EU law on woman's rights during birth

[cantreachmytoes]

One World Birth

A film has been made about women's rights to choose the type of birth they want - hospital, home, midwife centre, whatever(!) - and their right to privacy during it, based on an EU law passed following a case brought by a Hungarian woman.

It features the UK, US, Chinese, Aussie presidents of their respective colleges of midwives, as well as human rights lawyers and others.

This is the abridged version (15 mins), the original is 1 hr.

[LaVolcan]

But also I think it's a national scandal that healthy women giving birth in obstetric led units are having DOUBLE the rates of unplanned surgery when compared to women in midwife led units. I mean - HELLO! - this is completely insane!

Absolutely agree here, and it's not as though it can be justified by better outcomes for the baby.

[PeoniesPlease]

I think it is a national scandal that women's choices in such an important area are disregarded and minimised, even by other women. Instead of pointing to potential barriers, why don't we all work to support each others choices, even when they are completely different from what we would choose for ourselves?

[PeoniesPlease]

"We are talking about how resources are allocated within maternity services AT THE MOMENT, and without further massive increases in funding."

Actually, I am talking about the rights issues in intervening without consent/refusing treatment arbitrarily. This thread was started as a discussion about the ruling in the ECHR. If women start having to enforce their rights in court, then perhaps the NHS bods will have to stump up more cash to ensure that women are respected in their birth choices. This should not be a zero sum game and I'm not going to agree that women who choose a vaginal delivery should have more access to resources than women who choose a surgical one. No one has any less right to appropriate and respectful treatment here.

[LaVolcan]

unlike many labouring women who don't even have one bloody midwife to themselves.
...or worse, can't even get across the threshold of the maternity unit because it's heaving and has had to close its doors. Who then have to go driving up the motorway to find another unit, who eventually get the support they need after being in labour for 50 hours. This is only one example I know of; perhaps it's an exception but sadly I think, not so much of an exception as it should be.

[Ushy]

Shag "obstetric units are having DOUBLE the rates of unplanned surgery when compared to women in midwife led units. I mean - HELLO! - this is completely insane!"

But there is a trade off between interventions and safety and it should be the parent's choice.

Induction is a case in point. 'Doing nothing' at 40+14 days might result in more normal births but it would also result in a huge rise in total baby deaths which rises eightfold from 37 weeks to 43 weeks. Shouldn't it be the parents who decide whether they want intervention or not?

Excellent post Peoniesplease It's a bit of a battle, though, to get that simple, reasoned, ethical, argument across

[Ushy]

Ugh! I used that horrible term 'normal' birth by mistake. Wash my mouth out. It's a vaginal birth.

[Shagmundfreud]

Peonie - the NHS has a responsibility to provide the safest possible care and the most clinically beneficial care for the largest number of mothers. That is its remit. It is a health sevice after all. If 'respecting women's choices' to have elective surgery means diverting funds currently used to pay for midwifery and consultant cover on labour wards into increasing access to surgical birth when there is no evidence of clinical benefit, then you are basically prioritising maternal choice over safety and efficacy - and there is no other area of the NHS where this would be encouraged or even tolerated.

You have to be realistic - the biggest barrier to a healthy and happy birth in the NHS at present is the lack of midwives and lack of consultant cover on labour wards. This needs fixing FIRST. And if we have to choose how limited resources are spent - and we do - then we can't justify widening access to surgical birth while basic safety on the wards is being neglected due to poor staffing.

And yes - in a fantasy world it would be wonderful if we could all have everything we want from the NHS, including free dentistry and as many rounds of IVF as it takes to get pregnant. But this is the real world and it's not going to happen any time soon. Or ever.

[Shagmundfreud]

Do you not use the term 'normal conception' or 'natural conception' either Ushy? What about normal breathing? Normal eating? Would you prefer the term 'physiological birth'.?

[Shagmundfreud]

There is no trade off between intervention rates and good outcomes when you are comparing births to healthy women which take place in different settings Ushy.

Healthy w omen who give birth in obstetric units have massively higher levels of medical input and yet are no more likely to take home a well baby than a mother giving birth in a birth centre.

[elizaregina]

Yes - lets just stop treating refugees and illegal immigrants who pitch up at our hospitals. They can die on the streets. sad


No Shag, if you saw the documentary these are health tourists - they are NOT POOR REGUGEES OR IMMIGRANTS they are people who would have to pay thousands for the same care in thier own country - therefore they come here - pay back handers to people who get them onto a Gps books. The cost of the flights - the back hander is STILL cheaper than paying for thier own medial bills back home.

Also as said - other Euorpean countries are robust at chasing us for hospital bills our nationals have run up. We however for some reason are not so robust at chasing up thier nationals.

Your issues are cost related - you are saying the NHS should prune and chose X Y and Z on womens care because they are very poor at the moment.

I say we should ALL be campaigning for the NHS to stop needlessly hemoragging money as per - PANORAMA documentary ......

As well as looking at ways to stop the mindless drunkness that our emergency services are having to deal with on weekends and all the problems/costs incurred by that.

BEFORE we start looking to prune back already crap maternity services.

I can only agree with a previous poster - that cost is infact a smoke screen - its nothing to do with cost for some people just blind ideolagy....and an inability to look at the bigger picture.

[elizaregina]

Lavolcan, where we are hospitals regulary close doors as they cant cope sadly.

[LaVolcan]

Who talked about 'doing nothing' Ushy? What about monitoring? It's the policy of using protocol to drive a woman's care which I find wrong.

Yes there is a trade off between interventions and safety and it should be the parent's choice. One thing last year's Place of Birth study showed was that more intervention didn't equate with more safety for the baby but did show a substantial increase in EMCS/perineal trauma etc. Would women necessarily choose intervention if they knew this? How many are given a real choice? I don't call being told 'We will book you in for induction...' a choice if you don't know that you can say no.

[elizaregina]

Declan Lawn reports on how 'health tourists' are obtaining free NHS treatment they should be paying for - at a cost of millions to our health service. Panorama goes undercover inside a black market where NHS access is being bought and sold, and finds an NHS practice manager taking money to register health tourists. Declan also discovers how easy it is for foreign nationals to get free treatment - with many hospitals across the country not making the required checks.




" And if we have to choose how limited resources are spent - and we do - then we can't justify widening access to surgical birth while basic safety on the wards is being neglected due to poor staffing.

And yes - in a fantasy world it would be wonderful if we could all have everything we want from the NHS, including free dentistry and as many rounds of IVF as it takes to get pregnant. But this is the real world and it's not going to happen any time soon. Or ever. "

[Shagmundfreud]

There is no trade off between intervention rates and good outcomes when you are comparing births to healthy women which take place in different settings Ushy.

Healthy w omen who give birth in obstetric units have massively higher levels of medical input and yet are no more likely to take home a well baby than a mother giving birth in a birth centre.

[Shagmundfreud]

Eliza - nobody is suggesting pruning outlay on maternity services. I'm suggesting the absolute opposite in fact. More money. More midwives. More doctors. More birth centres. And if funds allow and basic safety is being attended to, more access to elective surgery and epidurals. But only once all women have access to one to one care in labour.

As for ideologically driven views of birth - google an article on birth called 'fish can't see the water'.

[rainrainandmorerain]

Very good posts Peony.

Out of interest - how many rounds of ivf in the nhs do you think a woman should get right now, Shagmund?

Btw, I barely saw my mw when I had my elcs. She sad hello before the op - weighed the baby - left. I shouldn't think she was there for ten minutes (to no ill effect, I should say - I and ds were absolutely fine). It's actually quite nice to think she was freed up to go and attend to a mother who needed her care more.

[LaVolcan]

How many people were in the room when you had your ELCS?

[Xenia]

If it costs no more for an intervention than not then I'm not against a woman's choice for an intervention even if she doesn't need it as long as medically it is not damaging to her. We cannot have doctors do things that are medically wrong because someone patient is forcing them to do so.

If there is extra cost and the thing you want costs more then you can pay for it but I don't want to fund it. I am already in the 1% of tax payers who pay 30% of all tax and one feels little thanks for that.

I am pretty happy with my right to kill my child in utero by refusing all intervention. I think that's the right line for the law to draw. Once the child is born then the rights position changes. That is perfectly correct.

As for health tourism there needs to be a better curb on that as we seem to do nothing about recovering the money after. Could we not not let them leave until they have paid for example or seek when possible to have them put up a bond before we do very expensive treatment (those who are not entitled)? Or put it in the hands of people paid on commission. If someone said to me I could have 10% of recoveries from Russians or Nigerians who had gone back abroad (or student loan defaulters) I would be more than happy to start a business with contacts in those countries to recover the money and that would only cost the state my commission.

[PeoniesPlease]

"the NHS has a responsibility to provide the safest possible care and the most clinically beneficial care for the largest number of mothers."

Yes, and as a public service it also has a positive obligation to uphold human rights. The ECHR ruling has gone some way to clarifying the law in this regard, although there is still room for further progress as RedToothbrush outlined way upthread.

[Ushy]

Shag Healthy women who give birth in obstetric units have massively higher levels of medical input and yet are no more likely to take home a well baby than a mother giving birth in a birth centre.

I know the study you are talking about and medical interventions are higher in obstetric units but one of the 'medical interventions' was epidural - yes, of course, this intervention is lower - most birth centres don't offer them.

Secondly, that study did not match women for risk and the 'low risk' women who went to the obstetric unit had lots more risks than women who went to birth centres.

As for 'fish can't see the water' I did google it and some of it is so one sided!

Look at this extract below - complete and utter bunkum:

"How effective is epidural block in relieving pain? In around 10% of epidural blocks it doesn't work and there is no pain relief. Even when it works, around a third of women given an epidural will trade a few hours of pain-free labour for days or weeks of pain after the birth. Thirty to forty percent of women receiving an epidural during labour will have severe backs pain after the birth and 20% will still have back pain a year later."


Women need accurate information and be left to make their choice - home birth, caesarean, epidural ...I do't mind.. I do care that their choice is respected whatever it is. Can we agree on that?

[elizaregina]

My Father has just been abroad and need farily urgent medical assistance becasue he injured himself and couldnt stop bleeding.

He was so soaked in blood they had to cut his clothes off him when he finally got to hospital - THEY WOULDN'T TOUCH HIM BEFORE SEEING HIS INSURANCE DETAILS.

Did he blame them - say they were wrong? no!!!!

Simples.


As a start Xenia they could try actually being bothered to get a grip on the health tourism and claming money back from other EU states!!! Why are other EU countries zelously claiming back money and we are slack on it?

Its the lack of care - filmed on Panorma - by bodies involved that deeply upsets me - especially when the health minister has no idea how much money is being wasted in this manner! Most hospitals dont even have one person checking to see if the person is entitled to the care.

How can other countries manage to make sure WE have to produce x, y and z- and yet WE simply ignore it - whislt at the same time - talk about choosing how to manage a womans care due to cost.

The way alot of people acted on the panorma documentary you wouldnt think there was any cost problems....if the powers that be think that - why are we arguing about this service to women being denied because that one is more worthy...

Then people come on here and talk about denying women ELC or epidurals - to " cut costs"!!!!

Yes Shag - you want more money but your saying " right now" there is none so we have to choose.

I am saying - look at the broader picture - campaign for NHS to tighten up costs across the board BEFORE punishing women.

However if you think that someone who has deliberlty come here to fraudulently abuse our NHS for treatment to save themselves money is more worthy of that money than a woman wanting an ELC or epidural.....who is entitled to it from the UK....

[Xenia]

This was the lady I remembered

www.dailymail.co.uk/health/article-2010934/Milking-health-service-NHS-pays-200k-Nigerian-health-tourists-babies-provides-free-IVF-single-mother-39.html

[LaVolcan]

Given that the Place of Birth study refers to one of its strengths being .... the ability to compare groups that were similar in terms of identified clinical risk (according to current clinical guidelines) and to further increase the comparability of the groups by conducting an additional analysis restricted to women with no complicating conditions identified at the start of care in labour, and the ability to control for several important potential confounders. i.e. as far as able to compare like with like how do you work out that:

Secondly, that study did not match women for risk and the 'low risk' women who went to the obstetric unit had lots more risks than women who went to birth centres.

Their language seems pretty plain to me.

This is one of the things which annoys me about the current system. The vast majority of women are booked into CLUs either by choice or by lack of realistic alternatives. As long as units continue to hide behind the stock answer that their rates of intervention as as a result of the risk factors of the women presenting there will be little incentive for them to attempt to reduce them. Other things being equal I would imagine that most women would prefer to avoid an EMCS, forceps, severe tear etc..

[rainrainandmorerain]

la Volcan, how many people were in the room when I had my cs? It felt like a lot! I will try and remember.... anaesthetist, a theatre nurse, mw (briefly), surgeon, someone who seemed to be assisting the surgeon....

I think that was it. It is a fair few medical staff - although worth remembering that the op took less than 45 minutes.

my point about mws, because this is the group that shagmund keeps talking about, is that I used a FRACTION of that mw's time. Compared to someone having a homebirth, say. Women wanting to ensure one to one care are often advised on these boards to have a homebirth - sometimes, a bit controversially, told that if they just wait until they are in labour then a hospital HAS to send a mw out to them, regardless (no idea if that is true, btw - just something i have seen here).

I am not at all anti-homebirth, btw, for those women that want them. I'm just not sure why elcs mothers are criticised for getting 'one to one' care at the expense of other labouring women when the time a mw spends with them is so minimal.

Yes, I did see them after the op while i was i hospital - for the briefest of checks, and to hand me painkillers. That was all the care i needed, so I am not complaining - but including the op AND postnatal care over 2 days, I don't think I had a mw with me for more than an hour, total. (and they spent a lot of that time writing!)

[rainrainandmorerain]

An aside - but didn't the place of Birth study show that for severe tearing (3rd and 4th degree) then actually the rate was pretty consistent across all the various birth places?

Other differences were notable - but severe tearing seemed to be a similar percentage wherever the mothers were.

I'm happy to be corrected if I have misremembered.