{"id":42041,"date":"2018-05-10T11:24:56","date_gmt":"2018-05-10T10:24:56","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=42041"},"modified":"2018-05-17T16:50:56","modified_gmt":"2018-05-17T15:50:56","slug":"mary-higgins-irelands-eighth-amendment-i-want-to-care-for-women-not-abandon-them","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2018\/05\/10\/mary-higgins-irelands-eighth-amendment-i-want-to-care-for-women-not-abandon-them\/","title":{"rendered":"Mary Higgins: Ireland’s eighth amendment\u2014I want to care for women, not abandon them"},"content":{"rendered":"

On 25 May, Ireland will vote on whether to repeal the eighth amendment, which upholds the republic’s strict abortion laws. Mary Higgins explains why she’s hoping for change<\/p>\n

\"IMG_0701\"Miscarriage is often called the \u201csilent grief.\u201d For the one in five women and their partners who experience it, the realisation that a pregnancy is ending too early can be devastating. Gone are their dreams of the future, gone is a potential son or daughter, gone is their image of parenthood and their innocent belief that pregnancy will always end in happiness. For many women who have a miscarriage their loss occurs before they have told family and friends. Their symptoms may begin in public while working, travelling, lecturing, or mentoring a colleague\u2014their face may stay the same but somewhere in the back of their minds there is a scream of pain.<\/p>\n

Anyone working in maternity care will have met many women who have had this experience. Once they emerge from the sudden grief and begin to slowly speak of their experiences, a common theme is the realisation that they are not alone. I have lost count of the number of times a woman or man has told me \u201c<\/span>I never realised how many of my friends this has happened to.<\/span>\u201d I\u2019ve witnessed the sadness on their faces that they never knew until then the grief of others, as well as the comfort they have received in talking to those who will understand. They are not alone in this grief of the loss of potential.<\/span><\/p>\n

Compare that relatively silent grief to that of an Irish woman undergoing a termination of pregnancy. Currently, abortion is illegal in Ireland in all but the most restricted of circumstances, being only allowed where the risk to a woman\u2019s life from a mental or physical illness \u201ccan only be averted by carrying out the medical procedure<\/a>.\u201d Women with a fetal anomaly, women pregnant due to rape, women with dreadful social circumstances, women whose medical condition is \u201cnot serious enough<\/a>,\u201d and all other women have, essentially, three options: to travel to another jurisdiction, to find illegal medications and take them without medical supervision, or to continue with the pregnancy.<\/p>\n

I have been the doctor who has turned to a couple and uttered the words \u201c<\/span>I have something to tell you<\/span>\u201d and watched their faces change with dread about what I will say next. For some of the women with fetal anomalies, their decision will be to continue in the pregnancy and, in this, Ireland provides very good perinatal hospice care. But for some couples, their painful decision will be not to continue. Their faces will change again when we gently explain that we do not have the legal framework to provide that option to them in their own country and that instead they must travel abroad. In their darkest hours\u2014in their pain and in their grief\u2014these women, these couples, and these families now feel abandoned by their doctors.<\/span><\/p>\n

I have no practical experience of what it is like to board a plane or a boat to travel to another country with the purpose of obtaining an abortion, but I have a good idea. Reading accounts such as <\/span>@twowomentravel,<\/span><\/a> or the <\/span>stories of brave people<\/span><\/a>, or reading <\/span>books<\/span><\/a> will let anyone with an ounce of empathy know how hard it is. <\/span><\/p>\n

In my work I have met women after they travelled and they have told me stories of turning off phones so a foreign dial tone would not be heard, of the kindness of strangers, of being in a different country when all you want <\/span>is your mother beside you<\/span><\/a> telling you that you <\/span>can<\/span><\/i> get through this. I have met women in a subsequent pregnancy who tell me that I am the first person they have spoken to about the ending of a previous pregnancy, for fear that others may judge a decision they made in the depths of pain. Women who run while bleeding to catch the last plane home so that they can be with their other children. Women who have had complications during a termination who then cannot afford to stay in hospital in the UK, and so discharge against medical advice to travel home\u2014not knowing if they will be cared for with dignity and respect in their own country (they are for the most part, but it\u2019s not a guarantee). I have known couples who talk of how they can give the full facts to one half of their families but a heavily abridged version to the other half, for fear of how they may be judged and of the pain they may cause to those they love.<\/span><\/p>\n

I have met couples attending our annual service of remembrance who said it took years before they felt that they had a right to do so, as their pregnancy loss was due to termination rather than miscarriage, stillbirth, or neonatal death. They have held their experience up to the light of Ireland and have genuine concerns that a value judgment will be cast upon them because of their type of pregnancy loss. They have admitted to feeling shame and guilt.<\/span><\/p>\n

No woman, and no couple, come to the decision to have a termination lightly. Travelling without their families to a strange city in a different country makes an already difficult experience even more harrowing. I\u2019m grateful to the British obstetricians, healthcare professionals, and organisations who provide care to Irish women where we could not. Yet this cannot continue. We want to provide continuity of care, to be with our patients and to hold their hands. We wish to provide high quality bereavement care in our own country. Whether a woman wants to have all her family with her or none, we want that option for her. Where we cannot cure, we wish to care, not to abandon. <\/span><\/p>\n

Later this month the citizens of Ireland will vote in a referendum that could finally enable us to do this. We will vote on whether the eighth amendment to our constitution (that reads \u201c<\/span>The State acknowledges the right to life of the unborn and, with due regard to the equal right to life of the mother, guarantees in its laws to respect, and, as far as practicable, by its laws to defend and vindicate that right<\/span><\/i>\u201d) should be repealed and replaced with what may be the thirty second amendment<\/span> (<\/span><\/i>that may read<\/span> \u201cProvision may be made by law for the regulation of termination of pregnancy<\/span><\/i>\u201d). <\/span><\/p>\n

I have no idea if this referendum will pass or not. Ireland remains a traditional, family orientated country, where many people believe that abortion will never be an option they\u2019ll need to consider until they are faced with the decision. Yet I have faith that the people I know are also compassionate, and kind, and have listened to the facts as well as the personal experiences of affected women, couples, and families. If the referendum passes, and once the legislation is enacted, we would no longer need the help of other countries to care for Ireland\u2019s women. The ending of a pregnancy will remain desperately sad, but at least women, and their partners and families, would know that their country understands and supports them in their decision.<\/span><\/p>\n

Mary Higgins<\/strong> is an obstetrician working in Dublin who has openly spoken on both traditional and social media of her support to repeal the eighth amendment to the Irish constitution.<\/span><\/em><\/p>\n

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Competing interests:<\/strong> Nothing further to declare.<\/div>\n<\/div>\n<\/div>\n<\/blockquote>\n","protected":false},"excerpt":{"rendered":"

On 25 May, Ireland will vote on whether to repeal the eighth amendment, which upholds the republic’s strict abortion laws. Mary Higgins explains why she’s hoping for change […]<\/p>\n

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