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Apr 08 2013

As no threat to Savita’s life

The inquest into the death of Savita Halappanavar has begun in Galway. Today Praveen Halappanavar testified.

The Sunday it all went wrong, they were told Savita’s cervix was dilated and she would miscarry.

Mr Halappanavar said they were both shattered on hearing this news and his wife asked repeatedly why this was happening to her. They were told it would all be over in a few hours when she miscarried.

On Monday October 23rd her obstetrician Dr Katharine Astbury sent Ms Halappanaver for an ultrasound. Dr Astbury told her that “unfortunately” the foetus was still alive, Mr Halappanavar said.

He said the couple asked Dr Astbury for a termination but she told them this was not possible.

Fergal Bowers, health correspondent for RTE, who is live-tweeting the inquest, said Dr Astbury said there was no danger on Tuesday.

Inquest: Consultant obs, Dr Katherine Astbury will say termination not warranted on Tues Oct 23, as no threat to #Savita‘s life.

Really? Because what I learned from a lot of sources – medical sources, especially Dr Jen Gunter on Twitter – is that that’s just flat-out false: a protracted miscarriage is always dangerous. Period. There isn’t ambiguity about it. A dilated cervix is an open door to infection.

So if that’s going to be the line that Astbury takes…it looks like admitting stark malpractice. Or perhaps, more frighteningly, that Irish hospitals allow their standard of care to be warped by Catholic “teachings.”

32 comments

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  1. 1
    peterferguson

    If you want more depressing news, the Irish Medical Organisation recently held a conference where motions for abortion were defeated, even in the case of rape, incest, and medical terminations where the foetus is not viable for life. It is rumored that the Iona Institute (a Catholic “think-tank”) bused in pro-life doctors from across Ireland, some of whom are members of Opus Dei, to sway the vote.

    It’s times like this I am ashamed to be Irish, especially since I live 10 minutes away from where Savita died. Ireland’s strict abortion laws are only comparable to some Islamic nations.

  2. 2
    Kevin Donoghue

    I’ll be surprised if Dr Astbury says there was no threat to Savita’s life. But what she might say is that the threat was not great enough to to meet the standard set by the Supreme Court in the X Case: “a real & substantial risk to the life, as distinct from the health, of the mother.” If she can say that then I think she’s on pretty firm ground, legally speaking.

    As you’ve noticed I’ve been tweeting about the fact that nobody seems to know what a “substantial” risk is. Thanks for retweeting, because I think that issue deserves more attention. Was boarding the space shuttle a substantial risk? (I’d say so.) How about climbing Mont Blanc?

  3. 3
    Ophelia Benson

    Peter – I know; I did a short post on that a couple of days ago.

    I’m ashamed to be American for the same kind of reason though. Catholic hospitals are allowed to make their own rules according to religious directives, including rules that contradict actual (secular) law, and that allow women to die the same way Savita Halappanavar died. The Feds won’t enforce the law, and Catholic hospitals are swallowing secular ones at a great pace. It’s a fucking disgrace.

  4. 4
    Ophelia Benson

    Kevin – yes – I sort of figured that out as I was writing the post. Or I wrote it and then went through some tweets again and saw yours again and realized that might be the issue. God it’s insane. But we have the same damn problem, though not enshrined in law, so I’m not smug about it.

  5. 5
    peterferguson

    Luckily the IMO vote has no real bearing that I am aware of; however, it might give the present government an excuse to further drag their feet. Our Taoiseach (Prime Minister) and many senior members of his party are ardent Catholics. They wouldn’t dare refuse to make any changes to the current laws but they are biding their time until the furor has passed so they can enact the most minimalist of changes, just enough to appease.

  6. 6
    Marie-Thérèse O'Loughlin

    Lot of details to be had on the case in the Galway Independent | Praveen Halappanavar addresses Galway inquest http://galwayindependent.com/20130408/news/praveen-halappanavar-addresses-galway-inquest-S1580.html#.UWMeNSsGUec.twitter

  7. 7
    notsont

    As you’ve noticed I’ve been tweeting about the fact that nobody seems to know what a “substantial” risk is.

    In medicine risk is directly related to “reward” the reward being what is gained by taking the risk. If nothing is gained then ANY risk (no matter how small) is not worth taking. This seems obvious to me.

  8. 8
    Kevin Donoghue

    “If nothing is gained then ANY risk (no matter how small) is not worth taking.”

    That makes sense. Unfortunately Irish law puts woman and foetus on an equal footing. If you want to grasp the mindset, think of Savita’s doomed foetus as you would think of a terminally ill passenger in a lifeboat. Sure, in a storm you could probably chuck him in the water for the greater good. But it would have to be quite a storm.

    I’m not trying to defend this way of thinking about the problem, but it is a more-or-less logical consequence of that 8th Amendment we so unwisely inserted in the Irish Constitution.

  9. 9
    notsont

    That makes sense. Unfortunately Irish law puts woman and foetus on an equal footing. If you want to grasp the mindset, think of Savita’s doomed foetus as you would think of a terminally ill passenger in a lifeboat. Sure, in a storm you could probably chuck him in the water for the greater good. But it would have to be quite a storm.

    I’m not trying to defend this way of thinking about the problem, but it is a more-or-less logical consequence of that 8th Amendment we so unwisely inserted in the Irish Constitution.

    Your lifeboat analogy is a little off, its more like a deranged madman trying to kill you, who also happens to have a stomach wound and will die soon anyway but not before killing or maiming you.

  10. 10
    jamessweet

    Between them, Kevin Donoghue and notsont between them have come to the crux of the issue: Here’s the thing, Astbury isn’t entirely wrong in the fact that, most of the time, this kind of thing (even if left to nature, the way the theocratic fuckheads insisted) is not going to be that big of a medical risk. Yes, the dilated cervix leaves you vulnerable to infection, but most of the time it’s a relatively abstract risk, with a low probability of resulting in serious complications.

    BUT, there was absolutely no reason not to terminate the pregnancy, and — here’s the crucial point — that’s what the patient and her spouse wanted. And they were denied that routine risk-reducing care on the grounds of pure unadulterated superstition.

    That’s really what makes this case the perfect storm: Many couples are refused the same risk-reducing procedure, but since the risk really is pretty small, after all, the vast majority of the time there are no obvious tangible consequences, and the theocrats get to go on abusing their authority and putting people at a small-but-entirely-needless risk. But you keep rolling those dice long enough, and eventually you’re going to kill somebody for no fucking good reason.

    Astbury is right that the risk to Sativa was small, but she’s wrong to say that termination wasn’t warranted. Astbury refused a completely warranted treatment that would have resulted in a small reduction in risk to Sativa’s life, with essentially no downside. Presumably, Astbury has done this countless times without consequence. This time, the dice came up snake eyes and an innocent woman died to appease the doctor’s phony god.

  11. 11
    karmacat

    Didn’t they wait 3 days to treat her? I just can’t wrap my head around this whole situation. How can these doctors live with themselves. If a god asked me to sacrifice a woman for a fetus, I would hate that god and basically call it the pro-death god. There is nothing pro-life about letting a woman die who doesn’t have to die. I guess I can’t understand because I haven’t been indoctrinated and have learned to think for myself.

  12. 12
    Giliell, professional cynic -Ilk-

    Luckily the IMO vote has no real bearing that I am aware of;

    You are aware that this is a statement made by the very doctors you might have to rely upon when you’re pregnant? To say that it has no real bearing is false. It has no official bearing.
    +++
    As for the risk: pro-female-slavery people generally seem to view pregnancy as risk-free. Doesn’t matter that it’s false. Maternal death means death related to pregnancy, a death that would not have occurred otherwise. It kills women. It kills remarkably few women in the west. But that is not due because pregnancy is safe. I t is because we have become very good at preventing and treating extreme cases.

  13. 13
    Ophelia Benson

    James – But Jennifer Gunter is very definite that termination is standard of care in the US. The risk doesn’t sound all that abstract…

  14. 14
    peterferguson

    You are aware that this is a statement made by the very doctors you might have to rely upon when you’re pregnant? To say that it has no real bearing is false. It has no official bearing.

    The stance of the doctors of course have a bearing, but those stances persist either way and women may have to rely upon those doctors when they are pregnant regardless of the vote. The actual vote itself, however, has little to no bearing and to say so isn’t false. Unless of course the vote ends up having real world repercussions which could well be the case.

    A few weeks ago I emailed several pro-life organisations asking for their official stance on medical terminations. Only one replied and the person who sent the email is, in fact, an atheist. The essence being that life begins at conception and if the foetus is deemed not viable it should still be given the best care as life is life regardless of its longevity. The right to life should not be negated by a poor prognosis.

    I have been trying to find out if Dr Astbury is associated with any pro-life organisation as her reasoning to refuse a termination seems to coincide with the pro-life ethos.

  15. 15
    Giliell, professional cynic -Ilk-

    perterferguson
    Don’t underestimate the power of reinforcement*. Those doctors will return to their places of work being more convinced than ever that it’s better to let the woman die. Therefore we cannot easily dismiss such a vote as of “no bearing”
    *Have you ever participated in a large event of like-minded people? I t can even be a simple rock-concert: You liked the band before but now you’re totally convinced that it’s the greatest band ever!!!

    +++
    The Link Maria-Thérèse posted is a heartbreaking and infuriating read (trigger warning if you have trauma related to medical abuse and/or failed pregnancies).
    It is telling that the whoe tragedy started with the very same doctors dismissing the complaints of a pregnant woman, telling her that everything was fine. Duh, hysterical pregnant bitches….

  16. 16
    peterferguson

    Don’t underestimate the power of reinforcement*. Those doctors will return to their places of work being more convinced than ever that it’s better to let the woman die. Therefore we cannot easily dismiss such a vote as of “no bearing”

    Good point.

  17. 17
    notsont

    Astbury is right that the risk to Sativa was small, but she’s wrong to say that termination wasn’t warranted. Astbury refused a completely warranted treatment that would have resulted in a small reduction in risk to Sativa’s life, with essentially no downside. Presumably, Astbury has done this countless times without consequence. This time, the dice came up snake eyes and an innocent woman died to appease the doctor’s phony god.

    This is not entirely accurate, if she had fully miscarried within a few hours as they thought she would the risk would have been small. With each passing hour the risk increases after three days your pretty much guaranteed to have a dangerous infection.

  18. 18
    cgilder

    Content warning: Stillbirth

    I can attest that termination is not a standard of care I received, even when requested, during a protracted miscarriage. When my water broke on a Friday night at 16weeks and I started bleeding heavily, I went to the ER. No hope for the fetus. I requested termination, and they said they couldn’t because it still had a heartbeat. (30beats per minute. C’mon!). They kept me overnight, sent me home in the morning with a dead fetus inside me with instruction to call my OB on Monday to schedule a D&E at some outpatient surgery center. The next day, Sunday, I delivered a boy without warning. Cut the cord, wrapped him in a cloth diaper and put him in a child’s shoebox. Back to the ER where I eventually had a D&C to remove the very stubborn placenta. Baby Boy was buried in a mass grave.

    So, all that to say, I had 2.5 days of slow-motion second trimester miscarriage in which I requested a termination, was denied, was told they could not even perform the D&E after the fetus had died (I can’t remember why…) and some seriously traumatizing moments. I did not get an infection, fortunately. This was in Austin, where even the public hospital is run by the Catholics…

  19. 19
    Jadehawk

    Really? Because what I learned from a lot of sources – medical sources, especially Dr Jen Gunter on Twitter – is that that’s just flat-out false: a protracted miscarriage is always dangerous. Period. There isn’t ambiguity about it. A dilated cervix is an open door to infection.

    ah, but that’s the thing: “dangerous” and even “will inevitably lead to a life-threatening condition” don’t count in religion. That’s why many fundies think you shouldn’t be allowed to remove a ectopic pregnancy until you’re actively dying from it; just in case, you know.

    Same line of thinking applies here; apparently it’s more important to give a fetus that minuscule chance to maybe somehow not miscarry than it is to prevent a FAR more significant chance of death of the pregnant women.

    Priorities are obvious. And they’re decidedly anti-woman.

  20. 20
    Giliell, professional cynic -Ilk-

    How many times do I preview my comments and then forget to post?
    cglider
    Hmmm, what country?
    I know more about that topic than I ever wanted to know. After an early miscarriage I joined a support group. This was very helpful, because the outside world has the horrible tendency to give you “good advice” out of their asses. On the other hand it was very stressful because I got to know what else can go wrong.
    There were many stories, different situations, different ages of gestation when things went wahoonie-shaped, but apart from the cases that screamed “malpractise*!!!”, there was one common denominator: The health of the woman and her wishes, because since the fetus was lost anyway, it was important not to inflict more trauma onto her. So, if she wished to wait for it to end “naturally” and there was no sign of infection, that was OK. And if she wished to have a termination, she got one.

    *and there were a few of those. And almost all of them started with medical personel telling a pregnant woman who showed up with some problems that everything was fine and she should calm down, usually without any examinations.



    Btw, it only occurred to me right now: Anybody notice how similar this is to the Karen Santorum case? Only that she got the termination that saved her life (don’t call it a termination, they just sped up things, really, move on, no abortion to see here) and is still a good little catholic.

  21. 21
    Giliell, professional cynic -Ilk-

    cglider
    And since I don’t want to be that insensitive asshole.
    I’m sorry for your loss and what you had to go through

  22. 22
    cgilder

    @Giliell

    US, specifically, Austin Texas, about 5 years ago. Even though we’re the most liberal spot in Texas, we have no secular hospitals, and when the county established a local-tax-supported health district in order to provide women’s health services in a separate facility inside one of the hospitals, the Texas Leg created a law saying that “no county can create a tax-funded health facility that provides abortions.” Conveniently, Austin was the only district that had such a thing. *sigh*. The ultra-conservative lege delights in micromanaging & attempting to repeal Austin’s local policies, like our recently passed plastic grocery bag.

  23. 23
    dianne

    cg: I’m very sorry for your loss. I’m not an OB, but it’s my opinion that what you went through constitutes malpractice.

    Here’s what up-to-date* says about surgical abortion in a first or second trimester inevitable or missed abortion (aka when the pregnancy is nonviable and the only question is when it is ending and how much risk the mother is taking): “The conventional treatment of first or early second trimester failed pregnancy is dilatation and curettage (D&C) or dilatation and evacuation (D&E) to prevent potential hemorrhagic and infectious complications from the retained products of conception.” (In other words, the usual treatment in the absence of contraindications is surgical abortion.)

    “Surgical management is appropriate for women who do not want to wait for spontaneous or medically induced evacuation of the uterus (see below) and those with heavy bleeding or intrauterine sepsis in whom delaying therapy could be harmful.” (Note that patient preference is one reason for performing an abortion in the setting of inevitable fetal loss. Even in the absence of a clear medical indication. This means that you should have been given a D and E because you asked for one. No other “excuse” needed.)

    “Expectant management (EM) is an alternative for women with early pregnancy failure at less than 13 weeks of gestation who have stable vital signs and no evidence of infection ” (Expectant management, i.e. not doing anything unless something changes, is NOT appropriate for a 16 week miscarriage. Certainly not for a 17 week pregnancy where the patient had obvious signs of infection. Which they also seem to have missed.)

    *A reference for current standard of care treatment options in the US.

  24. 24
    Ophelia Benson

    cgilder –

    You know there’s a branch of the ACLU working on this? Trying to get the feds to enforce the fucking law, which would rule out the vicious malpractice you were treated to? If you feel like it it would probably be worth telling them about what that hospital did to you.

    This is a pervasive problem in the US, and getting worse all the time because Catholic hospitals are gobbling up secular ones. It’s mostly below the radar. THIS MUST BE FIXED.

  25. 25
    Ophelia Benson

    From Fergal Bowers on Twitter an hour ago -

    Dr Astbury says on Tues Oct 23, told #Savita legal position is she can not perform termination at that time in her case

    Dr Astbury: Weds Oct 24, felt if #Savita did not improve, or source of infection not found, abortion may have to be considered

  26. 26
    dianne

    source of infection not found

    Ok, now that’s just stupidity. The source of the infection was staring them in the face. Sterile space opened to the non-sterile outside world. What did they think was going to happen?

  27. 27
    Maureen Brian

    I wonder, dianne, is part of this because they have been so busy not doing abortion for so very long that there’s no-one in an entire teaching hospital who knows about the dilated cervix ->massive infection->stone-dead chain of events?

  28. 28
    Ophelia Benson

    From what I remember of what Dr Jen Gunter said about this last autumn, it’s textbook knowledge. You learn it in med school. There’s no wiggle room or ambiguity.

    So now I’m wondering how much medical textbooks vary from country to country and if anyone has done a survey on this. To be blunt, I’m wondering if priests actually dictate what goes into medical textbooks in Ireland. No joke.

  29. 29
    dianne

    But they did know. Otherwise they wouldn’t have been talking about doing an abortion “if the source of the infection is not found”.

  30. 30
    Ophelia Benson

    Ugh, ugh, ugh.

    When it happened I saw some people – in particular one who claimed to be a midwife – insisting that no one knew it was the miscarriage that caused the infection, it could be something else altogether.

    I wonder if they train themselves to resort to hyper-skepticism, in which they ignore the most obvious source of infection because it can’t be ruled out that there’s a different source. Kind of like people who are hyper-skeptical about vaccinations.

  31. 31
    Kevin Donoghue

    “To be blunt, I’m wondering if priests actually dictate what goes into medical textbooks in Ireland. No joke.”

    I’d say it’s more a case of a strong network of staunch pro-lifers in the medical profession itself. Prof John Crown mutters darkly about Opus Dei, but I’ve no reason to believe there are sectret handshakes and stuff. It’s more of an old-fashioned establishment clique.

    In fact I’d say it’s more a case of priests being instructed by the medics they know & trust. Priests don’t want to be thinking about dilated cervixes and other icky ladypart complications. So their line is: don’t legislate, trust the doctors (the sound ones of course).

  32. 32
    Anaa

    No one asked them to come. They could have gone to the north in the first 2 days when she wasn’t in danger. Even then they asked for abortion

  1. 33
    Tuesday at the inquest » Butterflies and Wheels

    [...] the law, but the law isn’t enforced. Catholic hospitals are allowed to make their own laws. This comment from yesterday on As no threat to Savita’s life illustrates [...]

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