Child taken by from womb by forced C/S for social services! II

[saragossa2010]

As the other is full.
There are far too many cases where the authorities rush to remove children and do not give both parents and wider family a say. Adoption is rushed through.
The fact a senior family judge is insisting he is involved in the rest of this case is a good thing and the more cases like this which receive publicity the better.

The point is it is like justice in China and Russia. If it's secret then those involved cannot justify themselves. If we have more in the public domain that is a greater good than any risk from disclosure to the children and parents involved. it is why open justice and published judgments and rights for all those involved in child disputes to use twitter, blogs and emails and no stifling of free speech.

Thankfully things are all moving this way and we lucky to have people like JM and C Booker to give publicity to the issues which need much wider debate. I would imagine most social workers and lawyers involved in this area are very happy that the issues get more public debate not less. Most professions would.

The judgement clearly states that she was 'despatched/escorted' to Italy. Those are not words used about independent travel by a private citizen.

you say glib, I say lighthearted...

It does not, however, state who it was that took her to Italy.

For all we know it was her legal team.

We just don't know.

It looks like the decision to remove the baby was taken also considering her past mental state? She's had two children removed already, a few admissions in a mental hospital in Italy. Is it possible the judge decided she'd had enough chances and the chances of her making recovery were so slim it is better for the baby's future to be adopted?
After her all her mother is looking after her two other children, and has refused to accept this baby.

It is an incredibly tragic story, I really feel for this woman, but it sounds like her mental illness is quite severe? (I imagine bipolar disorder comes like many others in differing degrees of severity? She sounds quite an extreme case to my lay eyes)

I would be very interested if someone could forward me details of mother and baby units where the staff are 'highly trained' to deal with psychotic mothers. I am not aware that any such unit exists.

I have had mothers sent to units with CCTV and staff who work through the night but they would not accept someone either in middle of psychotic episode or posing serious risk of relapse into one - it simply wouldn't be safe.

I do not think madamedefarge has been 'rude'. She is clearly exasperated and frustrated by having to explain the same simple things over and over again.

The beauty of the internet is that we are free to engage in this kind of discussion. But if you chose to engage you have to accept the consequences that some people may lack patience if you persistently mis represent what we now know to be fact or if you claim your opinions should be given equal weight and respect as those facts.

Bunch, have you ever had the care of a heavily pregnant psychotic woman? Have you seen the medical reports relating to this woman? Who on earth do you think you are to criticise these doctors who were dealing with a serious crisis? They will have been reviewing the situation daily to see whether the mother's mental health would improve, whether she was showing any signs of delivering etc; and going to court would have been the last resort requiring careful consideration throughout the Health Trust. Once they made that decision they concentrated on getting the case into court as quickly as possible in her interests. Do you think it really mattered that a busy doctor who had approved his statement hadn't yet signed it?

And I don't get why you think having the hearing in open court would have made any difference. The course of the hearing would have been identical. The fact of a hearing in open court certainly does not mean that copies of confidential medical records get passed round the reporters and public, nor that the hearing gets treated like a conference with all present weighing in with questions.

Think about it. If someone you loved became so ill that he lost capacity to make medical decisions for himself, would you really like it if his personal history and medical condition were broadcast in open court to become tabloid fodder if his behaviour were deemed sufficiently bizarre or horrific to provide a good story?

Honestly, how would we all feel if they had done nothing?

Put her in a mother and baby unit without sufficient staffing or resources to deal with someone in the middle of an acute psychotic episode? Let her go into labour naturally. Possibly without telling anyone? Refusing any monitoring of her own or baby's condition? Suffer a uterine rupture? Perhaps die or lose the baby?

Would we all be congratulating the doctors for respecting her human rights?

No, of course, we wouldn't and the bloody Daily Mail would be even more up in arms.

These are difficult decisions, undertaken with much thought by competent experienced professionals (both medical and legal). They do not relish such situations - anyone who has been involved in care cases can tell you that they are troubling for all involved. But these decisions need to be made and demonising the people making them for the purpose of selling papers is incredibly irresponsible.

Except to say if the mother had agreed to another c section, what would have been the point of going to court to get one sanctioned?

My understanding of mental capacity is that, if you are deemed not competent to make a medical decision you cannot consent or refuse as you are not in an informed position to make either decision.

Even if this woman had agreed to a section her consent was meaningless as it was not true, informed consent made by an adult with full mental capacity. Presumably this is why it was not opposed by counsel. There was no husband or family present to give the consent on her behalf.

I may be wrong

I think you are right NIgel, the judge did say no one appealed his decision to authorise the c-section, nowhere in the press was ever mentioned that her parents or any members of her family were even in the UK at the same time as she was in hospital, and if they were, they obviously didn't object either.

@Claires,

You know very well how things work in Italy.... I.e., we have no referral procedures for mental health patients, unless a court decides so and it has to be tipped off by close family (parents or sons/daughters, either way), it doesn't work like in the U.K. at all.

If someone has been sent to a psychiatric hospital in Italy, that means this lady has a very severe mental issue, she is also known to stop her medication easily or the mother, once she was on the phone with the police, wouldn't have told them that she had stopped..... My guess is that this lady left to go to the training course leaving her medication at home on purpose.

@MadameLefarge, I like your Poirot comments and I don't think you are rude at all. Sometimes enough is enough ;)

Except to say if the mother had agreed to another c section, what would have been the point of going to court to get one sanctioned?

According to the Judge's summary, she was in the grip of a psychotic episode with delusional beliefs so even if she had consented to a CS, there was real concern that she might change her mind or forget that she'd consented.....or a new concern might have arisen for her.

Without a court order, they would have had no option but to hope she continued to consent or was willing to be examined and monitored if she went into spontaneous labour.

That wasn't a risk they were willing to take, and I don't blame them.

Lake Yes, I think she has a history of coming off her meds. She seems to be stable and articulate while she's taking them, which is great - but it would seem that long term stability for the baby is dependent on her taking them & she hasn't shown consistency in this in the past.

Point 8 of the judgement relating to the withdrawal of contact after birth is very worrying. Drs said P should be placed with mother. The judge says he believes this would not have been in P's interests... but this is against all research and medical advice in this area. His judgement is basically subjective, not taking medical advice and expertise into consideration.

We can't really say that though, can we? Not suggesting the judgment comes across as particularly detailed or well argued, but we don't know the content of the medical reports that the judge would have seen before giving judgment. They might have made it clear that in this woman's particular circumstances, withdrawal of contact was essential to protect the child. For starters, we don't know the nature of the delusions from which the mother was suffering before and just after the birth. What if they had been such as to drive her to harm her baby?

According to that stuff in the Mail, which I take with massive pinches of salt, she stopped taking her medication because she felt it would not be safe for the baby. It seems pretty clear that she cannot possibly have discussed it with her doctors, otherwise they would have put massive safeguards in place and would certainly not have advised her to go off to another country on her own whilst heavily pregnant. I'm sure what she did was a direct result of her illness, but it does point up the fact that she really wasn't thinking rationally about what was good for her or the baby and it would have been very dangerous to leave the baby in her care.

I have had a uterine and urinary bladder rupture during labour. I wouldn't wish it on anyone. The Post Natal period becomes unnecessarily complicated and the thought of a deeply psychotic newly delivered woman in ITU is deeply unedifying. It would have further exacerbated her disconnect from the World.

And can I say that Puerperal Psychosis is NOT the same as the Psychoses that can characterise severe BPD relapse and other illnesses such as Schizophrenia.

Mother & Baby Units are not necessarily best placed to deal these. We try not to have a cookie cutter approach in MH.

I think there are a number of such specialist MBUs in the country... and certainly the one where I was an outpatient provided treatment in and around birth and in the postpartum period to women actively psychotic and not just with puerperal psychosis: women who were severely ill with bipolar and schizophrenia were on the wards with their babies. It was pretty much what they were there for and they had staffing and lots of different interventions to deal with the issues and with bonding etc.

There have been countless women on the mh boards here on MN who have bipolar who have been in MBUs with their babies while actively psychotic. I understand it is unusual for bipolar women to be ill during pregnancy so I appreciate this was a difficult case but it still very much reads in the judgement as though doctors wanted this approach but it was deemed by the judge to be inappropriate. Perhaps that is not the case but more detail would be welcome.

Everything I've ever learned about mh personally and professionally is that every effort is usually made to try and keep mothers and babies together. I am sure there may be cases where it is unsafe which warrant other action.. but how can that be deemed ahead of treatment being put in place? When this woman would have delivered, she would have immediately been able to be medicated with a far greater range of antipsychotics and it seems to jump the gun in predicting that there was no hope of her possibly being safe regardless of medication and treatment options.

The judgement speaks of a woman who has made strides forward with her health and wellbeing. It's a terrible shame to think there is a mother who was desperately unwell, who has worked very hard to become well, who loves her child and cannot be united with them. The final paragraph is heartbreaking and I don't think that as it reads the whole judgement really answers many questions about why this is the right decision for the long term.

What is a cookie cutter approach?

Yes there are some units. But there may not have been beds. In my local area, the trust is on the verge of collapse. Sectioned people are being turned away from units and sections lifted because there are no beds. Patients are being OAT to beds 500 miles away.

And just because there are units doesn't mean this person was appropriate for them, that the appropriate staff were available, that the trust was able to fund etc. That is what I mean by cookie cutter. What appears to be clear cut on paper (in the papers) is not necessarily so IRL. People don't fit into neat unit shaped holes.

As I said earlier, being in remission and having insight into what triggers relapse with the best will in the world is not guarantee of future remission. Risk assessments show the best indication of future risk is past risk. Not perfect but the best we have. It can take very little to destabilise remission with BPD in some people-a lost nights sleep, jet lag, hormonal blips, D&V, Influenze, surgery, moving house, travel....And as I said, the more ill you get, the less ill you feel.

"would this have happened with a British woman with bipolar presenting with psychotic symptoms in pregnancy "

yes quite possibly in similar circumstances - the judge interviewed on today said yes it is unusual but yes it does happen.

working, I think when you talk about the fact that the mother has taken major strides forward you are applying hindsight. That has only happened over the last year or so, and did not start happening until after she returned to Italy which seems to have been last October or November - well after the birth. As matters stood at the time of the baby's birth, the mother was severely psychotic and suffering from intrusive delusions, had stopped taking medication and travelled to another country whilst in the late stages of pregnancy, had a history of stopping medication, and had two children whom she was unable to look after and who had been traumatised by the effects of seeing their mother when manic. Should the authorities really have decided to leave the baby with her in those circumstances?

As I said earlier, being in remission and having insight into what triggers relapse with the best will in the world is not guarantee of future remission.

Not least becuase there are cases where prolonged stability is not a feature of that individual's presentation.

My later mother in law (here in Italy as coincidence would have it) had bipolar I. Her condition was enitrely unpredistable. Except for one thing. Stability, even when on a "to the minute" meds regeme, would only ever be a place she breifly visited when travelling from one extreme to another.

It is true that some people relaspe because they don't take their meds, (often for understandble reasons, the side effects can feel a whole lot worse than mania or depression, and that is before you take into account the physical side effects), but what also happens is people stop taking their meds... becuase while on meds they have become unwell. In other words the meds didn't hold their stable mental state, they slipped into mania/depression, and in that altered state no longer took their meds. But the destablisation preceeded the lack of meds. Med taking is not a magic bullet.

In the last year of MIL's life she went from manic and psycotic beyond all belief (We staggered around for months on no more than 2-4 hours sleep a night becuase she was too strong for us to keep here safe in shifts.) with a brief period of calm (a few weeks) then down into depression than resulted in catatonia. She took the meds the whole time. I was half dead with exhustion, but between us we checked, doubled checked and gave her her meds, checked they were down. Right until the end when she was in hospital with pnumonia, thanks to meds she aspirated, and it was too late.

Smetimes the illness is so severe that all the person and their family has in their future is a hellish yo-yo that only ends when grief and a funeral takes its place.

That is one reality of bipolar. Stephen Fry is another. In terms of what day to day and longterm reality looks like, the two have only a lable in common in terms of impact, outcome and potential for a happy(ish) ending.

No nenny, I'm not saying they should have been kept together no matter what even if treatment had occurred and had been unsuccessful... but there should have been treatment for a period of time to assess longer term suitability for them to be reunited I think. I am uneasy about not allowing contact directly after birth and the circumstances that led to the woman leaving the country which the judge says seriously hampered her later chances of being reunited with her child. There just doesn't seem to be a lot of information about this.

I don't entirely buy the thing about being traumatised by the effects of seeing a manic mother as my experience suggests really generally this isn't something taken into consideration routinely in this country - hence the millions of children living with addicted/alcoholic/severely unwell parents. I don't always agree with this at all, incidentally. Primarily I work with children and young people and I think sometimes decisions can be too adult-centric... but it's tricky, all of it.. and whether ultimately this was the right or wrong decision shouldn't mean that we don't investigate and scrutinise it closely as it is such a serious thing.

I appreciate what you are saying about MBUs being at point of collapse Mignonette... yet I'm not entirely sure this makes this any better.

I think it would be more worrying if these types of decisions were not challenged by the public and would ultimately lead to poorer treatment of people with severe MH illness and their children. I don't blindly accept that professional and legal decisions are always sacrosanct. There are just too many aspects of this story where I feel there isn't sufficient information to say definitively whether what happened was good or bad practice. In that case, I think we have to challenge any and all potential omissions....

@nennypops

Exactly. I actually wonder how journalists and lawyers were allowed to throw all this story to the audiences. In my point of view, in doing that they broke a few privacy laws (Italy has strict privacy laws too) and they actually affected her human rights too.
Because it is clear that they incredibly damaged and worsened this lady's situation, to the point that the public is actually rooting for the authorities and not her as she would have liked to, I think.

Going public with everything also allowed the audiences to have a say in the matter, in two countries. And for once, the majority of posters in Italy and UK agree that the British authorities actually made the right decisions.

@working9while5

The Italian court has ruled out, at the moment, that she will be reunited even with her oldest children, because they don't trust her.
How could she manage with a baby or a toddler?

Carpe You have seen the sharp end. . I have walked round the ward with a bowl of food trying to get nourishment into clients so manic they cannot do anything but race both physically and in their thoughts. And that is after maximum medication. They appear physically slowed because of the sedation but you can actually see the effects of their racing thoughts. It is such a complex illness and so varied in its manifestation. It is the illness I would least 'choose' if i had to have a psychiatric illness. Most people have no idea about it in its severest forms- try caring for a woman during menstruation who will not wear pads/tampons. Try maintaining her dignity on a mixed ward and having to resort to seclusion to protect it. The reality is FAR from what people like JH imagine. They do not have a clue.

I don't think these professionals are always right nor do I think we shouldn't call them to account. But accusing them of making mistakes in this case by people not in full possession of the facts, people blindly believing what the papers tell them - well how are these critics any better placed to make such important decisions? If I (and my colleagues) operated with the kind of knee jerk responses demonstrated by some of the people on the boards and in the media, there really would be heinous results.