Guest post: Savita and medicine.


I’m absolutely delighted to welcome Seonaid to guest post at the Tea Cosy- although I do, of course, wish it were in better circumstances. -Aoife

So, my international internet buddy Aoife posts a Thing about her reaction to hearing about the horrific way Savita Halappanavar died. And I cry, because like her, on October 21st-27th I was doing inconsequential things while a woman in a place in life not totally unlike mine lost a baby she wanted, and unnecessarily suffered and died. And I cry, because Ireland still has laws that outlaw all terminations of pregnancy, even cases of rape, incest, or where the mother’s life is in danger. And because the penalties are so great that no doctor would take the chance that perhaps the fact that the pregnancy was already terminating itself left room for an interpretation that the correct treatment might actually be legal.

Now I get self-centered and I cry some more because this is the type of thing that can’t happen here, where I live, in the United States, where people like Savita, and me, and any other person who menstruates, have fought for and won the right NOT to die like this. But also where the party that approximately half the population supports has just adopted similar ‘values’ as part of its official party platform. Where “repeal Roe v. Wade” and “support a woman’s right to choose” are opposing sides of a coin that is very prominent in any race for any elected position in the nation. Where we are saddened, but no longer surprised, when religious fundamentalists murder doctors who provide abortions.

And then an internet comment storm starts, with (astoundingly to this American so jaded by Republican/Democrat balkanization) hardly anyone screaming names like ‘demon’ and ‘murderer’. The most heated that side of it gets is actually very mild, to my ears, simply stating that the laws don’t need to be different to have saved Savita, that the right medical treatment was quite legal, and that it was criminal negligence on the part of the doctors that Savita had not been treated to stop her miscarriage.

Ah. Stop her miscarriage. And that’s where the commenter loses the ‘open to rational opposing opinions’ part of my brain that until then was willing to engage. Because as it happens, I know something about pregnancy, labor, pre-term labor, miscarriage, vaginal birth, and surgical birth. In the US, we deal with a different kind of suppression of reproductive choice: the right to give birth where and how you see fit. To give birth in a hospital and resist the immense pressure to let the staff ‘manage’ your labor is virtually unheard of (homebirth and midwives are a thing here, but are thought of as very ‘fringy’ and I was not aware at the time of my daughter’s birth that it was an option to be taken seriously).

And then I have an epiphany, the edges and vague form of which have occurred to me before but never in such clear, tangible form, that these two of my deepest-held causes (the right to choose NOT to give birth, and the right to choose HOW to give birth) are even more linked than parallel sentence construction and the obvious fact of the word ‘birth’. Because really, it’s all part and parcel of the same old disconnect: that self-proclaimed ‘pro-lifers’ are not pro-life in the slightest. They’re pro-birth. And yeah, that’s been said before, but it’s really not that my two causes are similar, related issues, it’s that they’re THE SAME ISSUE YOU GUYS. ‘Pro-life’ really means ‘pro-fetus-exiting-your-body-in-a-way-we-find-acceptable’.

Granted, that’s in the US, where we have much less access to birthing options even where they are technically available, so the parallels may be more obvious here. I’m not going to argue Irish law. I’m not going to talk about X, or A, B, and C. My own nation’s constitution and laws are difficult enough to understand, especially when you then get into how they interact with the 50 individual states’ constitutions and laws. Me arguing Irish constitutional law, Irish court rulings, ECHR rulings, etc. is pretentious at best and at worst leaves me looking like a nincompoop (as I proved to some small extent on Aoife’s facebook wall the other day).

But I know from medical interventions in birth. I know from pregnancy terminology. And what those people who are insisting that Savita should have been ‘treated for her miscarriage’ don’t understand is that preterm labor and miscarriage are not the same thing. Specifically, miscarriage is when pre-term labor has reached the point of no return. Miscarriage specifically means there is no treatment that will stop the fetus from exiting the womb one way or another. And Savita was diagnosed as having a miscarriage. So ‘scuse me while I get to the meat of this post: the technical details (pardon my American spelling of medical terms).

Preterm labor has three possible outcomes:

  1. Preterm labor can be treatable, that is, it can sometimes be stopped or slowed long enough to let the fetus grow to a more viable stage. Treatments, whether medical or surgical (progesterone or cerclage) are focused on preventing the water from breaking, preventing dilation of the cervix, because if these things occur, the fetus will be expelled from the uterus.
    In nearly all cases, treatment only delays expulsion of the fetus for a few days, but this may be long enough, if the fetus is of sufficient gestational age at the time preterm labor begins,  to administer certain drugs to the mother that will accelerate development of the fetus’ lungs and brain to increase viability.
  2. Whether treatable or not, preterm labor can end in a premature birth, where the fetus is born alive. The fetus may only live briefly, depending on how far along the pregnancy has progressed and what caused the preterm labor.
    Fetuses from 16 weeks on might have a heartbeat for a few minutes after birth.
    Long-term survival has never been reported for less than 21 weeks and 5 days.
    At 24 weeks gestational age, there is about a 50% chance the infant will survive long-term.
    At 26 weeks gestational age, there is about a 50% chance the infant will survive long-term without moderate or major neurological disability.
  3. Preterm labor can end in miscarriage. Up to 24 weeks, even if the fetus is born alive, the outcome is termed a miscarriage if it then dies shortly afterward. Untreatable preterm labor at 17 weeks can only end in miscarriage.

Miscarriage is also referred to medically as spontaneous abortion, that is, a pregnancy that ends naturally before the embryo or fetus is capable of surviving outside the womb. One of the stages of a miscarriage is called ‘inevitable miscarriage’. This means that the cervix is dilated but the fetus is not yet expelled.

Preterm labor is what Savita experienced before the point where her cervix was fully dilated and her water had broken. Inevitable miscarriage is what Savita presented with at the hospital, and what she was forced to experience for three days because her fetus would certainly die outside her uterus.

Her cervix was fully dilated, her water had broken, and her uterus was contracting. THERE WAS NO TREATMENT, LAWFUL OR OTHERWISE, that could stop the fetus from exiting her womb one way or another, and at 17 weeks of pregnancy there was no chance of its survival. What could have saved her life was medical induction of stronger contractions to make her uterus expel the fetus faster, once the diagnosis of miscarriage was confirmed, so her body could do what bodies do after any birth: contract the uterus down to near its pre-pregnancy size and close the cervix.

Let me paint a very different picture for you. If Savita had been 26 weeks along, the fetus would have had a 50% chance of survival without neurological disability.  After 12 hours of labor, the doctors would have become very concerned about stress on the unborn fetus. Well before 24 hours had passed, they would very probably have insisted on inducing stronger labor (the treatment she requested three times) or performing an emergency cesarean, because the fetus would have a greater chance of survival in neonatal intensive care than going through the physical stress of a prolonged labor.

And again, another, still different picture. If she had been 37 weeks along, they would have exerted extreme pressure on Savita, whether she wanted it or not, to let them induce stronger contractions or perform a cesarean once her water had been broken for 24 hours, because they would have perceived both her and the fetus to be at increased risk for septicemia. SEPTICEMIA. They would have done just about anything they thought would work to manipulate her into agreeing, in some cases even lying about her baby’s well-being. They would have done this even though it is actually repeated cervical checks that increase the risk of septicemia, and if they keep their hands out of laboring people’s vaginas, the risk does not increase.

In other words, if the fetus stood a chance of surviving the birth, they would have insisted on doing exactly what Savita asked them at least three times to do. But because Savita was only 17 weeks along; because this baby she wanted could not survive but had not yet died inside her; because the law on abortion in her adopted country is at best so ambiguous that no doctor could be sure they would not go to prison for life if they treated her appropriately, and at worst outright values the life of a fetus who is absolutely going to be born, and die within minutes of being born, over that of a mother begging repeatedly for her life to be saved… because of these things, she was forced to wait three days for her baby to die inside her. She was forced to wait, with her cervix open to infection and a uterus that was not able to contract sufficiently to expel a non-viable fetus and get on with the business of healing. She was forced to wait, because doctors were unable, on penalty of life in prison, to save her life.

I can’t think of a way to wrap this up neatly. It’s not a story of disgust and outrage, with a tidy resolution at the end. Because at the end of this story, Savita dies. This is real-life disgust and outrage, and real life is rarely story-shaped.

 

Anti-abortion is not pro-life.


Anti-abortion is not pro-life.

Have we learned this yet? Let me say it again. Anti-abortion is not pro-life. I am sick of anti-abortionists hijacking the language of life. As if pro-choice people were somehow pro-death.

We know better now. Don’t we? Shouldn’t we already? For years, clinics providing abortions in the US, Canada, Australia, and probably more have been victims of attacks by murderous anti-abortionists. ‘Pro-lifers’ willing to bomb, shoot and kill to further their goals. Do you remember George Tiller?

‘Pro-lifers’ will deny any connection to people who kill to further the very viewpoints they espouse. They’re not like that, they’ll say. They value life, they’ll say. And yet this is a group that thinks nothing of standing outside clinics shouting vile accusations at vulnerable women who they know nothing about, on what may be one of the most difficult days of their lives. Have you ever heard of pro-choicers bombing anti-abortion organisations? Shooting anti-abortion campaigners in front of their family and friends? Destroying the lives of people who are anti-abortion?

I could talk here about connections between the characterisation of women and doctors as murderers and violence against them. I could talk about hatred and dehumanisation and what it leads to. But that’s not for today.

Today is about the fact that even if anti-abortion rhetoric wasn’t full of violence against women, anti-abortion policies kill women.

Anti-abortion is not pro-life.

Anti-abortion is not pro-life

I might just start identifying as pro-life. I am pro-life. I believe passionately in defending the rights of women to our own lives. Both to the choice to live as we see fit, and to the right to continue living. I care deeply about preventing unnecessary pain and suffering. I never want a woman to die a preventable, agonising death.
I believe in the rights of children- all children- to be brought up by families who cherish them and for whom they are a joy. I want to live in a world where everyone who becomes a parent wants to do so, and where every child knows that their parents freely chose to have them.
I believe in the rights of living people. Not potential people. Potential people may have their time, but those who matter most are those who exist here and now. People with thoughts and dreams, friends and loved ones. People in communities. People who can feel fear and pain and love and hope. These are the people who matter most, because right here and now these are the people who are people. There was a time when they were not. But now they are.

Anti-abortion is not pro-life.

Love and Shame in the Wake of Savita


I love my city. It’s easy to love. In a pub in Glasgow the other day I heard people around a pool table mocking how much Corkonians love our city. Loving Cork is a tired old stereotype that just so happens to be true. There’s a lot to love.

My city is walking by the river on a chilly day eating takeaway gourmet sausage sandwiches from the English Market. It’s warm cafes and pubs you can spend all day in. It’s meeting people you know every time you walk down the street. It’s friendliness and openness. It’s laid-back, relaxed, shure it’ll be grand. My city is where I came out and was nurtured (and, er, some other things too!) by a wonderful queer community. My city is organic, free-range and fair-trade. It’s beardy lefties and bringing your kids and dogs along to the protest. My city is a wonderful sense of independence, knowing we’re as good as anyone and probably better, and doing it yourself.

I love my city. I am deeply ashamed of my country.

A lot of non-Irish blogs and other media have been talking about Savita this week. Of course they have! And to start off, I was aghast at how they talked about Ireland. As if we’re an ignorant, backward, priest-ridden society. As if we’re a nation of fundamentalists. I wanted to shout at them that we’re not like that. We’re a secular society! Many of us call ourselves Catholics, but we don’t hang off a bishop’s every word. We don’t. I wanted to say that we’re a secular society chipping away at a decades-old institutional veneer of religiosity. I wanted to share how easy it is to be irreligious, atheist or humanist as an adult in Ireland. I wanted to talk about how I’ve never had to come out as atheist like so many Americans I hear about. I’ve never worried about being shunned or rejected because of my lack of belief. I wanted to shout that we’re so, so far from stereotypes of Irishness.

But none of that matters.

A candle-lit vigil for Savita, her name in candles on the ground.

We’re not a secular society chipping away at a decades-old institutional veneer of religiosity. Not any more. We’re a society rotten to the core with the abject power and reach of the Catholic Church, with an easy, shallow sheen of secularism. We’re secular when it’s easy. As a childless adult, an Irish citizen without major health issues who moves in urban, educated circles, it’s easy. I don’t have to send a child to a Catholic school. I don’t have to stay in a hospital. I live easily.

Many of us live easily. And one of the things about being Irish is that we figure that if it ain’t broke, there’s no point worrying about it. We live our easy lives and we decide that it’ll be grand. Sure, abortion is illegal here. But can’t you get over to the UK for half nothing with Ryanair? Not a bother like.

Our complacency gave us an easy life. And now our complacency has killed.

I love my city. I love my country too, but as a Corkonian I’ve got to say that I love my city more. I love my city and my country, and I am deeply ashamed of them. My sweet, easygoing city is part of a country that sat for decades on a ruling that would have prevented Savita Halappanavar’s death. Because underneath our laid-back exterior is a cowardly and judgemental core.

Protester holding a sign with the word "shame"

We should be ashamed. We need to be ashamed. We need to feel our shame, take it and turn it into rage. We need to stand before Savita Halappanavar’s husband, parents, friends and family and tell them that we were wrong. We need to beg them for the mercy that we did not show their wife and daughter.

And then we need to stand up and take responsibility.

The world thinks that Ireland is a fundamentalist, backward country. They think that we would rather follow the bishops than our own consciences. They think that we don’t care about the lives of women. They are right.

We need to be ashamed, and then we need to change this. We need to change it NOW. Not next year. Now. Because in our hospitals today there are women suffering through miscarriages. There are women at risk of septicaemia. If we are to call ourselves a civilised country, we act now. We legislate for X, and we make that legislation rock-solid. And today, tomorrow, next year, ten years and a hundred years from now, when we talk about abortion we do not listen to a Church that would have women die. We listen to Savita’s pain, to the grief of her loved ones, to our deep and abiding sense of shame, and we do the right thing.

Abortion and journeys.


I wrote this yesterday morning. Meant to post it yesterday but after no sleep at all, got home and crashed out. Here it is.

I’m sitting drinking tea and eating overpriced breakfast in Prestwick airport. Lady Gaga is playing on speaker somewhere. It’s 5.40am.

I didn’t sleep tonight. Did you? I couldn’t. Not just because I knew I had to get up before 4am, or the loud drunk people in the hostel room next door, or because I’d just said goodbye to the Ladyfriend until the next visit and the bed felt terribly cold and lonesome. I couldn’t sleep because I couldn’t stop thinking of Savita. And I couldn’t stop thinking of all the Irish women lying awake tonight for early morning flights to the UK, while thousands around the country mourn and rage. I wonder how that feels. I hope that today of all days, they know that Ireland is waking up to the love and compassion it’s been hiding all these years.

I’m lucky. I’ve never had to make that journey. I’m lucky. I have the choice.

I don’t know about the details of Savita’s life. I’m sure I’ll find out more over the next days and weeks. But right now I want to ask a question. Did Savita have a choice? And what about the women who don’t?

Savita’s choice was denied her because by the time she made it she was in an Irish hospital with doctors who chose, for some reason, to inform her that she was “in a Catholic country”. Catholic countries have no compassion for dying women. But did she have a choice to start with?

Irish women, we have choice. Those of us who can afford it, at least. We can take our early-morning flights and make our escape. Many migrant women don’t have that choice, can live in Ireland for years knowing that if they need to leave, they can’t. I wonder how that feels. Knowing that life in the home you’ve made for yourself is a Russian roulette if you don’t want to be pregnant. Or if you’re pregnant and have a non viable fetus. Or if you’re pregnant and have cancer, or anything else short of the immediate threat of dying. Or even that. Knowing that as you lie dying, your doctor might just tell you where you live and leave. Leave, while you cannot.

Our country says that to migrant women. They made their beds, we say, as we force them to lie in them even to the death.

I don’t know the details of Savita’s life. But this isn’t just about Savita. She is one of the unlucky ones. She’s the one we’ve heard about. Savita is dead, and I can’t believe that she’s alone. Savita’s life is one part of our story of absolutes, lack of compassion and the devaluing of so many lives in the name of morality.

Sitting here in a UK airport before dawn this morning, I wonder about the rest of that story.

My country kills women.


I woke up this morning in a hostel in Glasgow. The phone was ringing. Sleepy passing the phone to my partner, burying my head in a pillow while she talked. We’d slept through breakfast time. She went downstairs to meet a friend across the road for tea. Failing to get back to sleep and not wanting to leave my duvet, I propped myself up to check my phone.

I have never felt so disgusted by my state as I am today. That is, by the way, a big statement. I come from a land of Magdalen laundries and cover-ups by supposed moral authorities of child abusers. Funding cuts to the most vulnerable while the people who got us into this mess get off free and disabled people and immigrants are scapegoated. These realities become callouses. It takes a lot to be shocked.

I spent the last week of October visiting my family. Catching up with my cousin after her honeymoon. Calling over to friends from back home. Dinners with family and friends, full of that wonderful bustling laughter and warmth of sharing with the people you love.

While I was passing the potatoes and poking around the kitchen for a bottle of wine, a few hours drive away Savita Praveen Halappanavar was dying.

Savita did not need to die.

She was pregnant. On 21st October, she went to hospital suffering from severe back pain. She was suffering a miscarriage. 21st October was the Sunday just after the Trans* Rally for Recognition. A lazy day at home for me, recovering from the week before. According to my journal I spent the afternoon on the sofa watching One Born Every Minute. Ironic, that I would watch a show about giving birth in the UK as a woman in Ireland was about to find out what happens here when pregnancy goes wrong.

Savita was having a miscarriage, but her foetus still had a heartbeat. She asked for the foetus to be removed, to bring this ordeal to an end. She was refused. She was in agonising pain. Ireland is a Catholic country. She asked again. She was refused. She asked again. She was refused.

It took three days for the foetal heartbeat to stop. Three days of unrelenting agony. Until Wednesday. Once the heartbeat stopped, her foetus was removed. Wednesday, by the way, when I was complaining about sitting next to a rather stinky loo on the bus down to Cork, after spending the morning sating a craving for Alpen. In the meantime, Savita had developed septicaemia- almost certainly caused by those three days with her cervix fully dilated and nothing to protect her from the outside world. She was taken to intensive care. On Saturday night- when I was kicking the cat out of my room so I could get some damn sleep- she died.

She was 31.

This isn’t far away. This isn’t a long time ago. This is here and this is now. This is hours or minutes away from our everyday lives. This is what Ireland is. We are a country that forces women to die preventable deaths in agony. We are a country that calls this ‘pro-life’.

I’m writing this from a cafe in Glasgow. Tomorrow morning I’ll fly home to Ireland. The flight over here took about 40 minutes. Forty short minutes that are the difference between life and death. If Savita had walked into a hospital here she would still be alive. Because she was a few hundred kilometers southwest, she died.

I don’t want to say that we must all be Savita. We’re not. We’re alive and she’s dead. But it’s about time that every single one of us became her friend. Became her family. Stood in solidarity and grief beside those who loved her. Beside her husband and her family and everyone who loved her and now has to wake every day knowing that, in the name of life, we took hers away. It’s high time we make sure that every one of our voices is heard and that what is heard is NO. We will not stand idly by while this happens. We will not allow our politicians to hide and put off legislation for decades while women die.

We need to take back the moral high ground. Need to wrench it back from every sneering ‘pro-lifer’ who says that abortion is never necessary to save a life. Need to stop talking about abortion as if it were a necessary evil and remember that a few weeks ago abortion would have been the absolute unquestionable right thing to do. We need to always, always remember that these are the people who hear a woman in agony begging for her pain to be taken away and say no. These are the people who leave a woman to hurt and die and refuse to make it stop. The next time that someone tells you that you are a murderer for supporting a women’s right to choose, remember this. Remember Savita.

Savita died an unnecessary, horrible death. Let us take that death and our grief and shame and let us stop this. She cannot have died in vain. Let us make sure that this never happens again and let us make sure that Savita’s name is never forgotten.