After 16 years of battling against the medical establishment, numerous trips to the High and Supreme Courts, a few notable triumphs and a final crushing defeat, home birth midwife Ann Ó Ceallaigh is ready to throw in the towel. “I’m shattered. I could have appealed it but I don’t have the money or the energy or the time,” she says of the High Court’s decision to uphold a finding of professional misconduct against her. “I don’t want to lose my house. I just want peace.”
Shattered maybe, but also unrepentant: “I did nothing wrong, and the mothers and fathers of the babies I have delivered know that I have done nothing wrong.”
Ó Ceallaigh has delivered 500 babies in their parents’ homes and, she says, never been the subject of a complaint from a client. More than 95 per cent of her clients gave birth at home – the rest being referred to a hospital – and virtually all went on to breastfeed.
Two Dublin maternity hospitals have taken a different view over this period, having lodged separate complaints 10 years apart.
In essence, the complaints alleged a failure on her part to seek outside intervention promptly for problematic home births. Last month, the Nursing and Midwifery Board found her guilty of professional misconduct for, among other things, failing to recommend a hospital transfer to a woman in a difficult labour.
Ó Ceallaigh sees her struggles with the mainstream obstetric community as ideological in nature, rather than arising from any failing in a particular case. “It’s about a clash between two different philosophies and two models of care, between home birth midwifery providing continuity of care before, during and after birth, and a hospital-based approach,” she says.
Whatever about the relative merits of home births versus hospital deliveries, Ó Ceallaigh's fight has also been about having matters decided in public, and not behind closed doors. The inquiries into her work, and most of the court proceedings arising from these, have been held in camera.
Few details have emerged about the births which were the subject of complaints by hospital staff, though it is known that the woman in the first case pleaded with the hospital to withdraw its complaint and felt it was using her to “get at” Ó Ceallaigh.
“I have nothing to hide, I have always been transparent, professional and accountable to my clients at all times,” she says.
Fitness to practise hearings for doctors are now held in public but it remains the case that hearings convened by the Nursing and Midwifery Board are private, and only the briefest details are published.
Legislation enacted in 2011 provides for public hearings but allows the board to opt out where it decides the circumstances are “appropriate”.
From Blackrock in Co Dublin, Ó Ceallaigh worked in the US, New Zealand, Canada and South Africa before returning to Ireland to set up her own business in 1983. “I specialised in natural childbirth all my life. I’ve practised it in the Canadian Arctic, where you can be six hours’ flying time from a hospital, in Africa where there is nothing and in New Zealand where I worked in a birthing unit as part of a general medical practice.”
Despite her advocacy of natural childbirth, she says it isn’t for everyone: “I don’t do women with diabetes, or cardiac issues.” She has delivered twins at home and sees no reason why some women who have had Caesarean sections should not go on to have normal deliveries at home – this issue is currently the subject of an unrelated High Court case.
The past six years have been financially ruinous because the board has stopped her working as a nurse as well as a midwife. Having already decided by 2007 to end her practice, she got a job with the aid agency MSF working in maternity services in Sierra Leone. Then the injunction preventing her working arrived and she had to pass up the job. She survives today working as a carer.
Just one in every 200 births in Ireland is a planned home delivery and there are fewer than 20 self-employed community midwives in the State. Ó Ceallaigh believes the reason for this is that childbirth has been made into a “fearful thing” even though home deliveries are a viable option for the majority of women.
