Institutional sexism is still wholly dominant in our maternity services

Maternity care won’t change in this country until it is labouring women themselves who dictate the terms, writes Victoria White
Institutional sexism is still wholly dominant in our maternity services
Marian Finucane

CAN WE blame absolutely everything that is wrong with our society on the Catholic Church? I’m not denying it’s handy. It puts RTÉ into a sticky sweat. It gets nearly everyone who has any power on our side.

But it doesn’t change very much because the problem almost never lies in the Catholic Church itself. It lies in the power structures within our society.

Never has this more been the case than in the row over the co-location of the National Maternity Hospital on the campus of St Vincent’s hospital in Dublin. The Vincents board, which meets today, is refusing to apply for planning permission for the co-location until the NMH agrees to be answerable to it.

Dr Peter Boylan, chairman of the Institute of Obstetricians and Gynaecologists, wrote to The Irish Times last week saying that the NMH should remain under the clinical direction of its own master and cited the example of Cork University Maternity Hospital’s co-location with the University Hospital as having limited its resouces. He added that Vincents was owned by the Religious Sisters of Charity this could inhibit its provision of services such as IVF, contraception, female sterilisation, or abortion. The chairman of Vincent’s, Jimmy Menton, described these claims as “groundless and sensational” and said the NMH would have full clinical independence under the Vincent’s plan.

Control is what is at issue here. The “master” model employed in the three Dublin maternity hospitals makes one senior clinician the controller of the universe of that particular hospital. KPMG’s independent review of maternity services for the HSE in 2008 argued that the role should be split into CEO and clinical director and work within the over-arching structure of the general hospital but this year’s national maternity strategy re-proposed the master model.

It is a model which is virtually unique to Dublin. But then Dublin hospitals are great founders of traditions within maternity care and none of them have anything to do with the Catholic Church. UCC academic Jo Murphy-Lawless has shown, through painstaking research, how the independent Rotunda Hospital pioneered the absolute control of women in labour as far back as the 1740s.

Fast forward to the 1960s and the National Maternity Hospital was developing and exporting world-wide its “Active Management of Labour” by which a pregnant woman is reduced to a large, insensate object which has to be got through “the bottleneck” of the labour ward. The third edition of their labour manual is a masterpiece of institutional sexism. Authored by two former masters, Kieran O’Driscoll and Declan Meagher, on the first page it assigns to them the glory of having been “directly responsible for 100,000 births”. It shows how they developed the policy of injecting first-time mothers with artificial birth hormone to make them give birth according to their timetable: The “partogram”.

It explains away this process, which helped manage a high birth rate on scant resources, because pregnant woman were saved the “massive emotional disturbance caused by prolonged labour which may endure a lifetime”. Only later is it admitted that “the shared sense of impotence” which doctors and midwives can feel in the face of long labour” means “control of duration of labour is almost as important for staff as it is for mothers and babies”. Who was the younger co-author of this third edition? None other than Dr Peter Boylan, master of the NMH between 1991 and 1998.

There is no need to personalise the issue because on the NMH Boylan is here no more than the very able spokesperson for his profession (and the son of two of my parents’ dearest friends, indeed!) But there is an irony in Boylan’s words as he discussed abortion in the context of the tragedy of Savita Halappanavar’s death on the Marian Finucane radio show on RTÉ in 2013 when he asked: “Where else are women denied an input into their care, in what other clinical situation? I can’t identify any. Women are very much involved in their care in obstetrics, in decisions to induce labour, decisions about caesarean sections, decisions about all sorts of things.”

Are they now? Many women would beg to differ. I was bullied into an epidural and an oxytocin drip at the NMH. Another friend fought, successfully, against a caesarean and still another fought, successfully, against induction of labour at the time of her mother’s funeral. The handbook to labour co-authored by Boylan explicitly denies the pregnant woman the right to diagnose labour, saying: “This method of procedure, which leaves the initiative in the hands of patients, has no parallel in other branches of medicine”.

Oh would that the Catholic Church were our problem as a society! We gaily ignore its teachings whenever we feel like it but we can’t ignore doctor’s orders. Institutional sexism is far harder to root out than religion and in my view it is still wholly dominant in our maternity services.

But we can’t expect the institution to root out the power imbalance within it. Boylan is no different than any other spokesperson of his profession in defending his peers and externalising blame. He blamed the death of Savita Halappanavar on the Eighth Amendment, saying on the Marian Finucane show that abortion would only have been legal in her case on the Wednesday she died, when it was too late.

By contrast the Hiqa review found 13 points at which she could have been saved, starting when she was admitted with symptoms caused by sepsis in 77% of cases. It is the hospital which has settled its case with her widower, not the Catholic Church.

Boylan has given evidence on symphysiotomy at the NMH, saying the procedure by which women’s pelvises were permanently widened to let the baby out “is an extremely safe procedure with minimum side effects” and arguing that the survivors’ mobility and incontinence issues may just be due to having given birth.

Marian Finucane
Marian Finucane

Most commentators assign blame for symphysiotomy to the influence of the Catholic Church, which might have been against caesarean sections as they limit the number of births a woman can have. This is highly unlikely. It is far more consistent with the culture of the hospital that the practice was championed by Boylan’s “professional mentor” Master Kieran O’Driscoll because it was cheap and effective and the long-term consequences for the women in question were not seriously entertained. Those consequences have so far led the State to pay out thousands in compensation to almost a third of the nearly 600 women who originally applied.

I hope Vincent’s and the NMH resolve their issues quickly because the current NMH building presents a health risk to women and their babies. But maternity care won’t change in this country until it is labouring women themselves who dictate the terms. Faced with two old nuns and an all-controlling master in full cry I’d be hard put to choose.

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