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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

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

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

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

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

15. 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

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