Expectant mums and right to a partner at birth and antenatal appointments in Guernsey

As You’ll know from my previous posts and my letters to the Guernsey Press and there was even a brief moment on Channel TV, I feel passionate about the rights of human beings and especially the rights of pregnant women on Guernsey during lockdown.

In an effort to try to help those women who have had their voice taken away from them through decisions made by the States of Guernsey, it was suggested I write to the CCA. The letter I wrote follows below.

I received a friendly and prompt response from Heidi Soulsby, who I very much respect. She says that she understands my concerns and how it would be the preference to have a companion at the birth of one’s child, but the decision falls under the mandate of HSC as part of its operational decision making, not CCA.

She explained that very difficult decisions are having to be made as the impact of COVID on the hospital is real and can be profound. She stressed that Guernsey only has one hospital and this has already experienced disruption due to a number of staff at all levels having to go into self-isolation - this is not a theoretical issue.

She very kindly offered to forward my letter to Deputy Brouard and ask at the next CCA meeting if he can look at whether anything further can be done to support mothers whilst we are in lockdown in light of the issues I raised.

I am hopeful that with decreasing rates of COVID, some of the stringent rules currently impacting expectant mums will be eased as part of the process of phasing out of lockdown. I do wonder if there is a broader picture here in respect of the need for a shift in perspective on birth generally. Even WHO stresses that a “good birth” does beyond having a healthy baby and stresses that each labour is different and that individualised and supportive care is the key to positive childbirth experience.

“We want women to give birth in a safe environment with skilled birth attendants in well-equipped facilities. However, the increasing medicalization of normal childbirth processes are undermining a woman’s own capability to give birth and negatively impacting her birth experience,” says Dr Princess Nothemba Simelela, WHO Assistant Director-General for Family, Women, Children and Adolescents. 

“If labour is progressing normally, and the woman and her baby are in good condition, they do not need to receive additional interventions to accelerate labour,” she says.

The article goes on to say that ‘Childbirth is a normal physiological process that can be accomplished without complications for the majority of women and babies. However, studies show a substantial proportion of healthy pregnant women undergo at least one clinical intervention during labour and birth. They are also often subjected to needless and potentially harmful routine interventions”.https://www.who.int/mediacentre/news/releases/2018/positive-childbirth-experience/en/

The need for intervention will likely only increase with the stress that expectant mums are under here in Guernsey especially now during lockdown but also with the medicalised approach to birth that we see here with the maternity services being located within the hospital.

Anything any of us can do to help raise awareness and keep the conversation open, with the hope of changing local attitudes towards birth (that it doesn’t need to be a clinical experience) and ensures that expectant mums and their partners have a voice and are empowered and feel safe to use it - can only be a positive thing for human rights generally.

….

Dear members of the CCA

Expectant mums and right to a partner at birth and antenatal appointments. 

I am writing to express my concern that expectant mums are still being denied the opportunity to be accompanied into theatre with a birth partner when requiring a Caesarean Section, and that expectant mums are also still denied the opportunity to take a partner with them to their antenatal scans. 

Expectant mum and birth partner during Caesarean Section

The World Health Organisation (“WHO”) strongly recommend supporting women to have a chosen companion during labour and childbirth, including during Covid-19: “When a woman has access to trusted emotional, psychological and practical support during labour and childbirth, evidence shows that both her experience of childbirth and her health outcomes can improve.  In Companion of choice during labour and childbirth for improved quality of care, WHO and HRP present updated information on the benefits of labour companionship for women and their newborns, and how it can be implemented as part of efforts to improve quality of maternity care. 

The current COVID-19 pandemic is no exception. 

WHO Clinical management of COVID-19: interim guidance strongly recommends that all pregnant women, including those with suspected, probable or confirmed COVID-19, have access to a companion of choice during labour and childbirth.

Again and again, research shows, that women greatly value and benefit from the presence of someone they trust during labour and childbirth.  A companion of choice can give support in practical and emotional ways. 

They can bridge communication gaps between a woman in labour and the healthcare workers around her, offer massage or hand-holding to help relieve pain, and provide reassurance to help her feel in control. As an advocate, a labour companion can witness and safeguard against mistreatment or neglect.   

The benefits of labour companionship can also include shorter length of time in labour, decreased caesarean section and more positive health indicators for babies in the first five minutes after birth.”

Please see this link to the full article, https://www.who.int/news/item/09-09-2020-every-woman-s-right-to-a-companion-of-choice-during-childbirth

Furthermore, and as you will know, human rights require public bodies to treat people with dignity and respect and to consult them about decisions and respecting their choices. Human rights law give expectant mums the right to receive maternity care, to make their own choices about their care and to be given standards of care that respect their dignity and autonomy as human beings. 

The Human Rights (Bailiwick of Guernsey) Law came into effect on 1st September 2006.The law incorporates the provisions set out in the European Convention on Human Rights into Bailiwick law. It also makes it unlawful for a public authority to act in a way which clashes with those provisions. The law ensures that everyone in the Bailiwick is entitled to the fundamental rights and freedoms of the European Convention on Human Rights.

The fundamental human rights values of dignity, autonomy and equality are often relevant to the way a woman is treated during pregnancy and childbirth. Failure to provide adequate maternity care, lack of respect for women’s dignity, invasions of privacy, procedures carried out without consent, failure to provide adequate pain relief without medical contraindication, and lack of respect for women’s choices about where and how a birth takes place, may all violate human rights and can lead to women feeling degraded and dehumanised.

Article 8 of the European Convention guarantees the right to private life, which the courts have interpreted to include the right to physical autonomy and integrity. The European Court of Human Rights has held that the right to private life includes a right for women to make choices about the circumstances in which they give birth. The separation of either parent from their newly born child also constitutes an interference with their (and their child’s) rights under this article 8 of the European Convention on Human Rights. 

Birthrights, a UK based organisation, protecting human rights in childbirth published legal advice on 12 February 2021, which states that, “The separation of either parent from their newly born child constitutes an interference with their (and their child’s) rights under article 8 of the European Convention on Human Rights. The circumstances of giving birth also engage the rights of the parents and the child under article 8.4. It is therefore wrong in law to suggest that “legislation” requires all parents who test positive for COVID-19 to self-isolate at all times. Being present during childbirth and at the neonatal stage may be necessary for the purposes of “medical assistance” or it may be necessary, depending on the facts of an individual case, to facilitate the exercise of article 8 rights.” JUDE BUNTING DANIEL CLARKE Doughty Street Chambers 29th January 2021. 

You can view the letter here: https://www.birthrights.org.uk/wp-content/uploads/2021/02/Note-on-lawfulness-of-NHSE-Guidance-sent-to-client-09.02.2021.pdf

The WHO believes “high quality care” should encompass both service delivery and the woman’s experience: “Our new recommendations on intrapartum care set the global standard on the provision and experience of care during birth. The guidelines place the woman and her baby at the centre of the care model, to achieve the best possible physical, emotional and psychological outcomes.

Critical components of a woman-centred approach include: avoiding unnecessary medical interventions, encouraging women to move around freely during early labour, allowing them to choose their birth position and have a companion of their choice by their side. It also means ensuring privacy and confidentially and providing adequate information about pain relief.”

See more here, https://www.who.int/mediacentre/commentaries/2018/having-a-healthy-baby/en/

It shouldn’t even be a matter of law or human rights or the WHO’s guidance on childbirth, it should be a matter of compassion and respect. Any woman who has experienced Caesarean Section will know how important it is to have a birth companion present.  I have experienced two Caesarean Sections, one planned due to pregnancy complications and another emergency, due to early rupture of waters and perceived risk of infection. 

Like many, my partner and I conceived through IVF, suffering loss in the process. We also experienced the trauma of early pregnancy bleeding and pregnancy complications so that by the time of the birth, we had been on a stressful and traumatic journey to parenthood together and we were keen to see that through to fruition together. We are not unlike many other couples, the journey to conception can be challenging, and there are often losses and complications along the way.

Birth is also not without its challenges, not least because of inherent fear of stillbirth but because of the current-medicalised nature of birth and the fear that accompanies a clinical hospital environment. During my first pregnancy, due to complications with the placenta, there was a risk that I would require a general anaesthetic. This notion caused me to feel extremely stressed because both my partner and I wanted to be present at the birth of our firstborn and be a family together - finally. 

Fortunately a general anaesthetic was not required but I spent the first part of the procedure shaking uncontrollably (and yet trying to keep still for the spinal block), surrounded by people I didn’t know, in a clinical theatre that I had never seen before, with bright lights and noise, wearing only a thin hospital gown to protect what was left of my modesty. This was not the environment that I had wanted for birth.

I cannot express the relief I felt when my partner was finally admitted to theatre and stood beside me holding my shaking hand. He was not only a source of much comfort as my baby was essentially cut from me, but he was able to reveal the sex and be part of the ‘birthing process’, an experience neither of us will ever forget – we have the photos if we do, because we were permitted an iPad in theatre. He was also able to hold his son while my low blood pressure was stabilised, and be with me for the duration of time spent in recovery.

To have expected me to do this on my own, and denied my partner the right to be with us as a family and welcome his son into the world would have been cruel and unforgivable. Yet here in Guernsey we are expecting women to do this during the stress of lockdown too. 

The strict new rules that have been implemented at the PEH further compound this, which will undoubtably cause more women to require medical intervention than may otherwise have been necessary, resulting in a higher incidence of Caesarean section and more partners missing the birth of their babies. 

Surely birth partners in full PPE, having taken a Covid test every 96 hours prior to birth, and self-isolated, should pose no greater risk than theatre staff and midwives who are not subject to the self-isolation rules prior to birth. Further, the argument that theatre staff shouldn’t be burdened with caring for a partner is nonsense; they do this ordinarily (together with a  midwife and the kindness of the anaesthetist in my case) so what difference does it make now. 

There is a thin line between protecting the vulnerable and creating greater vulnerability. In the CCA’s effort to protect the elderly and most vulnerable from death through COVID-19 and to ensure that the medical services are not overrun, CCA is overlooking the vulnerability of expectant mums and the increased risk of birth trauma and resulting impact on mother, partner and baby post-partum, leading to mental, emotional and psychological issues at a later date. This is not a time to be ‘selling out’ on the next generation.

Taking a partner to an antenatal scan

I am also concerned that the current strict rules in place in the maternity unit resulting in expectant mums not able to take partners with them for antenatal scans are infringing on their rights.

Albeit in the UK, Birthrights has received legal advice stating that maternity services which prevent partners from attending scans, and don’t allow partners to be involved in the appointment remotely, may be acting unlawfully and unreasonably.

This legal advice prepared by Shu Shin Luh of Doughty Street Chambers with support from Irwin Mitchell concludes that “a blanket prohibition on the use of streaming or recording during antenatal appointments in circumstances where the support partner is unable to attend in-person with a pregnant woman is likely to be unlawful, discriminatory and violate both Articles 8 and 14 of the European Convention on Human Rights.”

It makes clear that “there is a well-established body of clinical evidence showing that partner participation in antenatal appointments and through a woman’s pregnancy improves maternal and foetal health.”

The advice mentions that there is compelling evidence that having a support partner present at antenatal appointments improves maternal and foetal outcomes for pregnant women, a finding backed by clinical studies and by the WHO, even in the context of the pandemic; and evidence of potential harm and risk of harm to pregnant women and their families of not facilitating partner participation at important clinical junctures of a woman’s pregnancy journey. 

Furthermore, the advice stipulates that, “the outright refusal to make arrangements to enable pregnant women to involve their partners in the antenatal appointments, either by streaming or recording the appointments would, in my view, engage Article 8 of the European Convention on Human Rights (“ECHR”) and the right to of both parents’ to their private and family life. It is my view that it will be difficult to identify any clear or proportionate justification for taking such extreme measures, particularly given strong policy reasons for encouraging and facilitating partner attendance as clinically beneficial to maternal and foetal health.” SHU SHIN LUH Doughty Street Chambers, 21 January 2021. 

You can read the full advice here https://www.birthrights.org.uk/wp-content/uploads/2021/01/210114-Birthrights.Advice-filming-at-scans.pdf and the article from Birthright here https://www.birthrights.org.uk/2021/01/31/partners-should-be-able-to-join-maternity-scans-remotely-say-lawyers/. 

Again, perhaps it’s not until you have been an expectant mum attending a scan with a history of fertility and pregnancy complications that you appreciate the need for a partner to be present. 

Having experienced early pregnancy bleeding, I was extremely nervous attending the 12 weeks scans during both pregnancies, this after early pregnancy scans to confirm IVF pregnancy and continuation of pregnancy despite bleeding. There is a degree of ‘not being able to rest easily’ until passing 12-week scan threshold, when rates of miscarriage decrease, and expectant mums feel at greater ease of revealing the pregnancy publicly. 

The 20-week scan was equally as nerve racking if not more so, because at this scan the foetus is checked for visible abnormality. The sex of the foetus can also be revealed. It was at this scan that a problem with the placenta was identified and this required a transvaginal ultrasound, where a probe was inserted into the body. Regardless of any previous sexual trauma, it can be a stressful experience and I would have felt desperately uncomfortable having this transvaginal scan conducted without my partner being present in the room with me.  

Not only that but many women have suffered miscarriage and are highly stressed ahead of any scan. My friend who is 20-weeks pregnant attended a scan on her own here in Guernsey last week, this after attending a 12-week scan during her first pregnancy and discovering that there was no heartbeat. To have expected her to attend a 20-week scan on her own, without her partner, to check for birth abnormalities, after having suffered a miscarriage during her first pregnancy and this revealed to her at a scan is inherently cruel.

She asked the sonographer if she could take a video for her partner, this being their first baby together and possibly their only child, but this was denied. A question was raised in Monday’s States briefing about the reason women cannot take videos of scans to share with their partners but this went unanswered. I suspect it is to do with litigation, but this should not prevent the live streaming of scans to partners at home.

Deputy Al Brouard is quoted in the Guernsey Press on Monday 15th February 2021 as saying: “They (the medical staff) are 100% committed to helping women and families have the best birthing experience possible, whatever the circumstances”. I don’t agree with him and I am both ashamed with, and disappointed, at the States of Guernsey and their decision to deny women the opportunity to take a partner with them during Caesarean Section and antenatal scan. 

I believe that the States of Guernsey has a moral obligation as much as a legal duty, to show greater compassion towards the rights of women, men and families when it comes to medical care during pregnancy and birth regardless of Covid-19 and lockdown. I hope that you will reconsider the current rules and extend an apology to those women, men and families who have been denied the best birthing experience possible during lockdown on Guernsey. 

Many thanks and best wishes

Emma