Eilís Mulroy: Pro-choice side must not hijack this terrible event

THE case of Savita Halappanavar should make us all stop and reflect. Anyone who shares a concern for the protection of life extends their deepest sympathies to the Halappanavar family.

The question that needs to be asked is: was Ms Halappanavar treated in line with existing obstetrical practice in Ireland? In this kind of situation the baby can be induced early (though is very unlikely to survive). The decision to induce labour early would be fully in compliance with the law and the current guidelines set out for doctors by the Irish Medical Council

Those guidelines allow interventions to treat women where necessary, even if that treatment indirectly results in the death to the baby. If they aren't being followed, laws about abortion won't change that.

The issue then becomes about medical protocols being followed in hospitals and not about the absence of legal abortion in Ireland.

Professor John Bonnar, then chairman of the Institute of Obstetricians and Gynaecologists, spoke about the matter to the All Party Oireachtas Committee's Fifth Report on Abortion, saying: "In current obstetrical practice, rare complications can arise where therapeutic intervention is required at a stage in pregnancy when there will be little or no prospect for the survival of the baby, due to extreme immaturity.

"In these exceptional situations failure to intervene may result in the death of both the mother and baby. We consider that there is a fundamental difference between abortion carried out with the intention of taking the life of the baby, for example for social reasons, and the unavoidable death of the baby resulting from essential treatment to protect the life of the mother."

With this medical practice Ireland, thankfully, has one of the lowest death rates of mothers in pregnancy anywhere in the world.

Our generally excellent record on maternal care doesn't of course help Praveen Halappenavar, who is today dealing with the loss of his beautiful wife and the baby they expected together. Yet this terrible situation should not be used to push an ideological agenda to introduce abortion. Any debate on the issue of abortion should be carried out in a reasonable manner. It does no service to Savita's memory to use her tragic death as an impetus for legislation that is bad for both women and their babies.

Any investigation into the circumstances surrounding Savita's death will happen against the backdrop of another investigation into the practices of health professionals when dealing with pregnant women in Ireland.

As a result of an undercover investigation published by the Irish Independent last month, the HSE has launched an investigation into crisis pregnancy counselling services in Ireland that were found to be giving illegal and life-threatening advice.

The Oireachtas Committee on Health and Children has also asked for answers from the HSE. The undercover investigation was carried out at 11 state-funded Crisis Pregnancy Counselling services and revealed that some pregnancy counsellors in certain services, including the Irish Family Planning Association, were giving women dangerous and illegal advice, including telling them they could hide their abortions from their own doctors -- a practice that can endanger lives.

Incredibly, some counsellors advised women how to illegally smuggle an abortion pill into Ireland and take it without medical supervision.

A prompt investigation must take place into the death of Savita Halappanavar to best serve her memory and ensure a tragedy like this does not reoccur. The investigation into the dangerous practices being employed by some state-funded crisis pregnancy counsellors must also happen.

See this article on the Independent website here. 

Death as a result of infection during miscarriage rare

Dr. Muiris Houston, writing in the Irish Times. Article on the Times' website here. 

Background: A death as a result of an infection during a miscarriage is a rare event in the developed world. Referred to as a septic abortion or miscarriage, most cases are due to infection with bacteria such asE.coli or streptococci.

In a more severe form that spreads to the wall of the uterus, the patient will usually have a fever and a raised pulse.

The initial management of a suspected septic abortion involves taking a swab from the vagina and the neck of the womb. If the woman’s temperature goes above 38.4 degrees Celsius then blood is taken and sent to the laboratory to see if the bugs have spread to the bloodstream.

A combination of antibiotics is started even before the results of these tests are available. However, it is possible that despite the treatment the patient will go into medical shock, their blood pressure drops and a serious complication called disseminated intravascular coagulation (DIC) may ensue.

In this situation it is normal practice to wait until the patient has stabilised before surgically removing the contents of the uterus.

On rare occasions, a hysterectomy may be needed if the infection remains uncontrolled.

A miscarriage is defined as loss of pregnancy in first 24 weeks of gestation.

There are different types of miscarriage including:

* a threatened miscarriage with mild symptoms of bleeding and usually little or no pain. The neck of the womb remains closed;

* an incomplete miscarriage occurs if either the conception sac or the placenta remains in the womb;

* an inevitable miscarriage occurs with heavy bleeding, and the neck of the womb is now open. If the bleeding is severe the mother may slip into medical shock.

In an inevitable miscarriage, even though a foetal heart beat is present, the pregnancy cannot continue to term.

With the neck of the womb already open, the woman’s body prepares to naturally evacuate her womb.

However, with the neck of the womb open, there is an opportunity for bugs such as E.coli to travel from the vagina into the womb before multiplying and infecting the inside wall of the uterus.

Infection can then spread to the woman’s bloodstream, leading to shock and the onset of DIC, which occurs when the normal functioning of blood cells is progressively impaired, leading to multi-organ failure.

Medical teams focus first on pregnant woman's health, obstetricians say

Paul Cullen, Health Correspondent of the Irish Times. Read the article on the Times' website here. 

The main focus of medical teams treating a seriously ill pregnant woman is on maintaining the health of the mother, according to leading obstetricians.

Although there are no fixed rules governing practice in such cases, interventions to deal with the cause of the illness are not considered a therapeutic termination of pregnancy, one Dublin-based practitioner told The Irish Times.

In his hospital, intervention took place in cases where a mother’s life was in danger such as was required by the maternal interest, he said.

The cause of this intervention could relate to an independent condition such as cancer or a condition arising during pregnancy but in either case this intervention was not considered a therapeutic termination of pregnancy.

In all cases, the medical options would be discussed in detail with the mother where this was possible.

Septicaemia was an unpredictable event which could happen acutely and prove devastating for the affected person, he said. The existence of a foetal heartbeat could lead to a situation where it might not be considered that septicaemia was a possible complication.

Voluntary hospital 

Another obstetrician working in a voluntary hospital said that in situations where a pregnancy would never attain viability and the mother was critically ill, the main concentration of the medical team treating the woman would be on maintaining her health.

“In such situations, you expedite delivery,” he said. However, problems such as septicaemia could “creep up” very quickly and have devastating effects. Infection was one of the major causes of maternal death, he added.

“Decisions like this are usually clinically led. It’s easier in voluntary hospitals with clear clinical leadership. Where governance is more complex and bureaucratic it can be harder to get decisions.”

Under the Constitution, as interpreted by the Supreme Court in 1992, it is lawful to terminate a pregnancy if it is established “as a matter of probability” that there is a real and substantial risk to the life, as opposed to the health, of the mother.

The Medical Council advises doctors to undertake a full assessment of any risk “in light of the clinical research on this issue”.

According to its guidelines: “In current obstetrical practice, rare complications can arise where therapeutic intervention (including termination of a pregnancy) is required at a stage when, due to extreme immaturity of the baby, there may be little or no hope of the baby surviving.”

“In these exceptional circumstances, it may be necessary to intervene to terminate the pregnancy to protect the life of the mother, while making every effort to preserve the life of the baby.”

Maternal death is defined by the World Health Organisation as the death of a woman while pregnant or within 42 days of termination of pregnancy.

Death is due either to indirect causes or to a cause that can be directly linked to the pregnancy.

Ireland’s rate of maternal death, at six per 100,000, is extremely low by international standards.

Senators discuss crisis pregnancy counselling service scandal

The scandal involving Irish crisis pregnancy counselling services giving dangerous and illegal advice to women was discussed yesterday at the first sitting of the Seanad since the story broke.

The undercover investigation which revealed the information was recently published by the Irish Independent.  The investigation carried out by a number of women showed how IFPA and HSE-run services were giving life-threatening advice to women.

In the Seanad yesterday, Senator Marc MacSharry called for an investigation into the wrongdoing.  He said

 "Irrespective of one's position on this issue -whether one is pro-life, pro-choice, pro-debate -- very serious questions have arisen as a result of the investigative reporting by Independent Newspapers,"

He continued; 

"In my view it warrants the minister's personal attention and the Government should oversee this investigation.

Senator Catherine Noone said

"I join my colleagues in expressing horror at the alleged dangerous or illegal advice provided by certain pregnancy counselling organisations in this country.  As a woman, it is horrific to think women are being advised to withhold information from their general practitioners, who would find it difficult to advise their patients properly without full information".

The call for an investigation into the wrongdoings by the IFPA and others was supported by numerous other Senators including Senators Ronan Mullen, Paschal Mooney, Paul Coghlan, Jim D'Arcy, Fidelma Healy Eames, Labhras O' Murchu, Paul Bradford, Michael Mullins and Fergal Quinn.

The Oireachtas Committee on Health and Children was also due to consider this matter today.


Read the coverage of yesterday's Seanad exchanges in today's Irish Independent here

Read the coverage of the matter in today's Irish Times here

Read this story on our website here

Pro Life Campaign calls for independent inquiry after shocking revelations about IFPA and HSE clinics

The revelations from an undercover investigation into taxpayer funded crisis pregnancy agencies, published in today's Irish Independent newspaper, reveal “a widespread culture of disregard for women’s lives and health” according to Dr Ruth Cullen of the Pro Life Campaign.

She said: “Regardless of where one stands on abortion, the findings raise huge issues about women’s lives and safety. They also raise very serious questions about lax governance in the agencies.”

Dr Cullen called for “an independent public inquiry into how such professional malpractice has been allowed to go unnoticed and uncorrected by the body legally tasked with monitoring them."

“Since the Health Service Executive (HSE) are themselves implicated in the failure of proper governance of the crisis pregnancy agencies, they are part of the problem and obviously cannot be allowed to supervise the investigation,” she said.

Dr Cullen continued: “Particularly scandalous is the evidence from a number of Irish Family Planning Association (IFPA) clinics, an affiliate organisation of the IPPF, that women were advised to conceal their abortions from their own doctors including in the event of medical complications from the abortion procedure. One has to ask why this type of dangerous medical advice is being given to women?   Does it have something to do with protecting the reputation of abortion providers from any negative publicity, at the expense of women's health and well-being?”

 “The legislation (Abortion Information Act, 1995)  under which these agencies are in receipt of taxpayers money mandates a public policy of promoting alternatives to abortion. But the evidence emerging from this undercover investigation suggests a widespread culture of disregard for, if not opposition to that public policy,” Dr Cullen concluded.

See the Irish Independent stories below

http://www.independent.ie/national-news/revealed-the-abortion-advice-that-could-put-lives-at-risk-3276226.html

http://www.independent.ie/national-news/shocking-breach-of-good-medical-practice-says-rotunda-chief-3276112.html

Move by Marie Stopes 'deplorable' says Pro Life Campaign

Commenting on the news that Marie Stopes intends to open an abortion clinic in Belfast, Dr Ruth Cullen of the Pro Life Campaign said:

"It would be deplorable if Marie Stopes were allowed to impose an abortion regime on Northern Ireland in this manner. Clearly the official guidelines in Northern Ireland setting out the distinction between medical treatments in pregnancy and abortion need to be strengthened in light of what is being proposed."

She continued:

"Marie Stopes is in the business of providing abortions and has no regard for the rights of unborn children throughout the entire nine months of pregnancy. They are also in complete denial when it comes to the peer reviewed studies highlighting the negative long term consequences of abortion for some women. I am confident that the elected representatives in Northern Ireland will move fast to stop Marie Stopes from clearing the way for abortion."

Excellent 4 minute video on current Irish abortion debate

Check out this great new video on YouTube.  It addresses some of the key questions raised in the abortion debate in Ireland and features very moving personal stories.  

Click below to watch and then please share the video on facebook, twitter and other social networks.