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Damned if you do, damned if you don’t

It’s 10am. I’ve just sat down to a cup of tea after a busier than average 18-hour shift in a large Irish maternity hospital. Busy, but safe. I just went to see six happy, exhilarated, exhausted mothers and six chubby, pink, hungry, gorgeous babies that I had the privilege of seeing safely into the world last night together with my midwifery colleagues. My legs ache a bit and I need a shower.

 I sip the tea and tap into the news app on my phone. Another morning, another story about the maternity services. Today I see a case that centred on a woman who wished to deliver vaginally following three previous caesarean sections. I see that Justice Michael Twomey reasonably, fairly, and justly ruled that a woman has the right to decline what is felt to be the optimal medical treatment because this goes to the core of her bodily autonomy. No brainer, right? Of course.

But then, instead of sensibly going upstairs, turning on the shower and climbing under the covers, I click further and read the commentary that surrounds the judgement. I feel a stone sinking in my stomach, cup my face in my hand, exhale deeply and read on. Immediately the rocks are being thrown at the players from the ‘supporters’ on the side-lines.

My thoughts immediately turn to the team of midwives and doctors who are charged with the care of this woman and her baby. I am not familiar with the case, but I can only imagine the protracted discussions, debates, and wrestling with moral and ethical compasses that went on in their minds before they decided to ask for the wisdom of the courts to mediate the matter. Yet, the commentary on the judgement insinuates that the obstetric team aimed to force a woman into a surgical procedure she didn’t consent to. In reality I imagine they needed to clarify what their obligations were to this mother and baby in the case where the well-intentioned support of choice could lead to a severely brain-damaged baby or a life-threatening haemorrhage for the mother.

Effectively now in obstetrics, you’re damned if you do and you’re damned if you don’t. Had they not asked the courts for an opinion and a catastrophe ensued at delivery then they would no doubt be hung out to dry first in the media and then in the courts. The carers have no right of reply in order to protect patient confidentiality, so a persistently skewed narrative is presented to the public.

I am a trainee in my final year. Next July, following 10 years of training and working in the Irish maternity service, I will be a consultant obstetrician. I fell in love with the labour ward as a medical student, enthralled by the magic and humanity of it all; the pace, the ability to save lives and the pure and humbling joy of supporting a mother to birth her child. The emotional burden has been magnified even more so since I had my own children. I feel totally overcome in the presence of a happy couple and their new baby and equally I feel an aching sadness and struggle to compose myself when I sit with a couple that have had a stillbirth. Briefly, I entertained the idea of pursuing a career in general practice as I thought it would offer a better work-life balance but I couldn’t bear the idea of parting from this crucial, vital, and dynamic specialty.

But it’s getting harder to keep chipper. It’s getting harder to go in and put on a smile, roll up your sleeves and get to work. Every day now I read stories and opinion pieces denigrating, disparaging and eroding confidence in our midwives and doctors. Every day now I watch midwives and doctors begin to second-guess themselves, despair at their deteriorating relationship with their patients, and act to protect themselves from the medico-legal vultures. Every day now I see women becoming a little more suspicious, a little less trusting, a bit more fearful of what may happen to them and every day I hear of another midwife or doctor who has just left the specialty. All this occurs against the backdrop of a maternity service that is objectively, year on year, delivering a better service, constantly changing and improving our outcomes as evidenced in our annual reports.

 I’ll be the first one to point out our inadequacies, our under-resourcing and our lack of geographically equitable services. In my position as a senior trainee on the cusp of becoming a consultant I’m hoping to tackle these head-on. I want to be part of moulding a maternity service that is safe, equitable, evidence-based, modern, and compassionate. But as Muhammad Ali once said, “It isn’t the mountains ahead to climb that wear you out; it’s the pebble in your shoe.” Well the pebble in my shoe as an obstetrician in Ireland is the unfair and persistently negative narrative in the media surrounding our work. It’s beginning to feel like a witch-hunt.

Maybe I’m a bit jaded and cynical and I just need some sleep. I watched Finding Nemo with my four-year-old daughter recently. Dory’s advice struck me: “When life gets you down, you know what you do? Just keep swimming, just keep swimming.” I work with some of the most highly skilled, compassionate, bright, engaging, hardworking, forward thinking midwives and doctors in the world.

  1. LuvinLunch on December 26, 2016 at 8:03 pm

    Active management isn’t working

  2. Ursula Shell on December 16, 2016 at 8:09 pm

    Sorry I don´t feel sorry for doctors who don´t except autonomy of birthing women! You should never put a knife into a woman´s body when she says no! That is heavy medical abuse! With this stupid action to bring this poor woman in front of court(heavily pregnant)HSE destroys the trust between doctors and pregnant women!Trust is the basic for good modern medical care!In fear of forced treatments many women lie to doctors or midwives in pregnancy,labor and child birth!Very dangerous for mother and unborn!But also difficult for medical stuff!Yes, the baby might die if the mother refuses medical treatments in some cases.But you wouldn´t dream of bringing a parent to court to donate a kidney for his/her ill (already born)child!Yes, the imagine of Irish maternity system is very bad! Some years ago there was a case of a forced c-section in Dublin which went though international press!The woman was picked up by police and had a mayor forced surgery against her will!

  3. Dr Michael Crotty on December 8, 2016 at 9:05 pm

    Many thanks Dr Corcoran for a very well written article. You have excellently articulated the frustration that is increasingly apparent across all area of medical practice.

  4. Junaid Rafi on December 8, 2016 at 4:56 pm

    Truly said, previously English Media propaganda destroyed the excellent low Cesarean section rate in Dublin by criticising hospitals making decisions against women’s will etc etc.

    I myself an obstetrician totally agree with Author that you are blamed “If u do or if using do” . It’s always an obstetrician fault.

    I have personal experience where one woman was traumatised by long labour of 8-10 hours and on the same day saw a woman who was traumatised by very short labour of nearly 1-2 hours . So it make me think that how on earth an obstetrician can fulfill the expectations of two different individuals, and I agree that we should meet patient’s expectations but now I think that it’s gone too far.

    Patients and public should realise and be more realistic .

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