you're reading...
abortion, Ethics, pregnancy, prematurity

Did Irish Catholic law or malpractice kill Savita Halappanavar?

This is what is known. Savita Halappanavar was 31 years old and happy to be pregnant with her first child. Then, at 17 weeks, tragedy struck and she was “found to be miscarrying.” Her husband reports that she was in “severe pain” for three days at the hospital and a termination was requested. He says this request was denied because Ireland is “a Catholic country.” He and his late wife were led to believe that the law would only allow her to be delivered when there was no fetal heartbeat.

What does the standard of medical care say about this treatment? Without access to the chart, “miscarrying” at 17 weeks can only mean one of three things”

A) Ruptured membranes

B) Advanced cervical dilation

C) Labor (this is unlikely, although it is possible that she had preterm labor that arrested and left her with scenario B, advanced cervical dilation).

All three of these scenarios have a dismal prognosis, none of which should involve the death of the mother.

The standard of care with ruptured membranes (scenario A) is to offer termination or, if there is no evidence of infection and the pregnancy is desired, the option of observing for a few days to see if the leak seals over and more fluid accumulates. If no fluid accumulates and by some chance the pregnancy manages to go beyond 24 weeks (the vast majority of pregnancies with ruptured membranes delivery within a week), survival is unlikely given the lungs require amniotic fluid to develop. I have seen the rare case where a woman with no infection (and no fluid) elects conservative management in the hopes that might make it to at least 24 weeks in the pregnancy, however, I have never heard of a baby surviving in this scenario. Regardless, if infection is suspected at any time the treatment is antibiotics and delivery not antibiotics alone.

The standard of care with scenario B involves offering delivery or possibly a rescue cerclage (a stitch around the cervix to try to prevent further dilation and thus delivery) depending on the situation. Inducing delivery (or a D and E) is offered because a cervix that has dilated significantly often leads to labor or an infection as the membranes are now exposed to the vaginal flora. Many women do not want wait for infection. A rescue cerclage is not without risks and is contraindicated with ruptured membranes or any sign of infection. Rescue cerclage is a very case by case intervention and well beyond the scope of this post. These decisions are difficult and the mark of good medical care is that all scenarios are discussed, all interventions that are technically possible offered, and then the patient makes an informed decision. All with the understanding that if infection develops, delivery is indicated.

Not only do I know these scenarios backwards and forwards as an OB/GYN, I had ruptured membranes in my own pregnancy at 22 weeks, a rescue cerclage, and then sepsis. I know how bad it can be.

As Ms. Halappanavar died of an infection, one that would have been brewing for several days if not longer, the fact that a termination was delayed for any reason is malpractice. Infection must always be suspected whenever, preterm labor, premature rupture of the membranes, or advanced premature cervical dilation occurs (one of the scenarios that would have brought Ms. Halappanavar to the hospital).

As there is no medically acceptable scenario at 17 weeks where a woman is miscarrying AND is denied a termination, there can only be three plausible explanations for Ms. Hapappanavar’s “medical care” :

1) Irish law does indeed treat pregnant women as second class citizens and denies them appropriate medical care. The medical team was following the law to avoid criminal prosecution.

2) Irish law does not deny women the care they need; however, a zealous individual doctor or hospital administrator interpreted Catholic doctrine in such a way that a pregnant woman’s medical care was somehow irrelevant and superceded by heart tones of a 17 weeks fetus that could never be viable.

3) Irish law allows abortions for women when medically necessary, but the doctors involved were negligent in that they could not diagnose infection when it was so obviously present, did not know the treatment, or were not competent enough to carry out the treatment.

What we do know is that a young, pregnant, woman who presented to the hospital in a first world country died for want of appropriate medical care. Whether it’s Irish Catholic law or malpractice, only time will tell; however, no answer could possibly ease the pain and suffering of Ms. Halappanavar’s loved ones.

****

Since posting this piece I learned that Ms. Halappanavar’s widower reported that she was leaking amniotic fluid and was fully dilated when first evaluated. There is no medically defensible position for doing anything other than optimal pain control and hastening delivery by the safest means possible.

About these ads

Discussion

154 thoughts on “Did Irish Catholic law or malpractice kill Savita Halappanavar?

  1. Hi, Jen, thanks for the article. Obviously as a Canadian, you’d be less aware of the situation in Ireland legally, but as a medical professional, would they have known her life was at risk when she came in for treatment?

    Posted by bakingbeardy | November 14, 2012, 10:39 am
    • thanks for such a clear article. You might be interested in this – one of the consultant ob/gyns at the hospital savita died in – sued as he misdiagnosed a dead foetus which was actually alive, and also subject to other malpractice suits, makes one wonder if, along with the Catholic ethos of that hospital, there might have been something else at play:

      http://www.dailymail.co.uk/news/article-1286226/Surgeon-linked-major-childbirth-negligence-cases-regrets.html

      Posted by Lisa G. | November 15, 2012, 3:50 am
    • There are stringent processes attached with our responsibility as doctors and mother’s life is of paramount importance. There are many guidelines that are there to be followed so that a individual doctor’s judgemnet dosen’t go wayward. Looking at the story published here, serious warning symptoms were present since her presentation. Things can always go wrong even with the best of the medical attention, but a doctor in a developed country giving “RELIGION” as a reason for any judgement in patient care, is heights of negligence towards the care of any patient. This is unacceptable in Canada. Religion should have no role in the medical field.

      Posted by GB | November 15, 2012, 10:36 am
      • Irish law requires that all efforts are to be made to save the life of the mother. Thus Ireland is one of the safest places in the world to have a child.
        When I was a student nurse, in the largest hospital in London, and also a staff member, I saw many women having miscarriages. Cramping and bleeding were the presenting symptoms. Infection was not a factor and antibiotics were not needed. Only one patient came in with a fever. Her admitting diagnosis was “septic abortion” or “criminal abortion”. Even back street abortions usually occurred without complications since they were usually performed by moonlighting physicians and midwives. Dr. Bernard Nathanson, cofounder of NARAL, who performed 60,000 abortions, admitted, that in this country, the numbers of deaths from back street abortions were hugely inflated by the pro-abortion lobby.
        On my first try, I came across an August 1994 New England Journal of Medicine article, which stated that septic abortions usually only occur in third world countries. These days it is occurring, too much, in countries where women are coerced into taking abortifacients and have no access to safe follow-up medical care. WebMD and medicinenet also describe the symptoms of miscarriage as bleeding and cramping.
        I saw one story, which stated that the husband of this stunningly beautiful young victim, has stopped co-operating with the investigation.

        Posted by Lillian Porter | November 27, 2012, 1:21 pm
    • such a tragic story…

      Posted by Guido Kyosuke | November 17, 2012, 7:06 am
  2. You will be interested in this: http://bengoldacre.posterous.com/irish-miscarriage-case

    A pro-life obstetrician asserting that abortion is never required to save the life of a mother, associated with the hospital where Saveeta Halappanavar died.

    Posted by Alison Cummins | November 14, 2012, 11:32 am
  3. I see nothing has changed in Ireland in regards to women/mothers.

    My heart and soul weeps for this lady and her family.

    Still the same old patriarchal beliefs that women are Eve ill and feeble minded and so need males men in dresses to make all fertility decisions for them, backed up by the HSE employees.

    We have learned nothing from Drogheda and Dr Eeerie Neary and his hatred of women and him doing hysterectomies without reason- just to have power over women.

    Then we had the symphysiotomy survivors.

    http://www.irishtimes.com/newspaper/ireland/2012/1114/1224326573988.html

    Mothers against the Odds, a new documentary that focuses on the plight of Irish women forced to endure symphysiotomies during the mid to late 20th century.

    Same hospital- Catholic- nuns etc making women suffer for the sin of being pregnant- married or not.

    In 1950’s our parents went to North of Ireland or Protestant hospitals in Dublin because we knew and know the Roman Catholic rules re women in Ireland.

    Somehow younger people believe things changed, but they haven’t. That’s just an illusion to the rest of the world.

    This amazing woman was Indian and no matter what the Irish say- they are racist to the extreme- so this lady would have been seen as less than them too.

    I am Irish and a woman, so I know the truth and I am not going to defend those who obey men in dresses.

    Irish society a sadistic psychopathic system in place re women and children- the more suffering the more patriarchs like it. Women of god aid and abet as well. They too obey their masters in Rome.

    It is this sick society that will do all to excuse the Roman Catholic teaching and most likely blame the lady.

    Roman church still controls all depts in Ireland- no matter how it looks to the world.

    I excommunicated myself from the Roman Catholic cult years ago when they threatened to do it to me for not obeying.

    Now I wish the eyes of the world to see Ireland for what she is- as one ambassador put it- Ireland is worse than Saudi Arabia for women.

    Posted by Portia Mills (@PortiaMills27) | November 14, 2012, 2:38 pm
    • that ambassador has clearly never visited saudi and/ or ireland

      Posted by john | November 14, 2012, 6:16 pm
    • As an Irish woman who can vote, drive, own property, be alone with a man I’m not married to and dress how I wish, I don’t agree that I’d be better off in Saudi Arabia.

      However, that doesn’t in any way diminish the fact that I am terrified that if I find myself pregnant (although birth control is legal here so at least I have the right to minimise that risk if I wish to) my doctors may not be in position to make my well-being their top priority – or may choose not to. That is a fear I will live with every day until there is legislation protecting my right to life.

      Posted by Ellen | November 15, 2012, 2:04 am
    • “This amazing woman was Indian and no matter what the Irish say- they are racist to the extreme”
      – I think we can take our direction from this outrageous statement how seriously we can take the rest of your rant (which, ironically is indeed racist though, bizarrely, against your own people).

      I am amazed the moderators have passed this hate-filled misandry. Imagine the reaction to a post that vilified women as this does men.

      Posted by Brian Boylan | November 15, 2012, 4:06 am
      • I didn’t notice the vilification of men in general. I read a vilification of the Catholic Church, which is run by men.

        After seeing how much power the CC has weilded in our elections here in the US, I can only begin to imagine how it must be in a country where about 80% of the populous are adherents. This is why we are supposed to have a separation of church and state, so that ostensibly churches cannot write the laws. But that’s BS because they obvioulsy do, both here and certainly abroad.

        Oh, and yes, racism is alive and well in Ireland. It is alive and well anywhere there are poor and unemployed. It is fomented by governments in order to keep those who are struggling from peeking behind the curtain. It is much easier to have the disadvantaged point fingers at each other than at the oligarchs who are actually to blame.

        You dear Brian really need to read some history.

        Posted by Kathy Stuart | November 15, 2012, 12:53 pm
      • How do you know for sure that race wasn’t a factor, even unconsciously? Misogyny, religious extremism and racism tend to go hand in hand.

        Posted by Sam | November 15, 2012, 1:36 pm
      • It is interesting that you have focussed on this comment in light of the subject matter. The lady is obviously furious and yes having a ‘rant’ but the fact remains that the choice was made to allow this mother to die rather than doing a termination of a pregnancy that would never have resulted in a live baby. It is vital that we keep the focus on this horrible event. Something has to be done to change things and allow doctors to be true to the hippocratic oath they took when they became doctors – to do no harm. Every woman of child baring age in this Country is liable to the same fate in the same circumstances. What if that woman is your wife or sister?

        Posted by Susan | November 16, 2012, 2:37 am
    • I would just like to point out that Ireland is ranked fifth in the world by the OECD in terms of social and economic equality of women (just behind the top-of-everything Scandinavian countries). Survival rates for pregnant women are always in the top three; only 3 out of every 100,000 die, compared with an average of 14 in the rest of Europe and North America. I’m a female agnostic living in Dublin whose friends are homosexual, atheist, and never discriminated against.

      Savita’s case was a horrendous incident of malpractice and it seems to me biggotry, made possible by ambiguous and overly unforgiving guidelines left in place by lazy governments. It was a shocking tragedy that can never be allowed to happen again, and a dire indictment of the don’t-do-their-jobs Irish legislators, and, yes, a byproduct of the often head-in-sand attitude to abortion here that many of us are guilty of.

      But to suggest that everyone here isn’t appalled, or condemn the whole society, is just…missing the most important lessons here. Namely that we must clean up our laws, in many areas, and make sure they reflect what we would want for oursleves and others.

      Posted by AM | November 15, 2012, 12:45 pm
      • As someone said today, Ireland’s a great place to have a baby: it’s a bad place to have a pregnancy which can’t be continued. You’re right that overall care is good, but women whose foetuses are not able to survive just seem to be the overlooked population. But hopefully this will serve as impetus for it to be improved.

        Posted by bakingbeardy | November 15, 2012, 3:01 pm
      • Agree AM , although I would add that Irish Legislators are so slow to act and only react to crises. They re-invent the wheel with every piece of proposed legislation rather than tapping in to British Law which is culturally close to us – we should “tweak” this legislation to cater for cultural differences.I do believe though that existing laws are totally reflective of Catholic teaching and we must purge the most offending pieces from our laws asap.I am so angry about what happend here , so ashamed of successive Governments “ducking and diving” on this issue and so sad for this Woman and Her Family.

        Posted by A Duffy | November 16, 2012, 3:22 am
    • Things have in fact, changed for the better for women in Ireland in the last century, despite this absolute tragedy. You might be Irish, but your language is hyperbolic and offensive: Irish society is neither sadistic nor psychopathic nor sick and it is far from the worst place to be a woman in the world. I will not deny that Ireland is- on the whole- ignorant about race relations and immigration, but I will say that there is no indication in this case that Savita’s death had anything to do with her being Indian.

      By the way, your parents did not go north of the border or to Protestant hospitals in Dublin for abortions in the 1950s, because they weren’t legal. The first abortion provider in the North opened this year in Belfast. And abortion is illegal in all hospitals in Ireland– Catholic, Protestant and State– and has been since the founding of the Free State.

      Savita’s death is a disgrace and a tragedy that should never have happened. Hopefully, policies will be put in place to ensure that such a thing never happens again. My thoughts with her and her family.

      Posted by S_Morlowe | November 15, 2012, 12:46 pm
      • Was abortion banned before the amendment in 1983? I’ve always assumed so, but I’ve never specifically been told.

        Posted by bakingbeardy | November 15, 2012, 3:02 pm
      • She didn’t say they went for abortion – they went so that the mother’s life would not be automatically forfeit in case of complications, as Catholicism requires. The need for such precaution around Catholic doctors and hospitals was well known here in the U.S. during that era, too. It seems the time has come for a revival of such awareness.

        Posted by Elizabeth | November 29, 2012, 11:04 am
    • EXCUSE ME, PLEASE DO NOT COMPARE IRELAND WITH SAUDI ARABIA WHEN YOU DONT KNOW ANY THING ABOUT THE WOMEN THERE ,THEY ARE HAVEING QWEEN LIFE OVER THERE

      Posted by HHH | November 15, 2012, 3:55 pm
    • You make some valid points. However, some of your comments are atrocious, stereotypical and down right infuriating. As an Irish woman, I’m well aware of the issues that face us today, but there is no way that I will agree that this poor woman died entirely due to racism or because the country of Ireland is some sort of evil system that murders women and revels in their suffering.

      This is not a perfect country.
      Sadly,racism, discrimination, abuse, etc are alive and well here! Race, religion or gender imbalance may have been factors in this case, but we don’t know for sure and probably never will.

      Yes, the Catholic Church is given far too much sway in this country and has been for years. I personally have no faith whatsoever in it, and I’m not alone in this view. The church should be a single entity that does not intervene with other institutions, but it is not, and this will not change until our pathetic excuses for politicians get their acts together. The church does not seem to have the power it once had, and their numbers of followers are fast declining. People have less faith in it and don’t want to follow their ridiculous rules any longer.

      Due to the fact that the Catholic Church has had such an unbelievable amount of power in this country for so long, its rules are basically enshrined in Irish law. In this country, a woman’s body is not her own to govern once she becomes pregnant. We do not have comprehensive laws to govern abortion, fertility clinics (and the embryos/gametes stored in them) or the donation/disposal of embryos. This needs to change. Political cowardice and laziness has prevented this legislation from being created. It’s an absolute disgrace and obviously played a huge part in the death of the poor woman.

      It is also obvious that more should have been more done to save her. In most countries the termination of a fetus that is not viable is routine, especially if the mother’s life is in danger. At the end of the day, the doctors should have made the decision to save her life, no matter the consequences for themselves. Malpractice is certainly an issue in this case.

      However, comparing the medical professionals in question to that horrible man Neary (I’m a native of Drogheda, I’ve grown up with the horror stories) is cruel and unfounded. We don’t even know if the doctor in question is Irish, Catholic, atheist whatever! For all we know, this doctor may have said “This is a catholic country” in anger at the injustice of the situation and frustration at the years of stupidity that have left us without proper legislation. On the other hand, the incident may have occurred just as it’s been reported. Once again, we don’t know.

      In this country a doctor can be sued, struck off or even charged with murder under our laws, for performing a termination. Yes, that does not excuse them for letting her suffer and die, but there are no legislative guidelines to help medical professionals with these cases. Political cowardice has robbed this beautiful woman of her life. You might say the doctors were saving their own skin, but what doctor actually wants to see their patient die?
      We don’t know all the facts, and I doubt we ever will, therefore jumping to conclusions, making Ireland sound like absolute hell on earth and having a very disjointed, unfounded rant helps nobody.

      I hope Savita’s poor husband gets justice. I hope the law changes. I hope this never happens to another family.

      Posted by Jessica | November 16, 2012, 2:55 am
    • Gosh, I have been to Ireland three times in the past decade. I just returned from there about three months ago. I must say I would not recognize it from your description.

      Posted by Joanne | November 16, 2012, 10:15 pm
    • Gosh, I have been to Ireland three times in the past decade. I just returned from there about three weeks ago. I must say I would not recognize it from your description.

      Posted by Joanne | November 16, 2012, 10:18 pm
    • Dear Portia Millis,
      I do not know whether u r a doctor, but u r a courageous woman who can speak against the country and religion. I am an Indian Surgeon, practicing since 1978. We Indians are called backwards, illiterate, not having advanced medical infrastructure available; but what is this in a developed country? Does christian God has ordered Catholics that foetal heart sounds are more important than mother’s heart sounds? If this would have happened here, relatives would have filed a criminal complaint of murder against the doctor who was responsible for death of a young doctor? Shame on the person who calls him/her self a doctor.

      Posted by Sadanand Prasadi | November 23, 2012, 12:19 am
  4. Option 1A: The legal situation in Ireland is extremely unclear due to rights enshrined in the constitution not being legislated for.

    Posted by Philip | November 14, 2012, 2:53 pm
  5. the retrospectoscope is always 20/20 vision. Any doctor would agree that it is always easier to manage a case after the fact. Comments should be restrained until the full facts of the case are made public.

    Posted by john | November 14, 2012, 6:18 pm
    • The standard of care for ruptured membranes at 17 weeks with a dilated cervix is delivery. If those basic facts are correct, then any delay regardless of cause is poor medical care. This is not Monday morning quarterbacking, this is a complete disregard of the standard of care or breakdown of the system.

      Posted by Dr. Jen Gunter | November 14, 2012, 6:28 pm
      • That’s incredible to read because aren’t mortality rates below 21 weeks virtually 100%? Which is why (I presume) abortion in most countries is legal up to 24-28 weeks?

        Posted by Tez | November 15, 2012, 3:52 am
      • I noticed that you said the standard of care is “delivery”. Does that mean the standard of care is “abortion”? Can you please clarify your comments? Thank you.

        Posted by Laura | November 15, 2012, 6:49 am
      • Delivery = empty the uterus, either induction of labor or D & E

        Posted by Dr. Jen Gunter | November 15, 2012, 9:03 am
      • Delivery by what means?

        According to the press reports the woman wanted to be induced. Would you induce in a case like this?

        Posted by DavidS | November 17, 2012, 1:52 pm
    • Hear, hear. The only sensible comment made on this post thus far.

      Posted by ggg777 | November 15, 2012, 2:41 pm
  6. Irish law is murky on the issue. Abortion is illegal, but the High Court has legalized it in cases where the woman’s life is in danger. But for 20 years now, papist legislators have refused to translate that ruling into law. As a result hospital directives and such are equally murky. But if they had done the procedure, it’s almost certain that nothing would have happened to them. They are either incompetent, religious zealots or cowards.

    Posted by Steve | November 14, 2012, 6:56 pm
    • ‘it’s almost certain that nothing would have happened to them’

      I don’t know if this is true. Hospital doctors don’t work in isolation. Even if one doctor had decided to go ahead with the procedure, I think it’s likely that someone would have objected as it seems that standard practice was to wait until their was no foetal heartbeat. Either another doctor or theatre staff or administration would have called them out on it. I work in a hospital – they get twitchy about things that fall outside their comfort zone.

      Which, of course, is the very reason clear legislation on the matter is required.

      Posted by Sharon | November 15, 2012, 12:34 pm
    • “Irish Law is murky on the issue”. I would have to disagree. According to all of the obstetricians whose comments I’ve read (and there were several including some very well known ones) the law is quite clear in cases like this. The woman should have been delivered (though not by D&E which would have been dangerous for the woman and also directly killing the baby). The question is why that was not done. It is not a question of murky law, but a question of why the law, and proper medical procedures, which would have saved Savita’s life, were not followed.

      Posted by Joanne | November 16, 2012, 10:40 pm
    • I reply fuck off ! This is equaLLY offensive

      Posted by Harry the Horsw | November 22, 2012, 8:04 am
  7. I’m living in Ireland. The basic scenario is that the doctor’s hands were basically tied, there is no legislation. In 1992 an Irish teenager was raped and became pregnant (this is known in Ireland as the “x” case)her parents decided to bring her to the UK for an abortion, in their innocence they offered to give the foetus to the authorities as proof of the rape. They were immediately prevented from travelling as abortion was illegal in Ireland as per a 19th century law made while Ireland was still under British rule. This was taken to the Irish Supreme Court which decided that she could indeed travel for an abortion. The Supreme Court of Ireland declared that abortion should be legal in cases where there is a “real and substantive risk to the life of the Mother” this included the threat of suicide. This was never legislated for as successive governments have been to cowardly to push it forward, the religious, right wing,anti-choice people are very vocal and obnoxious, they threaten the government and scaremonger about the apparent rampant murder of babies that will happen if abortion is legalised. There have been three constitutional referenda in Ireland in the last 20 years, in each one the public have voted yes to abortion in cases where the woman’s life is under threat, this has been consistently ignored by every government in the last 20 years. About 2 years ago, three women took Ireland to the European Court of Human Rights because they were denied abortions where the pregnancies were putting their lives at risk. The ECHR has come down hard on the Irish government to bring forward clear legislation as a human rights issue and to make clear to the medical community what their position is. In the most recent poll in September 79% polled agreed with the introduction of abortion, especially in cases of medical necessity and rape. Since the ECHR ruling, the pro choice side have become much more vocal, there were protests and vigils held all over Ireland today with more planned for the coming days. Despite what a doctor at the hospital said, this is not a catholic country anymore, its a multi-cultural country like many of our European neighbours and many of those, including myself, who were brought up as catholics no longer practice, mainly due to disgust at the role of the church in the abuse, rape and death of many, many people, particularly women and children over several decades and a terrible attitude towards females. The power and control of that church has almost totally lost its grip on this country, this terrible situation is a result of the last vestiges of the grip of the church. This will probably finally push the government to legislate, its a crime that a young woman had to die to force their hand. The politicians, church and fundamentalists have blood on their hands. They have essentially said that a woman is nothing but an incubator and the life of the foetus she is carrying is more important than her life. This has to end, this is the view of most Irish people, we are horrified that Savita was allowed to die for an unviable foetus that she was miscarrying, no pregnant woman in this country or the people who love her want any chance of this happening again, it should never have happened in the first place, we grieve for her and her husband and family, we are demanding change and legislation and we WILL get it.
    Never Again.

    Posted by Kelly Davis-Jordan | November 14, 2012, 7:19 pm
    • Well said Kelly, as a Irish woman living in London and a healthcare professional , I am appalled at how little has changed in 26 years years since I left “home” The sad fact is that true to irish/roman catholic culture womens’ bodies are not their own to govern and we remain second class citizens. I remember too well that girl of 15 called Anne Lovett died in 1984 giving birth at a grotto in ireland http://en.wikipedia.org/wiki/Anne_Lovett,
      unfortunately Kelly, we said never again in 1984 hope that this time it really does not ever happen again, so so ashamed and humilatated to be called Irish once again

      Posted by Elaine O'Neill | November 14, 2012, 11:11 pm
    • Well said KELLY DAVIS-JORDAN,

      I live in Galway, where this happened. There is widespread disgust at politicians, who in April 2012 voted against legislation to cover circumstances such as this. The voted it down because the legislation was tabled by a socialist woman, and not a traditional man. Politicking of the highest and most disgusting order.

      Shame on you all, you have blood on your hands

      Posted by Shane | November 15, 2012, 1:54 am
    • Excellent……Very well wrote. This has educated me. It’s a shame that this young woman had to go through so much pain. I can’t imagine what it must be like for her husband, her family and friends knowing that her death could have been avoided.RIP Savita. Whatever has to be done to prevent this from happening again SHOULD be done asap…

      Posted by Mickey Forde | November 15, 2012, 2:30 am
    • Beautifully and eloquently said Kelly – I agree with you 100%. This event has shocked and angered me, and reminded me of the frustration Irish women feel about these issues. This rabid and vocal minority were stirring up trouble a few months ago http://www.thejournal.ie/readme/abortion-billboards-youth-defence-pro-choice/ .
      and have approached me on the street. I have always told them I am not interested in their views, that as a single parent for many years, I have never seen hide not hair of them. These people have never helped me, they never to anything to help mothers raise children. I too grieve for Sativa, and for her Family, and extend my condolences to them

      Posted by Emma Ní Dhúlaing | November 15, 2012, 5:31 am
    • Very very well said Kelly Davis-Jordan!!! I agree with every single point you made there….I am horrified that this lovely young woman has died….for no reason……things HAVE to change in this country, I know we’re not a backward nation…but my God sometimes it comes across as if we are exactly that!! Ciggie Quinn

      Posted by Ciggie Quinn | November 15, 2012, 7:25 am
    • Well said Kelly!

      Posted by Brenda | November 15, 2012, 8:00 am
    • Hear Hear

      Posted by Barbara | November 15, 2012, 9:54 am
    • Well said

      Posted by angela garrigan | November 15, 2012, 9:57 am
    • The Dr’s hands were not tied. He/she could have done the right thing and faced the consequences.

      Posted by Kathy Stuart | November 15, 2012, 12:59 pm
      • I have been thinking about this as well. I do not know the extent of consequences for violating whatever law they claimed was tying their hands. But wouldn’t some doctors out there decide, at that moment, that this woman’s life was worth more than their future career? Couldn’t they mount an unassailable defense of their actions using the available evidence of the woman’s condition when she was admitted?

        Posted by Robert Westbrook | November 15, 2012, 4:05 pm
    • Well said, a reasoned response.

      My wife and I sadly experienced a Micarriage at UCH Galway only 6 months ago, quiet similar to this case. However our experience of the care offered was the polar opposite of this case. The medical team offered a high standard of care that quite frankly left me speechless, compared to other parts of the health service the maternity team are superb.

      I would like to believe that this was a an isolated case of mal-practice, we shall see what the result of the enquiry will be.

      As to the implications that racism ayes a part in this, it’s laughable, anyone that has been under the care of the Irish healthcare system recently will attest to how many of our consultants are not Irish themselves and how they work tirelessly to support their patients in a creaking health service.

      Posted by Connor Jameson | November 16, 2012, 1:07 am
  8. If her care team is determined to have acted in malpractice, I’m skeptical that it’s because of anything NOT religiously motivated. Even if it’s not based on enshrined law, it’s based on the privilege that religious doctrine receives in administering medical care.

    Posted by Rebecca | November 14, 2012, 10:02 pm
  9. Thank you for your succinct evaluation from a medical perspective, whatever side of the pro-life /pro-choice line you happen to sit on this makes sobering reading for all. Will Irish politicians be honest enough to change laws and separate state from church? Not holding my breath on that one sadly

    Posted by Elaine O'Neill | November 14, 2012, 10:41 pm
  10. Dr., why are you putting her death down to chorioamnionitis? You don’t say that, but that seems to be the implication. Is it not possible that the one symptom that we know of, low back pain, was not from a prolonged preterm labor but instead derived from kidneys infected with e. coli? Lastly, I suspect that there was infection present as well, but I will refrain from saying that infection was “obviously” present when all we know is that she had low back pain, her cervix was dilated, and her water broke. Heck, as far as the reporting goes, we don’t even know that she had a fever.

    And, Dr., some others apparently violated the applicable standard of care:

    I just recently lost a twin to chorio.. my water broke at 17 weeks.. they couldn’t determine why.. we held on until 25.6 weeks ( 9 weeks!!) I drank a ton of cranberry juice and was on strict bed rest.. the whole goal was to give the other baby a fighting chance.. but we still had hope.. i ended up delivering baby a( the one with the infection) at home and baby b in the hospital..shortly after baby a delivered i spiked a temp of 104.7 and they induced me to deliver the other baby. baby b is currently in the NICU at 3 months old and is doing great – his original due date is August 11 and he should be coming home next week. sadly we lost baby a 3 hours after his birth.. they said the infection was so bad and his lungs were so underdeveloped that he had no chance of survival. i have so many mixed emotions – we are so happy that one of them survived but so sad for the loss of the other..

    Posted by Paul | November 14, 2012, 11:16 pm
  11. Just so I’m clear and have read you’re piece properly…

    You say the infection would have been brewing for several days. If this is the case then an abortion would not have saved her?

    Don’t get me wrong, I’m for abortion in this type of case, I just wanted to clear that one point up. Abortion would have made her comfortable and been the decent thing to do but it would not have been a life saving procedure yes?

    Posted by galwayrob | November 14, 2012, 11:31 pm
    • NO, abortion would have been to avoid the woman getting a fatal infection in the first place.

      If your cervix is open, you can get fatal septicemia within 2 hours.

      Posted by J. Metaneira | November 15, 2012, 12:19 pm
    • The reported information seems to suggest that this lady was fully dilated at the hospital for three days but no surgery was performed because there was still a foetal heartbeat present. Surgery carries a risk of infection itself. It is my understanding that where an infection is present or ‘brewing’, the earlier surgery is performed the better. I don’t know much about ob/gyn but say for example you had an abscess on your leg, if it is cleaned out, stitched up and dressed then it is less likely to progress to sepsis etc.

      It is impossible to know for sure, but it seems likely that if this woman had surgery a couple of days earlier she would not have had as serious an infection and therefore would not have died.

      Posted by Sharon | November 15, 2012, 12:24 pm
  12. @Portia Mills – I am Irish, and I am not racist, but thank you for generalising us all and putting us into a small box.

    I am appalled at the treatment (or lack of) that this woman endured and appalled at our laws/medical service.

    We, as citizens, NEED to make a change

    Posted by Gillian Whelan | November 15, 2012, 12:59 am
  13. I’m not a doctor, or a lawyer, so bear with me if I’m barking up the wrong tree.

    Presumably, the standard treatment for an ectopic pregnancy in Ireland is abortion rather than waiting for the fallopian tube to rupture. Ectopic pregnancies are unviable, but at the point of treatment it’s more a case of ‘this can only get worse and possibly kill you if not caught in time’ rather than ‘this is going to kill you if we don’t do this now’.

    As Savita’s pregnancy was found to be unviable, I can’t see a legal reason why a termination wouldn’t be possible when it is possible in the case of ectopic pregnancy. I assume Ireland doesn’t ship all its ectopic pregnancies over to the UK…

    Am I missing anything?

    Posted by Claire | November 15, 2012, 2:05 am
    • Claire, I think the standard procedure is the removal of the fallopian tube and the foetus. In line with RC teachings on the topic.

      http://en.wikipedia.org/wiki/Catholic_Church_and_abortion#Ectopic_pregnancy

      So the answer it no, abortion is not offered and your chances of conceiving again are halved.

      Posted by All for the purty colours. | November 15, 2012, 11:02 am
      • But if you’re removing the fetus, that’s abortion. Unless somebody’s got a magical fake uterus to grow them in after removal.

        Posted by Claire | November 15, 2012, 3:54 pm
      • Claire, See the following Catholic pro-life site: http://www.hli.org/index.php/cloning/400?task=view

        “The most common dysfunctions that may set a mother’s life against that of her preborn child’s are the ectopic pregnancy, carcinoma of the uterine cervix, and cancer of the ovary. Occasionally, cancer of the vulva or vagina may indicate surgical intervention.

        “In such cases, under the principle of the “double effect,” attending physicians must do everything in their power to save both the mother and the child. If the physicians decide that, in the case of an ectopic pregnancy, the mother’s life can only be saved by the removal of the Fallopian tube (and with it, the preborn baby), or by removal of some other tissue essential for the preborn baby’s life, the baby will of course die. But this kind of surgery would not be categorized as an abortion. This is all the difference between deliberate murder (abortion) and unintentional natural death.”

        So no, Catholic theologians call this “unintentional natural death,” not “abortion.” Basically the same as Jen.

        Posted by Alison Cummins | November 15, 2012, 3:59 pm
  14. Jen, that is a very good and balanced article. My own view (and obviously we need to get all the facts) is that it would have been perfectly legal, as well as clinically mandatory, to proceed with a termination, and the doctors involved, as well as this particular hospital, not to mention the Irish government, have very very serious questions to answer. It completely destroys the myth promulgated by the Catholic bishops that Ireland’s hindbrain anti-abortion stance somehow makes pregnancy *safer* in the Irish Republic than elsewhere in the developed world. This would not have happened in England, and I don’t even think it would have happened in Northern Ireland, which, like Southern Ireland, has woefully inadequate provision for termination in the law.

    Posted by Shane McKee | November 15, 2012, 2:20 am
  15. You ask ‘did Irish Catholic law or malpractice kill Savita’ – there’s a third influence: racism. That remark, ‘this is a Catholic country’, said to a migrant, suggests a hefty whack of passive aggressive anti-immigrant sentiment.

    Posted by badblood | November 15, 2012, 2:31 am
  16. Irish laws are backwards. It is a backwards country.
    Ms Halappanavar would have received better care in her native India, a country that we give aid to as a developing country. It is incomprehensible that a developing country that receives foreign aid is more kind, responsible, sensible and compassionate that a supposedly developed country.
    Perhaps it is India that should give aid to Ireland as it is Ireland that is truly backwards.

    To make into law the bidding of men in dresses, gold jewels and silly hats, is incomprehensible. To even begin to consider the word of this group of old rich men as reliable or trustworthy is sheer stupidity itself, when this same group of men has sexually abused and raped little boys in nearly every parish in the land.
    What kind of moronic peoples stays blindly chained to an institution which has committed some of the worst atrocities of the country’s history? Committed crimes against young pregnant women today and in laundries of yesteryear and rampant paedophilia and then covered it up and failed to punish those responsible and condoned the behaviour by moving perpetrators into new parishes.
    The catholic church has no moral high ground. It is no moral authority. It is rotten, callous and corrupt for what it has done to women and children.
    The catholic church has wealth and pretty ornaments but it is rotten and decayed and has the black heart of an abuser.
    IRELAND DESERVES BETTER.
    The world pitied us for our blind devotion to that which, has proven in its own actions, means us harm. Irish Catholic hierarchy does not know Christianity or charity or human compassion or the milk of human kindness, it knows only its own power and it’s own corruption.

    Posted by Winifred R, County Louth. | November 15, 2012, 3:31 am
    • Bravo, I agree with everything you have said. I would add that the rape and abuse of children included girls as well as boys. What I can not understand is how parents can continue to take their children into churches whether for christening,communion or confirmation. If a trusted adult takes a child into a place,that child assumes it is safe. The catholic church is not a safe place for women or children. Every priest and nun has at the very least colluded with child abuse by their silence and continued membership of a disgusting and morally corrupt institution. How can people walk past a church to burn a head shop? Perhaps they were short of matches.

      Posted by angela garrigan | November 15, 2012, 10:11 am
  17. 1. Unfortunately, being an expert in ob/gyn does not endow you with omniscience in every other field of knowledge, least of all in Irish law. What, could you please explain, is “Irish Catholic law” and where did you discover this concept?

    2. Your conclusions can be dismissed as, in expounding your “only three plausible explanations” for the outcome, you ignore tho most plausible and the likely explanation.

    Posted by Brian Boylan | November 15, 2012, 3:35 am
    • you ignore tho most plausible and the likely explanation.

      Which is ?

      We are holding our breath…

      Posted by Marcello | November 15, 2012, 12:15 pm
      • First, allow me to offer my condolences to the Hallapanavar family on their dreadful loss and my wish that the find the strength t live with this tragedy.

        I note I have had no answer to my query on the fascinating concept of “Irish Catholic law”. For the information of those who may be misled by such nonsense, no such concept exists. There is only secular law in Ireland. The Catholic church has no official position in the state, the official recognition of the “special position” of the Catholic church having been removed from the constitution by referendum of the people nearly forty years ago. Yes – those very people who find themselves the butt of racist slurs throughout the comments here took it upon themselves to throw out an anachronistic provision in the constitution in the interest of secular freedoms.

        Like the USA’s, Ireland’s constitution and legislation guarantee complete religious freedom and freedom from religion. Unlike the USA’s, they also guarantee freedom of conscience. So lazy, unresearched, false statements (I will stop short of “lies” only to give my post a better chance of surviving moderation) such as the statement of the existence of “Irish Catholic law” should have no place in what purports to be an informed expert commentary on the tragedy .

        Some here feel free to expound that “this woman was allowed to die”, etc. If she was, it would have been disgraceful, outrageous and unforgivable. However, I prefer to await disclosure of the facts before making categorical statements. I will not in any circumstance make hysterical statements. In that context, I speculate (rather than pontificate in the manner of Dr. Gunter) that, if the death of Mrs Hallapanavar was preventable, the MOST likely explanation for the failure to prevent it is that one (or perhaps more) of the medical team felt constrained by the absence of legislation giving clarity to the Supreme Court’s assertion of the permissibility of termination in the case of a threat to the life of the mother.

        I use the word “felt” because the absence of specific guidelines in legislation apparently leads to ambiguity in some cases, in the minds of some practitioners and therefore the major fault lies with successive governments in failing t provide such legislation.

        Having said that, it is worth noting there are Medical Council guidelines in place and that this is the first known case of the death of a woman in these circumstances, though the supreme court decision has been in place for twenty years. This seems to indicate that the number of practitioners who feel constrained by the absence of legislation is minuscule and that nearly all operate quite successfully under the Medical Council guidelines., though that is no excuse for the pusillanimous failure of successive governments to legislate in this area.

        Posted by Brian Boylan | November 16, 2012, 8:07 am
    • Thank you Brian for your response below.

      Posted by Laura | November 16, 2012, 1:44 pm
  18. Thank you so much for posting this Dr Jen. Having good, factual information from an OB/GYN is going a long way to counteract the disgusting, mealy mouthed handwringing from the Irish Pro-‘Life’ groups who as usual are trying to derail the discussion and claim a termination wasn’t necessary in this case.

    Posted by Thomas O' Malley | November 15, 2012, 3:37 am
  19. i don’t know what planet you’re living on Kelly, will all due respect. i’m a blow-in and have lived here for over a decade. Ireland is controlled by this catholic ‘cult’ (religion) and is extrememly racist. i am speaking from experience.

    Posted by Antjie Henn | November 15, 2012, 5:46 am
    • “With all due respect”, you say. Clearly, you don’t believe much respect is due to the people among whom you earn your living. I am an atheist and I see no evidence that “Ireland is controlled by the catholic ‘cult’ religion”. Perhaps you might offer an example or two?

      And Ireland is “extremely racist”? How, exactly, have you measured this? What is a normal level of racism that contrasts with the extreme that you experience here? Which countries are we more racist than? Are we less racist than any? As you might see on an exam paper, please treat this as an advanced-level question and so give evidence for your answer.

      Of course, it doesn’t seem to occur to you that your comments are offensive and racist.

      Posted by Brian Boylan | November 16, 2012, 8:14 am
      • Brian, I am well aware that Irish people wish to be seen in the cliche’d welcoming way; but the reality is very different. My husband decided to come back to his homeland and as a mixed race woman, I did not imagine that things could be any worse than what I experienced growing up in South Africa during the difficult apartheid years. However, I have been treated so differently, that I ask my husband to deal with any services we require (shopping) while I prefer to stay indoors so as not to initiate the dirty looks I get from people. Having needed a medical procedure recently and being prepped for theatre, I was surrounded by staff interrogating me wanting to know why I had come to steal their irish men and asking what I was doing in the country. Indidentally I had been married since the changeover in South Africa in 1994 and had no thought of emigrating to Ireland at the time. This was my husbands wish as he is Irish. So as to your question, how have I measured this and what countries are you more racist than? ….I would say that never have I been left standing at a counter waiting for assitance and receiving none from a laughing group of “Assistants” as I have here in Ireland or been purposely pushed over in a shopping isle because of the obvious hate in the eyes of Irish “lady”. Certainly, there were problems in South Africa, but the naked racist attitude has taken me completely by surprise and it is for this reason that I am convinced that the Doctors in Savita’s case could have found extenuating circumstances, but chose not to because she was Indian and from their point of view, had no right to be here and therefore applied the full force of Catholic law. The fact that the Doctor said “this is a Catholic Country” falls stronger on the side of politics rather than medicine. So although I know that as indiviuals, there are many kindhearted Irish people. Unfortunately, I have personally seen far more of the negative than the positive which has not been the case amoungst the majority of white South Africans during the apartheid years.

        Posted by Adele | November 18, 2012, 10:07 pm
  20. There’s no such thing as “Irish Catholic law”. You made up that phrase to be sensationalist.

    Posted by Alan | November 15, 2012, 6:27 am
  21. There are major issues with regard to abortion in Ireland that need to be sorted out. The problem is that the subject is so contentious that successive governments have failed to implement legislature on referenda that have already taken place.

    I think it is worth noting that according to the UN, Ireland is one of the safest countries in the world for a mother to give birth in.

    Posted by Cian | November 15, 2012, 6:41 am
    • Tell that to Ann Lovett and Savita and to the other victims of the Irish state.

      Posted by angela garrigan | November 15, 2012, 10:13 am
      • Unfortunately agree – the so called “statistics” on safe child birth are suspect – besides these cases we are talking about are “pre-natal” and whilst Ireland may be safe for full term pregnancies and deliveries this may not apply to other situations where problems arise prior to birth.The Law appears deliberately ambiguous in Ireland , it recites the importance of BOTH the Mother and the Baby without stating which is MORE important. If this decision is left to the Medical Profession you are likely to have orthodox Catholic Doctors taking a particular view that ALL abortions are wrong.There cannot be any ambiguity here – the MOTHER’s health is Paramount. I believe the law was deliberately ambiguous so the Legislators could “satisfy” the pro-life lobby but appear to deal with the issue – which of course it does not. This was an accident waiting to happen and I suspect it has happened many times but is not recorded.

        Posted by Anton | November 17, 2012, 5:13 pm
  22. Reblogged this on Activism and Agitation and commented:
    Posted by Dr. Jen Gunter

    Posted by Sharrow | November 15, 2012, 9:27 am
  23. Since posting this piece I learned that Ms. Halappanavar’s widower reported that she was leaking amniotic fluid and was fully dilated when first evaluated. There is no medically defensible position for doing anything other than optimal pain control and hastening delivery by the safest means possible.

    100% agree

    http://looneyatoms.com/2012/11/15/so-proud-that-elly-is-my-cousin/ &
    http://looneyatoms.com/2012/11/15/my-placard-reads-shame/

    Posted by Barbara | November 15, 2012, 9:45 am
  24. For those objecting that we don’t know why she died: “An autopsy carried out by Dr Grace Callagy two days later found she died of septicaemia “documented ante-mortem” and E.coli ESBL.”

    They knew she had a life-threatening infection before she died.

    Posted by Alison Cummins | November 15, 2012, 10:19 am
  25. Terrible judgement. She was married, why didn’t anybody sensible realise this, and make a quick decision to help them. I think there’s a lot more to this than first appears. Also, them being Indian and not Irish probably didnt help. The doctor who refused them help should be severely punished. His/ her license revoked, and sent to jail. That will send a clear message for doctors to exercise clear, informed + good judgement. While Europe is bending over backwards to help the likes of Ireland, Greece and the like, the Irish themselves seem reluctant to be even sensible in the slightest of circumstances.
    On the subject of religion, if one believes in a god, how are they to be punished for the sins of another person? Does that make sense? That the butcher should suffer because the shopper bought meat from an animal with a divided hoof? Do they really think that the god they believe in is that stupid? Or do they even know what they believe in? Haven’t they read the scriptures. That the person who sins will be answerable for their own sin. So if she wanted an abortion (and was sick – which i don’t think falls into sin for a married woman) she should have been assisted, with urgency!
    But for some grave error in judgement, a wife is dead, leaving behind a broken husband who will never recover.

    Posted by gnstr | November 15, 2012, 1:38 pm
    • Why does anyone care whether she was married? I haven’t seen any Catholic teaching that a pregnancy may be terminated to save the life of the mother… but only if the mother happens to be married.

      This Catholic pro-life page on saving the life of the mother says nothing at all about marriage. http://www.hli.org/index.php/cloning/400?task=view

      Posted by Alison Cummins | November 15, 2012, 2:14 pm
      • That may well be the case, but the fact that she was married surely should be a reason for medical staff to believe them when they said she was sick, and be more willing to assist. In other words, it wasn’t (i) an affair gone wrong (ii) a product of adultery (which is what is one part part of the religious objection to abortion) (ii) irresponsible couple (it was going to be their first child – and they had not requested this procedure b4)

        Posted by gnstr | November 15, 2012, 2:22 pm
      • The doctors were the one who diagnosed her with a life-threatening infection. They knew she had to deliver as soon as possible, which is why they kept checking for a fetal heartbeat every few hours so they could remove the pregnancy immediately. It wasn’t a question of believing she was telling the truth about being sick because she was married, *they knew she was about to die of septicaemia unless she could be delivered immediately.*

        And they didn’t deliver her.

        Posted by Alison Cummins | November 15, 2012, 2:27 pm
      • GNSTR – she didn’t come to the hospital looking for an abortion. She was happy to be pregnant. But after being told she was having a miscarriage and the baby could not survive, and apparently after suffering considerable distress, she asked for a termination to end her suffering. There was never any possible outcome where the baby could have survived, and it was doctors who told her that, not the other way around.

        Posted by Sharon | November 15, 2012, 2:33 pm
    • I’d like to point out that it’s unlikely that the doctors or other health care professionals involved were acting directly out of their own personal religious beliefs. Rather, it’s a complex situation involving a lack of legislation, confusion around legislation that does exist, a vocal minority objecting to progression in this area (and standing in the streets with pictures of foetuses) and a culture of politicians and others ignoring this obvious problem in the hope that it will go away. I don’t believe there was anyone suggesting that some kind of ‘sin’ was involved, or that her being married was a factor.

      Many Irish people are sensible. I like to think I am one of them. I also can’t say that I know very many devout Irish Catholics. I can’t think of anyone I know personally, religious or not, who would object to abortion in the circumstances described above. It’s been all anyone’s talking about here, and I haven’t yet heard a person say that what happened was acceptable. But the fact is that no one knows what might happen when the first Irish doctor performs an abortion where the mother’s life is at risk and if I was a doctor, I can’t honestly say that I would want to be the one to stick my neck out like that.

      Posted by Sharon | November 15, 2012, 2:22 pm
      • Both the Law and the doctors are at fault. Doctors take the Hypocratic Oath, they failed to abide by it and are hiding behind the law to save their careers. I think that regardless of the law they should have acted for the mother’s safety as quickly as possible and to hell with out of date legislation. A person’s life should be more important.

        Posted by Michaela | November 15, 2012, 4:02 pm
    • How dare you make such a stereotypical statement about the whole nation of Ireland? According to you the entire country decided to let this woman die because the church said so and because we’re too stupid to reject the church. WE DO NOT KNOW ALL THE FACTS. Therefore, neither you nor I can pass judgement on what happened and what punishments are necessary etc. You aim blindly with your disgustingly unfounded remarks.

      Posted by jammiidodger | November 16, 2012, 9:17 am
  26. I lean towards this explanation:

    2) Irish law does not [explicitly] deny women the care they need; however, a zealous individual doctor or hospital administrator interpreted Catholic doctrine in such a way that a pregnant woman’s medical care was somehow irrelevant and superceded by heart tones of a 17 weeks fetus that could never be viable.

    The hospital in question is technically not run by a Catholic order, and is a state funded teaching hospital, a named “Centre of Excellence.”

    However if you study the recent history of the “Dublin Declaration” – which has become a talking point for abortion ban proponents – the link is clear to be seen, as a Professor Eamon O’Dwyer, professor emeritus of obstetrics and gynaecology at NUI Galway and a conference organiser, would no doubt have a powerful influence on the OB/GYN team that he would have nurtured and taught.

    The Dublin Declaration states:

    As experienced practitioners and researchers in obstetrics and gynaecology, we affirm that direct abortion is not medically necessary to save the life of a woman. We uphold that there is a fundamental difference between abortion and necessary medical treatments that are carried out to save the life of the mother, even if such treatment results in the loss of life of her unborn child. We confirm that the prohibition of abortion does not affect, in any way, the availability of optimal care to pregnant women.”

    This tragedy has opened a never before seen dialogue on the issue in Ireland, and we may soon see legislation and much needed clarification for professionals on the matter.

    Posted by Auntie Dote (@AuntieDote) | November 15, 2012, 4:10 pm
  27. A good, clear, non hysterical article which is exactly the kind of thinking we need a good dose of on the issue of abortion here in Ireland. We need international pressure to add to our protests here to ensure this never happens again. https://www.facebook.com/events/175080575964011/

    Posted by Rita Harrold | November 15, 2012, 6:27 pm
    • Just an add on to your comment Rita, the Irish branch of planned protests
      https://www.facebook.com/events/243742145755096/permalink/244339175695393/?notif_t=epted

      I would urge everyone to try attend. We have for too long rolled over and accepted our governments mistakes. It is disgraceful that in the two previous referendums prior to the recent Children’s referendum we voted no,the Irish government then re held these till they got their ‘yes’, but in the past three (?) abortion referendums where a yes vote was reached in the first vote, they ignored the need to clarify the issue despite being directed by both the Irish Supreme Court in the 90’s and the EU courts two years ago. A stand needs to be taken, this has also happened to two Irish women Michelle Harte & Sheila Hodgers, and god knows how many other undocumented.

      Posted by C | November 15, 2012, 7:05 pm
  28. Irrespective of its legislation about abortion, Ireland seems to be a developing country in gynaecology. As someone prevously said in Ireland “women whose foetuses are not able to survive just seem to be the overlooked population”. As far as I know a lot of foreigner women who work in Ireland back to their countries when they need adequate gynecological cares.

    Posted by Andy | November 15, 2012, 9:52 pm
  29. I think religion should not interfere in medical decision

    Posted by ashok rai | November 16, 2012, 3:45 am
  30. Even in Irish-Catholic law, the life of the mother takes precedence over the life of the fetus. This is a case where NO 17 wk old fetus could possibly have survived, and where the life of the mother was in immediate danger. I’m totally pro-choice, against having religion interfere with the secular decisions a hospital must make, but, even from a religious pov, something was wrong. I’ll call malpractice here.

    Posted by Stella | November 16, 2012, 8:36 am
  31. A few years ago, a former Tanaiste admitted that abortion is carried out in Ireland for ectopic pregnancies and other situations, so no we don’t export women with ectopic pregnancies. I’m not sure if exposing a feotus to Roaccutane falls into this category but it was made plain and clear to me, if I got pregnant while taking it I would be having an abortion, whether in Ireland or organising it with a hospital in the UK I’m not sure. As to what the repercussions are for a medical team who carry out an “illegal” abortion or rather one which doesn’t fall into the ectopic etc category, well it would be criminal prosecution and being struck off.
    I also read it was a midwife not a doctor who made the “This is a Catholic country” remark which they may have meant something as simple as “We can’t offer that to you because this is a Catholic country or didn’t you know?”. We are a very multicultural society these days and a fair amount of hospital staff are in fact foreign, I therefore do not see the midwife/doctor or whomever made that statement being racist at work in front of their (more than likely foreign) colleagues although you never know with some people…
    Her husband has said she presented herself in “agonising pain” not “lower back pain” and was sent home only to return an hour later at which point they demanded to see a doctor not nurses as they had previously. It’s reported they told her she was miscarrying and they were basically waiting for nature to take its course solely because of the presence of a heartbeat. I think the statistics are actually 6 deaths in 100,000 pregnancies. Though I saw on SKY News ages ago that the UK government was to advise women abortion is safer that pregnancy (I would assume they have similar statistics to us).
    Ireland isn’t as Catholic as you’d think these days although at school we had a special book in religion class devoted to morality, abortion and birth control etc which wasn’t that long ago. People are complaining they don’t have enough choice with regard to schooling as in Catholic schools you are pretty much forced to conform and pray. Statistics show that more and more people are opting for a civil ceremony than a church wedding. Church attendance is down drastically and all as a direct result of the litany of Church abuses and cover ups we are ALWAYS hearing about. To be fair, I know of clergy who advocate the use of condoms and abortions as they recognise unplanned/unwanted pregnancy in young people as bad (hard to get a good education, good job, raise kids etc).
    I doubt this will change anything in the short term as the government cannot be seen to be bullied into changing/enacting new laws based on this case alone (they’ve just issued a statement saying as much apparently) as that would set a precedent for change which they do not want!

    Posted by Moo | November 16, 2012, 10:24 am
  32. Thank you very much for this clear explanation of the medical issues involved in this tragic case. I did not doubt your explanation but I tried Googling “medical treatment incomplete spontaneous abortion” to see what I would find. (Spontaneous abortion = miscarriage.) Not surprisingly, everything I found concurred with your opinion on the medical issues. In one scholarly article I found, the very first sentence was this: “The principle of “emptying the uterus as quickly and safely as possible” remains the cornerstone of management in inevitable or incomplete spontaneous abortion.'”
    Another included an easy-to-follow flowchart for decision-making when managing miscarriage and deciding whether or not to consider a “wait and see” approach. In the case where any complications are present, including bleeding, sepsis or pain, the recommendation is to proceed with uterine evacuation.
    One question I have is why it seems the medical team was checking for fetal heartbeat at all? From descriptions I have read, it seems this was checked for several times. Is that the usual procedure? Is it something that a doctor needs to know before a D&C (or whatever procedure is done)?

    References: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1677365/pdf/bmj00014-0028.pdf
    http://www.utilis.net/Morning%20Topics/AAFP%20Articles/SAb.pdf

    Posted by SKeenan | November 16, 2012, 12:22 pm
  33. Thanks for this article, it’s very helpful, I just have a quick question. I note that you have said, based on the current facts, “delivery” was the appropriate course of action to take, and that you clarified that this meant “induction of labor” or “D&E”. I would be opposed to D&E because I am opposed to the intentional, willful destruction of the life of the foetus, so I’m quite interested in the case of inducing labor (even though the certain outcome is still death of the foetus I think this is the better option from a moral point of view).

    So the question: How much stress would the induction of labor at 17 weeks put on the woman’s body, given that she is already fully dilated? Would you be able to say how long this procedure might take?

    Posted by JP | November 16, 2012, 5:08 pm
    • Labor or D & E makes no difference to a 17 week fetus with ruptured membranes. Whether you do nothing, induce labor, or a D & E fetal demise is the inevitable outcome.

      Posted by Dr. Jen Gunter | November 16, 2012, 6:47 pm
      • I understand it does not make a difference to the foetus. But I am curious as to whether labor or a D&E make a difference to the mother, in terms of pain/discomfort/length of procedure/risks involved/drugs and so on. In short, what would the two procedures involve? Or are they largely similar?

        Posted by JP | November 16, 2012, 8:03 pm
      • I realize this is now quite an old post, but to say that fetal demise is “inevitable” in this situation is overstating the case. Just because you have “never heard of a baby surviving in this scenario” does not mean it has never happened. In 2011 I had a patient whose membranes ruptured at 18 weeks and never re-sealed (yes, slightly greater GA, but still pre-viability by any measure.) The residents who first evaluated the patient gave her your line about “inevitable fetal demise” but she chose conservative management, did not deliver until 26 weeks (yes, with no fluid on repeated ultrasounds) and now has an adorable almost three-year-old. Medical judgment is rarely 100% certain. We make the best decisions we can with the information we have.

        Posted by sorac | May 29, 2014, 8:48 pm
  34. What you would have done if she was an IRISH woman or your own sister or wife?

    Posted by DR. JAGDISH | November 17, 2012, 1:52 am
    • Irish women, as far as we know, are given the same treatment. You can read some stories from Irish women here: https://www.facebook.com/MakeTerminationForMedicalReasonsAvailableInIreland, e.g.:

      ” Eventually, at 30 weeks I was in so much pain I was admitted to hospital, I was on daily morphine and pethidine. I begged the doctors to induce my labour, I didn’t want termination, I didn’t want to delay the inevitable. Their hands were tied legally though. I continued in pain, in hospital, on so much pain medication, away from my husband and 3 year old son for most of the following 10 weeks. Out for 2 days, back in for 5…..and so on. I had to have fluid drained via a syringe inserted in my tummy 3 times to relieve a little pain. All the time knowing at the end of it all my baby would die. ”

      “I began to haemorrhage at home and rushed to hospital. I was told that this was nature taking its course but the baby had a strong heartbeat so there was nothing they could do and I was admitted for observation but no other treatment was or could be given to me. The bleeding subsided but never stopped but I was sent home and told to just keep waiting. The following week having continued to bleed, I started to haemorrhage again. Back to the hospital again and again, the baby’s heartbeat was strong but there was critical amounts of fluid around the baby and I was told my baby would not survive but again there was nothing they could do. I begged them to do something. They told me that my baby was not going to survive, that not only was she afflicted with a chromosomal abnormality that was likely fatal but I was constantly bleeding and having to endure the frightening experience of very heavy haemorrhages at any time. They said as long as there was a heartbeat, there was nothing they could do. I was discharged again and this happened twice more and each time, things were getting worse for both of us. Again, in tears I begged my doctor to do something but his hands were completely tied legally.

      It’s worth pointing out that we only know about Savita’s death because her husband Praveen spoke to the media (and I’m so glad he did). We have no idea how many other women – Irish or not – have suffered (and died) for the same reasons.

      Posted by QoB | November 17, 2012, 11:52 am
      • Hi , this is a disturbing story – a Philipina Lady in Dublin told Me Her Sister in Law died in Ireland as a result of a refusal on the part of the Medical Profession to intervene ie terminate the dangerous pregnancy. I am begiining to suspect that the “Statistics” being trotted out are sanitised – that there is a much bigger story here and that this has come to the surface because it was a Non Irish Non Catholic Woman involved here.

        Posted by A Duffy | November 17, 2012, 12:41 pm
      • It’s happened two Irish women that I’ve heard of, so god knows how many more…

        Posted by C | November 17, 2012, 6:03 pm
      • A Duffy – the statistics definitely are sanitised. Anti-choicers love to saw that Ireland is one of the safest countries in the world for pregnant women, but the stats aren’t clear.

        http://www.irishhealth.com/article.html?id=19075

        http://www.medicalindependent.ie/page.aspx?title=maternal_death_%E2%80%93_into_the_great_unknown

        And when the Irish government was asked by the European Court of Human Rights to show how many women in Ireland get abortions to save their lives, they couldn’t, because stats on that aren’t kept.

        Posted by QoB | November 18, 2012, 2:09 am
  35. FWIW Irish doctors have clarified that they need legislation. My friends who are doctors have said that they need legislation. Doctors calling for legislation include:

    Dr. Rhona Mahony, Master of Holles St Maternity Hospital in Dublin
    Prof PK Plunkett, consultant in emergency medicine at St James’ Hospital, Dublin
    Dr Sam Coulter-Smith, Master of the Rotunda Maternity Hospital in Dublin

    http://www.herald.ie/news/we-need-law-on-abortion-now-doctors-3295676.html

    Posted by QoB | November 17, 2012, 11:44 am
  36. Not only should the doctors who tortured this woman to death be named, but the nurses, the aides, the administrators, the consultants, and the useless chanting nuns and priests and other professional virgins who refused to honour their oaths to first do no harm. Their heartless comments should be made public. They should be forced to recount, in public, every minute, every pain, every indignity and cruelty that any and all of them put onto this young woman. They should be forced to say why they thought she should be the blood sacrifice for a lot of perverted men who think pain is a gift to God and that by making her pain continue, God would love the torturers more. Then, perhaps, the root of this spreading hatred, which runs worldwide through the church, could be exposed for what it is.

    Posted by WA | November 17, 2012, 11:46 am
  37. I hope they all get struck off

    Posted by sarin.pk | November 17, 2012, 6:09 pm
  38. I think it might be better to wait for the investigations – clearly, the chronology is crucial. I see you have Infectious Disease experience, and it appears that the patient had DIC,organ failure several days before she died. Her husband in interview Irish radio mentions dialysis so she had renal failure. What is unclear to me is the chronology and whether the physicians were dealing with a constellation of crises trying to save the patient and when trying to prioritize it MIGHT have seemed that surgically completing the abortion was not the most urgent especially if there was a hemorrhagic diathesis.

    You might find this Link of interest from Hema Divakar,President Elect Federation OBGYN India:

    http://www.thehindu.com/news/cities/bangalore/city-doctor-defends-irish-counterparts/article4100988.ece

    “Based on information in the media, in that situation of septicaemia, if the doctors had meddled with the live baby, Savita would have died two days earlier.”

    ..“Delay or refusal to terminate the pregnancy does not in itself seem to be the cause of death. Even if the law permitted it, it is not as if her life would have been saved because of termination,” she said. “Severe septicaemia with disseminated intravascular coagulation (DIC), a life-threatening bleeding disorder which is a complication of sepsis, major organ damage and loss of the mother’s blood due to severe infection, is the cause of death in Savita’s case. This is what seems to have happened and this is a sequence which cannot be reversed just by terminating the pregnancy.”
    ________________

    I find this opinion somewhat problematic as well but in general I think it better to await more information, The “this is a catholic country..” is pretty shocking since the RC Hierarchy in Ireland would probably dispute this; about half the medical professional in University Hospitals in Ireland are not Irish so I am also anxious who made this atrocious remark.

    Posted by s branagh | November 20, 2012, 7:58 am
  39. Thank you Jen for a lucid analysis in which you rely on your own medical knowledge and knowledge of law. I am a Canadian and support the approach we have in Canada to abortions, which, in the wake of a landmark decision of the Supreme Court of Canada back in 1989 to strike down the abortion law as unconstitutional, is to permit them on demand. The wider issue that Savita Halappanavar’s tragic death highlights, then, is the extremely restrictive law regarding abortion in Ireland, a restriction that effectively means abortion is only permitted in a clear case where a pregnant woman’s life is in danger. As to the narrower question of what exactly happened in Savita’s case, as you have alluded, there may well have been medical negligence on the part of the attending physicians at the Galway University Hospital. Either that, or extreme cowardice on their part. Surely, and entirely for the sake of my argument, even if the law prevented the physicians from acting to terminate Savita’ pregnancy, the defence of medical necessity would have been available to them after the fact had they terminated the pregnancy and then were subsequently charged with violating the law. In any event, this truly is a glaring example of the law on this matter being an arse.

    Posted by Brian Seaman | November 21, 2012, 9:38 pm
  40. Where is the difference between Irish Catholic law and that of Alshabaab?

    Posted by Donald | November 22, 2012, 8:19 pm
  41. Reblogged this on Indian Lawyers Express.

    Posted by qualandar | January 5, 2013, 10:00 am
  42. I am just curious why, if she was already fully dilated and contracting she did not go on to have a spontaneous delivery?

    Posted by V boome | March 24, 2013, 11:22 am

Trackbacks/Pingbacks

  1. Pingback: This IS What It Looks Like, America « herlander-walking - November 14, 2012

  2. Pingback: Woman dies in Galway Hospital after being refused termination - Page 55 - November 14, 2012

  3. Pingback: Three doctors | Butterflies and Wheels - November 14, 2012

  4. Pingback: Savita: candle lit vigil Saturday 17th of November 4 pm Garden of Remembrance. - Page 32 - November 14, 2012

  5. Pingback: Savita Halappanavar | Atheism, Music, and More… - November 14, 2012

  6. Pingback: Irish Woman Dies When Denied Abortion - Page 16 - Religious Education Forum - November 14, 2012

  7. Pingback: An OB/GYN Writes | Broadsheet.ie - November 15, 2012

  8. Pingback: Savita Halappanavar’s death: don’t just sit there…do something. | building19thcenturyireland - November 15, 2012

  9. Pingback: Talking to prolifers | Edinburgh Eye - November 15, 2012

  10. Pingback: :) So proud that Elly is my Cousin! :) « Day One - November 15, 2012

  11. Pingback: I am perturbed « for whom the bell tolls - November 15, 2012

  12. Pingback: Savita Halappanavar and Religion | PEI Curmudgeon's Blog - November 16, 2012

  13. Pingback: Savita Death Sparks Debate Over Irish Catholic Abortion Law - November 16, 2012

  14. Pingback: Time to Say Enough | Abigail Rieley - November 16, 2012

  15. Pingback: Ireland needs a change | Irish Farmerette - November 16, 2012

  16. Pingback: BMJ Group blogs: Journal of Medical Ethics blog » Blog Archive » Savita Halappanavar: A Woman who Died Needlessly, not a Political Wedge’ - November 17, 2012

  17. Pingback: Publics pubblication (weekly) | Matteo Rossini - November 17, 2012

  18. Pingback: NEVER AGAIN. Protest for Savita's Laws November 21, 2012 6:00pm - Page 27 - November 18, 2012

  19. Pingback: Guest post: Savita and medicine. | Consider the Tea Cosy - November 19, 2012

  20. Pingback: GUEST POST: Who Killed Savita? Part I – Malpractice | Eclectablog - November 19, 2012

  21. Pingback: Did Ireland’s Pro-life Law Kill Savita Halappanavar? | Beyond the Dish - November 19, 2012

  22. Pingback: The panel investigating Savita Halappanavar’s death must change and why « Dr. Jen Gunter - November 20, 2012

  23. Pingback: Dail vote on X legislation 6 pm 28 November - Page 3 - November 24, 2012

  24. Pingback: Irish Catholic Bishops reveal ignorance in statement on death of Savita Halappanavar « Dr. Jen Gunter - November 28, 2012

  25. Pingback: The bishops really do mean it | Butterflies and Wheels - November 28, 2012

  26. Pingback: Hopeless. Fucking hopeless, Sir! « my brain just threw up a little… - November 29, 2012

  27. Pingback: SBP/Red C Poll 2 December FG 28 FF20 SF 17 LAB 14 Others 21 - Page 17 - December 1, 2012

  28. Pingback: Abortion: A Case Study in Perspective | 37G - December 9, 2012

  29. Pingback: Sex In San Diego: When Religious Rules Trump Science - December 20, 2012

  30. Pingback: Abortion, health care, HPV, chronic pain: what I’ve learned from my most popular posts of 2012 « Dr. Jen Gunter - January 1, 2013

  31. Pingback: Saving Lives: Abortion and Exemptions | HealthCetera – CHMP's Blog - January 7, 2013

  32. Pingback: Religious Doctrine Has No Place In Public Healthcare - Page 5 - January 13, 2013

  33. Pingback: Changing Ireland’s abortion law will not save any mothers and could lead to 11,000 more abortions annually | CMF BLOG - April 9, 2013

  34. Pingback: Savita’s death is a tragedy but is not a reason to change Ireland’s law on abortion | CMF BLOG - April 9, 2013

  35. Pingback: Dear Ireland, the answer to allowing medical necessary abortion isn’t an inquisition | Dr. Jen Gunter - April 24, 2013

  36. Pingback: Abortion comes to Ireland | Last Days News4Christians - May 11, 2013

  37. Pingback: ACLU should sue the doctors as well as bishops over denied medically indicated abortion | Dr. Jen Gunter - December 4, 2013

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Recent Tweets

  • Combing your best friend's hair for lice. Now that's love. 5 hours ago
  • A positive screen for domestic violence? The next question should be: Is there a gun in the home 11 hours ago
  • Where the police drive your street and run plates bc they are worried for you, but the guy you fear can still buy a gun. America. 11 hours ago
Follow

Get every new post delivered to your Inbox.

Join 1,189 other followers

%d bloggers like this: