Landmark High Court case over right to have a home birth

The clock is ticking for expectant mother Aja Teehan as she seeks to overturn restrictions imposed by the HSE on women who want to have a home birth.

Now 29 weeks pregnant, Ms Teehan, who lives in Thomastown, Co Kilkenny, will go the High Court tomorrow to fight for what she believes to be her right to have the birth she wants for her child.

Among the long list of medical criteria that preclude an independent midwife presiding at a home birth is a previous Caesarean section. Ms Teehan had one six years ago during the birth of her first child at St Luke’s Hospital in Kilkenny.

She argues that the HSE refusal to allow her to have a home birth is a breach not only of Irish law, but also the European Convention on Human Rights.

Risk of rupture
Under the HSE guidelines, it is not permissible to have a home birth with a medical professional present if the expectant mother previously had a Caesarean section. This is because of the risk of a rupture of the scars left from the operation.

Without the presence of an independent midwife or a doctor, it would be impractical and downright risky for a woman to give birth at home without professional assistance.

The risks of a rupture are calculated at between 0.2 and 0.5 per cent of all VBACs (vaginal birth after Caesarean) or between one birth in 500 and one birth in 200.

The HSE deems that such a risk is enough in itself to rule out a home birth, but advocates of home birth believe procedures carried out in hospitals such as the giving of oxytocin to speed up labour actually add to the risks involved.

This is the point Ms Teehan intends to make tomorrow in the High Court.

A lecturer and IT specialist at NUI Maynooth, Ms Teehan says she has the intellectual capacity and experience to analyse the data and come to her own conclusions about the risks she will face.

“I’m not going against the medical evidence. Everybody is agreed on the medical evidence. This comes down to having a sophisticated understanding of risk and probability which I have and then it comes down to a personal choice,” she said.

“We examined many sources of information to assist us in coming to this conclusion: peer-reviewed articles in medical journals, publicly available statistical reports such as those generated by the ESRI, and websites belonging to organisations involved in birth [in Ireland].

“The risk in all of this is minimal. It is written down in law that you are the person who makes decisions about your healthcare, yet the fact that I’m pregnant seems to cause an issue with that right, so that people are prepared to overrule my autonomy in any situation if I’m pregnant.”

She also believes a home birth minimises the risks of a rupture because it allows birth to progress more naturally.

“In the home I don’t get oxytocin which increases the chances of something bad happening by 300 per cent to 1,400 per cent. I don’t have an epidural which masks abdominal pain. Basically, oxytocin and epidurals are the two things that I need to stay away from.”

Criminal offence
VBAC home births were ruled out as a result of a memorandum of understanding signed between the HSE and independent midwives in 2008.

The HSE agreed to take over the indemnifying of independent midwives from the then Irish Nurses Organisation (INO) but imposed terms which restricted home births that they deemed to be an unacceptable risk, including VBAC. Under the new Nurses and Midwives Act it is a criminal offence to carry out a home birth outside the terms laid down by the memorandum of understanding.

Ms Teehan says she and her husband have reviewed all the medical evidence and she now believes it would be safe to have a home birth.

“I have been very careful to avail of excellent medical advice during this period, and I have every intention of continuing to do so,” she said.

"However, ultimately, I claim and take responsibility for the decisions made regarding me, my body, my baby, my birth and my family. I have personal and family rights, and I intend to exercise them."

Support
Ms Teehan has been using her blog to raise awareness of her situation and has been receiving support in her case from organisation such as the Association for Improvements in the Maternity Services Ireland (Aims Ireland). They intend to stage a protest outside the High Court tomorrow.

Independent midwife Philomena Canning described Ms Teehan's action as a "very significant case" for patients' rights in general and pregnant women in particular.

“It is about the right to informed decision-making. If you go to a solicitor, you are going for their advice. Whether you take it or not is up to you.

“It is the same thing with the medical profession. Our role is to advice people so they can decide for themselves. We don’t have a role to accept one thing or another, but that’s the approach that the State has taken,” she said.