My Month in Ireland Megan Madrigal Obstetrics Gynecology

My Month in Ireland Megan Madrigal Obstetrics & Gynecology National Maternity Hospital Dublin, Ireland

Social & Legal Issues in Reproductive Health • Predominantly Catholic country • Legally contraception and fertility treatments are allowed • Legally pregnancy termination is allowed only after the mother’s life is in danger

Social & Legal Issues in Reproductive Health • Most women used contraception ▫ Cosmopolitan environment ▫ Majority on pills ▫ Very few on longer acting forms �IUD, Depo or Tubals

Social & Legal Issues in Reproductive Health • Reproductive services utilized but not discussed ▫ Lower use than American women ▫ Only six certified centers in Ireland ▫ Services not covered by national healthcare �Must pay out of pocket ▫ Protests outside of fertility clinic �Not as contentious or as stigmatized topic as abortion

Social & Legal Issues in Reproductive Health • No open hostility to abortion, but passive silence on the issue ▫ Topic not discussed with patients ▫ Only one patient brought up the topic �Conversation quickly ended by resident • Behind the scenes, most physicians spoke on need for terminations in healthcare ▫ But accepted the legal restraints of the country

The Irish Midwife: An Essential Component • Most profound clinical experience was working on the labor ward • Midwives completely manage uncomplicated labor ▫ Doctors only appear for operative deliveries or to go to the OR ▫ In US, used mostly for coverage �Only recently seen increased utilization

Masters of the Labor Ward • Midwives assess, admit and remain with laboring women from arrival to delivery ▫ In the US, roles split among doctors and labor nurses • Practice expectant management of labor model ▫ As hands off and natural as possible ▫ Use birthing stools, exercise balls, hot showers & nitrous oxide �Oxytocin, prostaglandins, epidurals used later

Close relationships • Irish midwives are intimately a part of the process ▫ Use their own bodies as stirrups ▫ No gowning or breaking down the bed • Strong relationships formed quickly in the labor ward

Cultural Experiences • Ireland provides public healthcare as well as semi-private options ▫ Countless examples of excellent care ▫ Opportunities for paternalism to emerge • Patient asked to be induced at 40 weeks ▫ Wanted husband who has to travel for work present at birth ▫ Denied ▫ No discussion allowed on topic

Subtle Paternalism in Public Care • Little to no conversation about care or plans ▫ Never heard, “Are there any questions? ” ▫ Rarely seemed to be an issue for the patients • No recourse if patient objections to care plan did arise • Unwillingness to entertain the idea of the patient’s preference

Exploring Dublin & Beyond Above: The National Maternity Hospital, housed in a Georgian building Left: Food market on the Grand Canal in Dublin

Exploring Dublin and Beyond Above: Hiking in Bray with Dr. Higgins Right: Trinity College Campus in Dublin

Exploring Dublin & Beyond Above: View from the top of Bray’s Head, just south of Dublin Right: After the hike

Exploring Dublin & Beyond Above & Left: Visiting the Cliffs of Moher in the West of Ireland

Exploring Dublin & Beyond Above: One of the many bays in the Ring of Kerry in the Southwest of Ireland Right: Skellig Islands in the distance while driving along the Ring of Kerry

Exploring Dublin & Beyond Above: Bay on the Dingle Peninsula in the Southwest of Ireland Left: Another bay on the Dingle Peninsula