Human Rights in Irish Childbirth - A Woman's right to choice on how and where she births.

This petition was created by AIMS Ireland and HBA Ireland, Feb 2013

Abstract: There is an overwhelming failure to recognize human rights in birth in Ireland. In December 2011 the Fine Gael and Labour Government passed legislation, called The Nurses and Midwives Act, 2011,which governs the way midwives are insured to attend homebirth in Ireland. The Act refers to guidelines which, whilst not part of the Act itself, were created by the Health Service Executive (HSE)and collated into a Memorandum of Understanding (MOU) between midwives attending home births and the HSE.The MOU for home birth service does not recognize a woman's right to decide how and where she births. Midwives who make an individual assessment, that the mother and baby are safer birthing at home than in a hospital setting, desite falling outside generalized guidelines, are punishable by law with a €60,000 fine and/or a 10 year prision sentence. Women who make an informed decision, against the uninformed terms, are threatened with having their midwife barred from attending them in childbirth and having their baby taken into State custody at birth.

The aim of this petition is to address two issues: (i) reject recent proposals to make it mandatory for two midwives to attend every birth, threatening homebirth services in Ireland and (ii) to demand revisions to the MOU, to define, recognize, and under-pinwomen's human rights in childbirth to choose how and where she births, regardless of criteria recommendations. These revisions should reflect a woman’s right to give birth how/where she wishes, fully insured, by the care provider of her choice. Please share this petition widely. Recognition of human rights in Childbirth affects women in every care choice spectrum. Background: In 2011 the Fine Gael and Labour Government passed legislation, called The Nurses and Midwives Act, which regulates the terms on which a woman may access homebirth services in Ireland.A Memorandum of Understanding (MOU) was created to outline the terms in which a midwife is insured to attend a woman at home. Midwives who book women outside of the rules and hse criteria, in theinterest of safety for thewoman and baby,are punishable by lawwith a €60,000 fine and/or a 10 year prison sentence. Women who make an informed decision, against the un-informed terms,are threatened with having their midwife barred from attending them in childbirth and having their baby taken into State custody at birth. Women have also been threatened with risk assessors, mental health assessments and doorstep visits from relevant stakeholders.

AIMSI has raised concerns on the criteria in the MOU at every level due to failures by the HSE, State, and stakeholders involved in the process to recognize the woman’s right to choice on how/where she births in this process. AIMSI published HSE proposals which recognized the Gardaí as 'relevant stakeholders' in homebirth and have documented examples of threats women have recieved when exercising their choice for a homebirth outside of 'the rules'.

A finalized version of the MOU is currently being negotiated through the National Steering Committee for Homebirth. Proposals to the finalized MOU include the mandatory attendance of two midwives per homebirth. The implementation of two midwives will end independent midwifery and homebirth in Ireland. Proposals to Finalized MOU – mandatory attendance of two midwives AIMSI and HBA are concerned by proposals in the finalized MOU in which it will become mandatory for two midwives to attend every homebirth; this has raised serious concerns and, if included, the implications on homebirth will be immense. Ireland simply does not have the infrastructure to implement this proposal. The impact of such a proposal would deeply restrict homebirth in many areas and would threaten the existence of independent midwifery. The proposal of two midwives also infringes on a woman’s right to privacy, the decision on how and where to birth, and the continuity of care relationship between woman and her midwife, as the primary caregiver. Mandatory attendance of two midwives is not evidence based, nor is it routine practice in other EU States.Restrictions in homebirth places addedstrain on over-stretch hospital based services.Homebirth costs less andopens services inconsultant-led care for women who want or need this option.

Human Rights in Childbirth – Ireland: AIMSI and HBA rejects the Government’s belief that the decision on where and how to give birth is with the HSE, insurance companies, and the Government; not the woman. Current legislation to negate a woman’s right to choose where to birth her baby is in breach of the European Convention on Human Rights which enshrines the fundamental right to bodily integrity. The legislation and current prohibitive criteria in the MOU also is in conflict with the European Union court of human rights Article 8 : Ternovsky vs Hungary - December 2004 - which found in favour of the right to choose the circumstances in becoming a parent. On a local level, the Irish Constitution upholds the right to bodily integrity and autonomy. The HSE recognizes the right to informed choice in medical treatment and health. Pregnant women should be afforded the same rights to bodily integrity and autonomy in her health care as other citizens. As informed, equal citizens, pregnant women have equal rights to making decisions on her choice of healthcare, privacy, and place of birth. Neither the Government, nor the HSE, nor the panel of "experts" who created the MOU have the authority to make decisions for individuals in relations to their personal health and care options. International best practice, clearly defines a woman’s choice as final, regardless of recommendations. The Irish Maternity Services has failed to implement recognition of these rights, and instead, relies on blanket criteria outlining who may access midwife led care options. Best Practice clearly defines recommendations as a means to guide women and health care professionals towards a recommended care option, but guidance should never replace the right to informed choice. The removal of choice, as seen in an Irish context, is never best practice. There is currently no protection for the rights of pregnant women in Ireland. Ireland has the European Social Charter, the European Convention on Human Rights and the International Covenant on Economic, Social and Cultural Rights, but nothing specific to the Irish State that gives pregnant women rights, that protects pregnant women, nor defines women's right to autonomy in childbirth such as NICE. Petition: We, the undersigned, recognize a woman's right to informed choices, bodily integrity, and autonomy in childbirth. We recognize that women have the right to decide how and where she births. We recognize the findings of the EU Court of Human Rights, which found in favour of the right to choose the circumstances on becoming a parent. We demand revisions to the MOU, to define, recognize, and under-pin these rights, regardless of criteria recommendations. These revisions should reflect a woman’s right to give birth how/where she wishes, fully insured, by the care provider of her choice; be it hospital, MLU, or home. We reject the implementation of mandatory two midwives per homebirth into the MOU.

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Discussion

  • Fiona Keane I am very disappointed that the option of having a home birth is not available to me. I cannot even have a water birth in the hospital as there is no facility for this. It is hard to believe that this is the case in this day and age.

  • Emma Keelan Its disgraceful how we are stuck in an outdated system when the rest of Europe is far ahead in creating women-centric care. All we are looking for is choice and respect.

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