Call for rethink on birth Bill

IT IS an ill-wind that has blown some good for the opponents of the controversial Nurses and Midwives Bill.

The Bill was at report stage, having gone through the Dáil and the committee stage without amendment.

Had the Government gone on much longer it would have become law in the spring, but the political turmoil of recent months has scuppered it.

It will now be up to the forthcoming government to decide whether to resurrect the Bill or let it fall by the wayside.

The Home Birth Association of Ireland, the Community Midwives Association, AIMS (Association for Improvements in Maternity Services) Ireland and the Irish Nurses and Midwives Organisation (INMO) were among the groups lobbying for changes to the Bill.

Its most controversial provision was to make insurance compulsory for independent community midwives involved in home births and to restrict the scenarios in which they could operate and how much ante- and post-natal care they could provide.

At present, clinical indemnity insurance is not mandatory, but all community midwives have it through the Health Service Executive, which is the only body which will provide insurance.

Campaigners say section 40 of the Bill as currently constituted would make it very difficult for community midwives to practise as they would be subject to restrictions imposed by the HSE which would curb the opportunity to use their clinical judgment.

For instance, if a woman had not given birth within 24 hours of labour starting, she would be obliged to go to hospital under the new scenario.

Campaigners also objected to section 24 of the Bill which would put the midwifery profession under the control of the Nursing Board and, therefore, midwifes would lack the power to govern themselves.

Such a provision would make midwives the only major health profession incapable of governing themselves, they argued.

AIMS Ireland spokeswoman Krysia Lynch said there was relief that the Bill was no longer going through in its present form.

She warned that, had it done so, it would have faced High Court challenges on grounds that section 40 was discriminatory as it made insurance mandatory for midwives but not for doctors or nurses, and such restrictions were a breach of human rights.

Ms Lynch said they had been lobbying Fine Gael health spokesman Dr James Reilly, who is tipped to be the next Minister for Health, and Labour health spokesman Jan O’Sullivan in relation to both section 24 and section 40 of the Bill.

Ms Lynch said she had impressed upon both parties that it was critical that midwives had insurance as a right as opposed to having it subject to conditions laid out in the HSE memorandum of understanding (MOU).

Dr Reilly said the Nurses and Midwives Bill would have to be reviewed by any new government and it would not be reasonable for midwives to practise without indemnity.

He said insurance would be mandatory for midwives, but he understood their difficulties in getting such insurance. “We would not preside over a Bill without this being addressed,” he said.

He also said the issue of representation would be reviewed by a Fine Gael government. “Clearly, given the importance of midwifery, they should be entitled to proper representation,” he explained.

Ms O’Sullivan said much of the Bill was not contentious and could be enacted as planned, but the provisions which restricted the ability of midwives to practise would have to be addressed.

“I understand what they want to achieve and we are strongly supportive of them. It is critical that community midwives can continue to deliver babies at home if they wish to,” he said.

The Community Midwives Association (CMA), which represents nearly all of the midwives involved in home births in Ireland, has called for a period of reflection and a comprehensive review of all Irish maternity services.

CMA president Bridget Sheeran said such a review in the UK in 1992 paved the way for more midwifery-led care and also contributed to the setting up of the only two midwifery-led clinics in Ireland, both located in the northwest.

The CMA has submitted a document calling for a comprehensive review of Irish maternity services by the Oireachtas Health Committee, which would address the issues of midwifery-led care and also the low rate of home births in Ireland.

Ms Sheeran described the Nurses and Midwives Bill as “inadequately understood and therefore poorly worded”.

She said it had very little support in the medical profession and should not be resurrected in its present form.