Baby blues: are maternity services misogynistic?
Ireland remains a relatively safe place to deliver a baby but hundreds of women have been telling traumatic stories of their experiences in maternity hospitals. What's gone wrong, asks Catherine O'Mahony
The Government's 10-year National Maternity Strategy is an impressive 133-page document, promising multiple improvements to current services and a greater focus on patients and their choices. It stipulates, among many other things, that "good communication, compassion and support are very important and will contribute to a positive birth experience".
This is the theory.
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The fact is that funding for new developments in the National Maternity Strategy has been halted this year.
And listeners to RTÉ's Liveline show in recent weeks would be forgiven for concluding that communication, compassion and support - theoretically at the heart of maternity services - are wholly absent. More than 1,000 women have contacted the show to report having been brutalised emotionally by their experiences of hospital maternity services. Most described encounters with a high-handed culture that - they felt - didn't care how they felt.
Woman after woman described feelings of isolation and degradation during childbirth. Some women said they felt they were being scolded by the medical staff for "not being able to do it [childbirth] properly". "Say nothing, touch nothing and get out as fast as you can," was one woman's advice.
The issue is expected to be raised for debate at the Oireachtas Health Committee and has sent shockwaves through maternity hospitals.
Sinn Féin health spokeswoman Louise O'Reilly believes women who use maternity services should be contacted a year after they give birth to give feedback and that this needs to be passed on to staff.
"The paternalism thing is really a matter from the top down. The very senior members of the team need to be saying - this is not the way we want women to be treated.
"But I don't think this is a matter of lack of empathy. Staff are working in very tough conditions. A midwife might see five or six women a day. If the Government actually resourced its maternity strategy, that would be a help."
Leading obstetricians do not accept the characterisation of their services as being devoid of empathy. Rhona Mahony, former Master of the National Maternity Hospital and now director of women and children's care for the Ireland East Healthcare Group, said she was very concerned about the impact of the Liveline shows on staff.
"It's just not comprehensive," she says. "While some of it might be deserved, if you paint a universally dismal picture, then that's genuinely at odds with my experience over 25 years. Yes, there have been times when things could have been better. There were times when I could have been better. But across the board we get very good feedback, and we always deliver babies as carefully as we can.
"It's very demoralising for young registrars and midwives in particular to be so criticised when they work so very hard for very long hours every day," she says.
"I accept the feedback - it's important - but it's certainly not been my experience that all obstetricians are un-empathetic towards patients or cruel in any way."
Trauma, neglect, pain and fear
Ever since the first call to Liveline, from a woman called Michelle Roche on April 2, the conversation around maternity services has been about trauma, neglect, pain and fear.
Michelle told of her three-day stay in hospital over last New Year for her fourth pregnancy, which she said had disappointed and shocked her. Nobody had come in to check on her or anyone else on the ward on either the second or the third night of her stay. She had had a Caesarean section and was in considerable pain. And yet in the days after delivery, she was essentially left to manage herself, plus a newborn infant.
The call struck a nerve. Researchers started to take dozens of calls from women who wanted to have their stories heard. The dozens of calls turned into hundreds as the days went by. They ultimately exceeded 1,000 - making this one of the biggest themes the programme has ever handled.
Emer (she did not give her surname) told of being admitted for a scheduled induction in 2015 and ultimately being told she needed an emergency Caesarean section. But she had to share theatre with another woman and the atmosphere, she said, was not good. Her insistence that her pain relief had not kicked in and she could feel the incision was ignored, she said. And so she shut up. "I felt the pain throughout. I eventually bit that back and went through the pain."
Martina was suffering from high blood pressure and was given an emergency Caesarean section after 37 hours of labour. She too felt intense pain during the surgery and eventually passed out from the pain of being stitched up.
"They swept everything under the carpet," she told the programme. "They said you are fine now, go home. I just want to say that a vet would have more compassion for animals in a clinic than what I went through."
How representative these experiences were is hard to say. But these are not the first such accusations against medics who treat Irish women. Gabriel's Scally's report on the CervicalCheck scandal went so far as to say consultants' attitudes verged on misogyny.
'Practically perfect' deliveries
It is also clear that - while maternal death ates are consistently low in Ireland - some level of delivery complication is normal for Irish births. Each year, there are in excess of 60,000 births in Ireland and a survey published last year in the Irish Medical Journal concluded that fewer than one per cent of those births constituted what the authors termed a "practically perfect" delivery, meaning the baby arrived at full term, had no health issues and the birth needed no major intervention.
The HSE concedes that it should not have been the case that women felt they needed to call RTÉ about their trauma.
"When someone is dissatisfied with their clinical care, or the manner in which they were treated, they can make their views known directly to the hospital or through the Your Service Your Say service," it said.
"The HSE will always endeavour to address these concerns in a compassionate and professional manner."
The HSE says that, since 2016, an additional €18m has been invested in maternity care, and that this has supported the appointment of Directors of Midwifery in each of the 19 maternity units. In 2018, an additional 150 posts were approved for maternity services, including more than 70 midwives, and nine additional obstetricians.
Funding is key to fixing problems in maternity services, in the view of Fianna Fáil TD Margaret Murphy O'Mahony, who also sits on the Oireachtas Health Committee.
"To be fair to the staff, I think most of us are basically kind, but it is hard to be kind under pressure.
"I am very saddened to find that so many women had such a hard time when their baby's birth should be one of the happiest moments of their lives. I do think it should be looked into,
"The most worrying thing is that these seem to be everyday occurrences - most of these women went home with healthy babies and they still had a terrible experience."
Coombe hospital obstetrician Chris Fitzpatrick is spearheading a new initiative aiming at teaching consultants better ways of showing patients empathy at crisis points.
He is the driving force behind a training scheme run by the Abbey Theatre for the Royal College of Physicians of Ireland to help doctors training as obstetricians and gynaecologists to deal more sensitively with parents experiencing stillbirth and pregnancy loss. Some 60 trainee doctors have been through the first phase of this training.
This is not an acting course, per se, Fitzpatrick stresses, it's about using the arts to help doctors "draw out from themselves" a better way of talking to people in crisis.
Fitzpatrick objects to the characterisation of maternity services as misogynistic. But he acknowledges that there is a problem with the way women experience maternity services. He and his colleagues were, he says, "deeply upset" to hear the stories women told on Liveline.
Funding, he says, is another issue. "This doesn't happen in a vacuum. but despite pressures on funding and all of that - we can't justify a lack of kindness. We can't justify lack of respect. Words can hurt. We need to find the right ones.
"We need to look at how we are training our medical students and young doctors. We want to deliver the highest standards of care in every encounter and that's hard. But we have been making efforts to improve and we have made some inroads."