Power and control in the Irish Maternity Services: AIMS Ireland

The National Maternity Move to St Vincent’s campus has exercised anyone who has an interest in a maternity service that is woman centred,  evidence based and free from religious ethos and bias. This move in its current agreed form will not provide that. We say that with confidence in spite of what Dr O’Mahony, Minister Simon Harris and their foot soldiers say. The move within the current agreement clearly demonstrates that the St Vincent’s Hospital Group, an entity entirely owned by the Religious order The Sisters of Charity, will be owners of a brand new€300 million maternity hospital paid for by us the taxpayer. The agreement also reveals that in addition to being the owners, they will also exert their influence.

The agreement between the NMH and SVHG

The reserve powers of the Minister to ensure autonomy of the 4-4-1 Board of directors of the new hospital (basically the bosses), is welcome, no one is disputing that, but 4 people on that board will never be autonomous (even if they wanted to be), they will be appointed to represent the interests of the Sisters of Charity, and as such they will be fettered to a Catholic ethos, so how will the Minister ensure that his or her reserve powers can force them to abstain or vote a certain way? How exactly would that work? Answer: it won’t. What if one of the 4 appointees of the NMH cohort is a member of  Opus Dei (not entirely outside the bounds of possibility), and consistently votes with the SVG, the Board will be stacked to support Catholic rule. Furthermore, what of the independent “international expert”? Roisin Shorthall TD revealed on the 27th April that her investigations had led her to understand that the appointing committee for this international outside expert will consist of a panel of 3 consisting of 2 members appointed from the SVHG and 1 from NMH group. Will someone please enlighten us as to how could this international expert could actually be independent then?

The “agreement revelations” points to the new NMH clinical governance coming under the supra umbrella of the SVHG, including all private practices. Playing it forward, does that mean that private abortions performed under new legislation will have to be reported to the Sisters of Charity? The agreement states that there will be sharing of clinical facilities “seamlessly”. How seamless will this be with respect to procedures not compatible with the SVG ethos?  Will we find that in the future surgeries booked in the main St Vincent’s campus relating to procedures not falling within the Catholic ethos are re scheduled? Will we find theatres overbooked? Unavailable?

SVHG Control

The amount of control afforded indirectly to the Sisters of Charity is potentially extraordinary and it doesn’t just relate to the ownership of the building, it relates to overseeing all clinical practices, it relates to the clinical governance of the NMH being a sub strata of the clinical governance of the SVHG, with the NMH clinical director having to “report” to the overall top dog director of the SVHG (appointed of course by the Sisters of Charity). The entwining of control and the insidiousness of the Catholic ethos in this agreement points in one direction and one direction only; it will afford the Sisters of Charity (yet again) control. Control over the NMH and effectively over the women and pregnant people who birth there. This agreement has religion written all over it. It has religious power and control written all over it.

The expert knows more than the woman

Women pregnant and birthing in Ireland are of course no stranger to control and power battles fought around, over and within them. The public opinion on abortion seems (albeit  reluctantly) willing to take on board abortions in which the decision is given extra weight and credence by an outside expert; in cases of rape and incest for example. Why are these abortions viewed as more acceptable than an abortion in which a woman simply no longer wishes to be pregnant? Why is the thought of a woman making an informed decision about her reproductive health so abhorrent? Is it because it makes her autonomous? Is it because it makes her free of the control permission and approval of others?

In these “acceptable” abortions note that it is not just the woman, or in many cases child, making an individual autonomous decision about her pregnancy. Here there will be experts involved. Experts who can attest to what is really going on in a woman’s body and mind much better than the woman herself can. Experts in whom the state invests more trust than the women they observe, probe and question.  The voice of the “expert” now carrying the weight that the woman’s voice  cannot.

This of course is the ethos on which the foundations of the PLPA (2013), are built, where only by actually killing herself, can a woman exercise her choice to terminate her pregnancy free from outside “required approval”. Only after the event will those who doubted her, realise they didnt hear her, that her voice was not listened to and not “approved”.

Informed refusal and informed consent

Bodily autonomy control and power in our maternity services are not all about abortion, no not at all. They apply to every aspect of a pregnant person’s journey through the maternity services. Neither is control and the power play to achieve and retain it all about religion and religious ethos. The instant someone becomes pregnant in Ireland, their choices in their care are limited by the constitution via the 8th amendment. This now gives the State power over the woman’s body. Those working in maternity care then work within these constitutional constraints. In reality this means that women have historically been “done to”. They have not been in control or in partnership about choices and actions. Misogyny and patriarchy have also played their part, no doubt influenced by the state and by the Catholic ethos that has pervaded so much of Irish health care.

Our support files are filled to the brim with stories of women denied informed consent, denied informed refusal and being coerced into accepting procedures that they did not want and which were not informed by evidence. This happens every day in our maternity hospitals. Women’s bodies are still “handed over” and are still being “done to” with the full support of the state.

Some health care professionals were afforded so much power that it was almost impossible to curb them. The obvious example is Mike Neary, disgraced obstetrician from OLOL who performed caesarean hysterectomies at will, and then aided and abetted by his staff informed the woman how she had been saved. By him. Yes indeed “salvation” and and “delivery”. Whilst Neary is an extreme example, there are similar power dominant consultants in many hospitals, doing it “their” way. Because they can.

Take back birth

How do we take back birth? How can we influence the power balance in favour of self-autonomy in the maternity services? Well first on the cards is say no to any further religious interference or influence. We have had enough! That would include saying no to any NMH move to SVHG.

Secondly, we need to all work to ensure that women and pregnant people are afforded the opportunity for informed refusal and informed consent. Both these issues can only really fully be realised with the removal of the 8th amendment as it stands from the Irish Constitution.

Thirdly, lets work to ensure that care is received in partnership with the woman her health care provider and her wider family. Finally, lets ensure that the womans voice and the service user is fully represented in all areas of policy, decision making and corporate policy and management.

Finally, the 8th amendment as it stands must be removed

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