Opponents of a new bill say it will force expectant mothers back into hospitals
SUPPORTERS OF a woman’s right to have a home birth say the practice could be driven underground if new legislation is passed. Tomorrow, the Association for Improvements in the Maternity Services (Aims) Ireland will deliver a petition to the Dáil while picketing the building to highlight their concern that the Nurses and Midwives Bill 2010 will effectively prevent the practice of professional midwifery in the home.
“This is taking away a mother’s human and constitutional right to choose where to have her baby, having informed herself any risks,” said Krysia Lynch, co-chairwoman of Aims Ireland. The bill goes before the Select Committee on Thursday.
Among those who would not be allowed to have a home birth are Caitríona Ellis, from Portarlington, who delivered her second child at home last week.
If the legislation had been in place last week, Ellis would not have been allowed to give birth at home: she would have had to be transferred to a hospital. The proposed bill states that a mother in labour must be transferred to hospital if 24 hours have passed since her waters have broken and she has not given birth. Ellis gave birth 32 hours after her waters had broken.
She wanted to stay at home in order to avoid hospital infection, with the approval of her midwife Philomena Canning. “This is a human rights’ breach. The legislation takes away the woman’s right to choose the birth she wants,” said Ellis, just hours after the birth.
Catríona Clarke, from Glasnevin, would not have been allowed to have her second baby at home five weeks ago either because her first baby was born by Caesarean section. Under the bill, all women in her situation would have to give birth in a hospital.
“I thought I was more likely to have a natural birth at home and more likely to have interventions in hospital. I really believe that childbirth is a natural process that has become medicalised and that home was the best choice for me,” says Clarke, who says hers was a “beautiful, gentle” natural home birth.
Any midwife assisting in a birth in situations where these criteria are not met would be liable for a fine of up to €160,000 and a prison term of up to 10 years, if the bill is passed.
These two stipulations mean that self-employed community midwives (SECMs) will need to have insurance managed by the State Claims Agency’s Clinical Indemnity Scheme, since clinical indemnity is not available to midwives on the open market.
Until 2008, insurance cover for SECMs was arranged through the Irish Nurses and Midwives Organisation. It was withdrawn and replaced by the State scheme, via the Health Service Executive, which set up a national steering committee to look at the insurance implications of the practice of midwife-assisted home births.
If a home birth were to go wrong and the parents sued, the State could have to make an enormous payout. The legislation is an attempt to minimise that possibility.
It was decided that the scheme would cover only low-risk births, where there was no history of medical or surgical problems that might affect pregnancy and no present or previous complications.
“Having had a previous Caesarean section increases the risk of serious complications including placenta accreta, uterine rupture and peripartum hysterectomy,” the Department of Health has said. The waters breaking – the rupture of the membranes – was associated with an increased risk of serious infection, which was best dealt with in a hospital setting, it added.
Philomena Canning, a midwife who has delivered hundreds of babies, disagrees. In women who have had Caesareans, the 0.6 per cent risk of scar rupture in a vaginal birth is a statistic from the hospital environment, whereas at home women are more relaxed and trusting, making the risk lower, she says.
There is also evidence that the risk of infection following waters breaking is higher in MRSA-riddled hospitals, she adds.
Canning says the proposed legislation could contravene both the constitutional rights of the midwife to practise and an EU council directive requiring member states to facilitate midwives in the practice of their profession.
“In the context of mandatory insurance, it is questionable whether a restrictive package of insurance constitutes the facilitation of the midwife to practise when insurance is otherwise inaccessible,” she says.
From a practical point of view, if a pregnant woman refused to go to hospital 24 hours after her waters had broken, the midwife would have to leave the scene under the new legislation.
The Irish Timesinterviewed one mother to whom this has happened already.
Canning, however, says the the midwife has a duty to remain in attendance on the mother in childbirth, even if the mother refuses to comply with her advice.
She spends a lot of time with her expectant mothers, talking them through the experience of childbirth and securing their agreement that, if in her professional opinion they need to go to hospital, they will do so.
Any midwife is relying on the mother to trust her judgment and be willing to follow it. Under the legislation, were the mother to fail to comply, the midwife would be at risk of prosecution if she stayed on the scene.
Gillian Kane, a mother of two, had her first baby by elective C-section in hospital and planned a home birth for her second.
As the second birth progressed, Canning diagnosed a serious problem and transferred Kane to hospital, where she remained with her.
Kane had to have a second C-section, but she says her baby benefited from having a normal labour that was allowed to progress as far as it could at home.
“When the decision to go to hospital was made, it was by a medical professional I trusted – I had developed such a strong relationship with her and had such belief in her,” says Kane.
It is that relationship of trust that those opposed to the bill want to protect.
Canning says the legislation will make the role of a midwife one of coercing women to go to hospital. “This scenario is intolerable in a civilised society,” she says. “The right to informed decision-making is a well-established minimum requirement for woman-centred care. Professional ethics demand respect for the choices women make.
“The home birth scheme and the terms for SECM insurance. . . give no recognition to the role of the mother as an active participant in her own care.”
