.html

The number of caesarean sections has trebled in Ireland over the past 20 years, with more than 20% of all babies born this way. Fear of natural labour and litigation are fuelling the increase. There is no breakdown available of the number of c-sections carried out in Ireland for medical or elective reasons, but figures in Britain suggest that 8% of caesareans are now elective.

lazygal

Yeah I don't like the impression that c-sections are handed out willy nilly to women who are too posh to push or to placate doctors' holiday schedules, because that certainly wasn't and isn't my experience. I know in Holles Street, VBAC is what is routinely offered and I very much get the impression that if I'm a good candidate for it, that'll be my destination. If anything, I know of women who fought to get a section after a traumatic first or second delivery rather than a c section being the first option discussed.

lazygal

LittleBook wrote: »

No doubt LG (and sorry, I know this is going OT but) I googled "growing number of c-sections in Ireland" and found these articles:

http://www.irishhealth.com/article.html?id=2472



http://www.irishexaminer.com/archives/2004/0309/ireland/c-sections-up-mothersapos-infection-risk-595962877.html

I know I'm going on anecdotes myself, but I do think there's an increase in the risky cases, as I said, older women, overweight/obesity and fertility assisted births. From chats with my doctor she's mentioned seeing patients who simply wouldn't have been pregnant ten years ago because of medical issues but with new fertility treatment are presenting with multiple births or are having a second child many years after a first. I'm a private patient, and I'd hazard a guess that many women who've had a tough road towards getting pregnant might go private for peace of mind.

There was a period where 'once a c section, always a c section' was the policy in many hospitals but I think that's moved on a bit to offering a VBAC to women who are suitable candidates.