HSE tried to get High Court Order to C-Section woman without her consent!

dublin99

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Moonbeam

What is the purpose of this thread?

dublin99

Moonbeam wrote: »

What is the purpose of this thread?

Sorry Mod. Feel free to remove thread. Heard about this story but had to remove details for privacy reason till judgement confirmed by the courts. Just to affirm women who want to try VBAC should know they have the right to and a lot of support to do so!

dublin99

HSE objected to the lifting of the in camera rule, therefore case was only reported after the High Court ruled on it:
http://www.irishtimes.com/news/crime-and-law/judge-refused-to-order-woman-to-undergo-caesarean-section-1.2852130

seamus

Can't see the full story because it's behind a paywall.

I'm going to guess though that the woman was insistent on going for a vaginal birth despite all recommendations against and the doctors considered the risk to the child grave enough to try and go to court over it.

I can see both sides here. I wouldn't condemn doctors for bringing this to court if they felt it was absolutely necessary (some people just refuse to listen to medical advice), but I'm also glad that the High Court denied the request.

The sooner we can repeal the eighth, the sooner these kinds of cases will stop coming up.

volchitsa

Yes, I found this article about the case too (no limit on articles, so everyone can read it).

It's shocking, but not terribly surprising for anyone who's had dealings with them, that our health service thinks their role is to take a labouring woman to court just for expecting basic her human rights to be respected.

http://www.thejournal.ie/high-court-judgement-caesarean-section-3059414-Nov2016/

“At present a pregnant woman’s right to make fully informed refusals are limited by the HSE’s national consent policy for pregnant women. This is in turn informed by the 8th amendment to the Irish constitution,” it said.

And after all that they wanted to keep this under wraps as well.
It's really all about what's good for the HSE isn't it? Never the patient.

intheclouds

seamus wrote: »

I can see both sides here. I wouldn't condemn doctors for bringing this to court if they felt it was absolutely necessary (some people just refuse to listen to medical advice), but I'm also glad that the High Court denied the request.

People do not HAVE to listen to medical advice. If I go to a doctor with cancer and he recommends chemotherapy and I dont want it - I dont have to have it.

Forcing people to undergo medical procedures is not where we should be at.

Incidentally, the womans waters broke the day after the court ruling and she did agree to have the C-section and all was well.

Shedite27

seamus wrote: »

The sooner we can repeal the eighth, the sooner these kinds of cases will stop coming up.

So we can prevent the birth rather than deciding how to give birth?

eviltwin

intheclouds wrote: »

People do not HAVE to listen to medical advice. If I go to a doctor with cancer and he recommends chemotherapy and I dont want it - I dont have to have it.

Forcing people to undergo medical procedures is not where we should be at.

Incidentally, the womans waters broke the day after the court ruling and she did agree to have the C-section and all was well.

This. People make decisions that go against medical advice all the time. People refuse life saving treatment. Pregnant women are not treated with the same respect any other patient in our hospital system is. This is what the 8th has brought us to.

eviltwin

Shedite27 wrote: »

So we can prevent the birth rather than deciding how to give birth?

This has nothing to do with abortion.

volchitsa

intheclouds wrote: »

People do not HAVE to listen to medical advice. If I go to a doctor with cancer and he recommends chemotherapy and I dont want it - I dont have to have it.

Forcing people to undergo medical procedures is not where we should be at.

Incidentally, the womans waters broke the day after the court ruling and she did agree to have the C-section and all was well.

But isn't this the problem : how did communications break down to that extent in the first place?

Adult women are not stupid, they don't want to die or have their baby die just for a whim, which is why adults are considered to be mentally fit to give consent for a medical procedure unless there's some evidence that they are not fit - but the HSE doesn't seem to feel it has to take pregnant women's views into account at all. They prefer to bully and browbeat women rather than discuss, and taking someone to court at this stage of her pregnancy is just an extreme version of what happens all the time.

rainbow kirby

Shedite27 wrote: »

So we can prevent the birth rather than deciding how to give birth?

The 8th has major ramifications in continued pregnancy, not just abortion. Informed consent doesn't exist when pregnant as a result of it, treatment for other conditions is affected, miscarriage management is affected and even end of life issues are too. It's absolutely ridiculous.

volchitsa

Shedite27 wrote: »

So we can prevent the birth rather than deciding how to give birth?

Are you not aware that the woman in question wanted the baby?

Abortion didn't come into it at all.

The 8th amendment did, but that's because the 8th amendment has far more effects on women's healthcare than just being a nominal, and ineffective, ban on abortion.

intheclouds

volchitsa wrote: »

But isn't this the problem : how did communications break down to that extent in the first place?

Adult women are not stupid, they don't want to die or have their baby die just for a whim, which is why adults are considered to be mentally fit to give consent for a medical procedure unless there's some evidence that they are not fit - but the HSE doesn't seem to feel it has to take pregnant women's views into account at all. They prefer to bully and browbeat women rather than discuss, and taking someone to court at this stage of her pregnancy is just an extreme version of what happens all the time.

+1

Just to play Devils Advocate for a minute though, the HSE probably felt that if she didnt agree to C section and then baby died as a result that they could have been liable for criminal investigation for not upholding the 8th - so they were covering their own asses to bring it to court in the first place.

seamus

intheclouds wrote: »

People do not HAVE to listen to medical advice. If I go to a doctor with cancer and he recommends chemotherapy and I dont want it - I dont have to have it.

Forcing people to undergo medical procedures is not where we should be at.

Absolutely agreed. My point really is that from the doctors' point of view it could be analogous to a Jehovah's Witness refusing a blood transfusion; from their point of view, the patient is putting their child at risk through some irrational insistence on ignoring the risks.

So I understand completely where they're coming from and I don't condemn them for bringing this to court if they felt like they needed to. In fact, one could argue that the doctors are duty bound to do everything they can within their legal power to save the patient. If that means pursuing the high court action, then they are duty bound to make that attempt, even if they personally don't believe they should.

Irish case law is still a mess in this regard, and the 8th just complicates things further. Odd that this ruling was made in 2016; 10 years ago the High Court ruled that a Jehovah's Witness could have a blood transfusion forced on her against her will (her child had already been born). 10 years before that, the Supreme Court had ruled that nobody could be forced to have medical intervention.

So some surity for doctors in these cases is badly needed - so they can stand back and let people make their own medical decisions and not feel duty bound to save the individual against their wishes.

volchitsa

intheclouds wrote: »

+1

Just to play Devils Advocate for a minute though, the HSE probably felt that if she didnt agree to C section and then baby died as a result that they could have been liable for criminal investigation for not upholding the 8th - so they were covering their own asses to bring it to court in the first place.

Id love to agree, but I think the recent reports into several neonatal deaths, and indeed possibly some maternal deaths, all show a staggering lack of care on the part of the HSE.

I fear that it's far more likely that it's more about running the service : women giving birth to order or on schedule simplifies the planning of staffing rosters enormously. The continued use of AML in birth situations where the NHS has explicitly banned it is a blatant case in point.

Mr. Incognito

I suspect that the baby was in distress and this was an emergency procedure

The same woman would sue the hospital if the baby died.

intheclouds

volchitsa wrote: »

Id love to agree, but I think the recent reports into several neonatal deaths, and indeed possibly some maternal deaths, all show a staggering lack of care on the part of the HSE.

I fear that it's far more likely that it's more about running the service : women giving birth to order or on schedule simplifies the planning of staffing rosters enormously. The continued use of AML in birth situations where the NHS has explicitly banned it is a blatant case in point.

Well I was just playing Devils Advocate!

Could you please say what AML is - the first two links on google tell me its Acute myeloid leukemia or anti-money laundering.

intheclouds

Mr. Incognito wrote: »

I suspect that the baby was in distress and this was an emergency procedure

The same woman would sue the hospital if the baby died.

No thats not what the case was at all.

The woman had had previous C sections so was not recommended to have a natural birth. No emergency.

rainbow kirby

intheclouds wrote: »

Well I was just playing Devils Advocate!

Could you please say what AML is - the first two links on google tell me its Acute myeloid leukemia or anti-money laundering.

Active management of labour.

intheclouds

rainbow kirby wrote: »

Active management of labour.

Thank you.

Again I googled to see what that meant - its when they break the waters?

rainbow kirby

They also require cervical dilation to occur at a steady 1cm/hour or they will use a syntocinon drip to augment the contractions. It basically puts births on the hospital's time frame rather than the woman's (the aim is to be done in 12 hours, it was originally 24) but leads to more interventions and labours being labelled as "failure to progress" too soon.

volchitsa

intheclouds wrote: »

Well I was just playing Devils Advocate!

Could you please say what AML is - the first two links on google tell me its Acute myeloid leukemia or anti-money laundering.

Sorry - active management of Labour. (I see you've had some explanation already)
Developed in Dublin, where they had great results in reduction of numbers of caesareans, apparently. Unfortunately nobody else was able to reproduce these results, so it's fallen out of use except in a few situations. But is still commonplace in Ireland, and importantly, not always with the woman's consent.

http://onlinelibrary.wiley.com/store/10.1111/j.1471-0528.1999.tb08229.x/asset/j.1471-0528.1999.tb08229.x.pdf;jsessionid=E9BC34E9953A499068970DF119D30207.f01t02?v=1&t=iv25jt3p&a9b71f98

Here's a rather uncritical (Irish Times) description of it:
http://www.irishtimes.com/news/health/what-is-active-management-of-labour-1.322290

Beanybabog

Good decision by the Judge... imagine the alternative, could we drag women kicking and screaming from their homes for C sections they don't consent to??
She was fully compos mentis and able to make her own decisions about her body, regardless of whether her final decision went contrary to the best medical advice available at the time.

The 8th amendment is an atrocity

Beanybabog

rainbow kirby wrote: »

They also require cervical dilation to occur at a steady 1cm/hour or they will use a syntocinon drip to augment the contractions. It basically puts births on the hospital's time frame rather than the woman's (the aim is to be done in 12 hours, it was originally 24) but leads to more interventions and labours being labelled as "failure to progress" too soon.

Interesting.... I know little to nothing about labour and my ante natal class midwife spun the 12 hour / active management thing as in your best interest, because best practice suggests that after 12 hours women are tired, and you are unlikely to progress if you have not by that stage. I suppose i blindly accepted it!! Must look into it more.

rainbow kirby

Labour is not a linear function of time. In my own case I was 3cm when I got to the hospital, 3cm 6 ish hours later when my waters broke at 3am (though we suspect that lazy night shift midwife just didn't want to do a transfer to birth centre at that hour), 9cm when the day shift midwives came in around 7 and my little boy arrived before 9. The use of AML practices probably would have triggered the cascade of interventions when all I really needed was peace and quiet, darkness, freedom to move and the gas and air.

lazygal

Beanybabog wrote: »

Interesting.... I know little to nothing about labour and my ante natal class midwife spun the 12 hour / active management thing as in your best interest, because best practice suggests that after 12 hours women are tired, and you are unlikely to progress if you have not by that stage. I suppose i blindly accepted it!! Must look into it more.

I found the same in Holles Street-it was full of what you're 'allowed' rather than best medical practice. I say this as someone who was happy to have two c sections and has no desire whatsoever to aim for a vaginal delivery in the future. The eighth amendment affects every single aspect of maternity care, along with a significant cohort of medical and nursing staff who don't like being challenged on their evidence or being told you don't consent to something.
I am a bit different to this case, in that I refused to consent to a procedure to help me achieve a vaginal birth and instead was firm that I wanted a section instead. The consultant treating me was not impressed when I used the term consent and his attitude was appalling.

Beanybabog

lazygal wrote: »

I am a bit different to this case, in that I refused to consent to a procedure to help me achieve a vaginal birth and instead was firm that I wanted a section instead. The consultant treating me was not impressed when I used the term consent and his attitude was appalling.

I found the midwife very wishy washy when someone asked her about consent in relation to the injection they give you to bring on the afterbirth. It seemed like if it's not coming they just stick you with the needle! I'm a solicitor so I know a bit about the the law in this area, and thus far I have gotten the impression for the medical staff consent it's very much an afterthought, or a niggling red tape matter they don;t want to deal with,

lazygal

Beanybabog wrote: »

I found the midwife very wishy washy when someone asked her about consent in relation to the injection they give you to bring on the afterbirth. It seemed like if it's not coming they just stick you with the needle! I'm a solicitor so I know a bit about the the law in this area, and thus far I have gotten the impression for the medical staff consent it's very much an afterthought, or a niggling red tape matter they don;t want to deal with,

I found they phrase it as 'I'm just going to do this now' rather than 'this procedure is for this reason, are you ok with that'. I remember getting an injection the morning after my first section, I wasn't told what it was for or why I needed it, and the nurse was a bit taken aback when I asked her to explain it rather than just jab the needle in.

Beanybabog

lazygal wrote: »

I found they phrase it as 'I'm just going to do this now' rather than 'this procedure is for this reason, are you ok with that'. I remember getting an injection the morning after my first section, I wasn't told what it was for or why I needed it, and the nurse was a bit taken aback when I asked her to explain it rather than just jab the needle in.

That's actually disgraceful and that's how mistakes happen - i.e. jabbing someone with an allergy

volchitsa

Beanybabog wrote: »

Interesting.... I know little to nothing about labour and my ante natal class midwife spun the 12 hour / active management thing as in your best interest, because best practice suggests that after 12 hours women are tired, and you are unlikely to progress if you have not by that stage. I suppose i blindly accepted it!! Must look into it more.

It's nonsense, you can't labour actively for hours, true, but the earlier stages of labour can go on for hours, some women even sleep during them - the problem in Ireland isn't the intervention itself, it's the systematic use of it far too early on in labour when it hasn't shown its usefulness and it can lead to complications.

A friend of mine nearly had a disaster when the injection of syntocin (IMUIC) sped up her labour so much it was suddenly out of control, and her little boy was born with shoulder dystocia because there wasn't time to adjust his position. The midwives were really panicking, and it was her third baby, so she knew what was normal at that stage.

(The baby was ok in the end, though he had to have physiotherapy for his arm, as they can be paralyzed if the damage is major - he wasn't, luckily. But the hospital admitted they caused the problem, and it could have been disastrous for the baby.)