Vol. 411 No. 6
10 Mr. Deenihan asked the Minister for Health if he will review the arrangements made by health boards in relation to couples choosing a home birth and his views on whether health boards fulfil their statutory obligations to provide proper midwifery services.
My Department are at present reviewing the overall position in relation to home births here in the light of various reports and research findings both here and abroad. I am satisfied that each health board make every effort to meet their statutory obligations in this regard.
The Minister indicated in the Dáil some time ago that he was still reviewing the matter. Does the Minister agree that the figure of £54 for midwifery services is completely inadequate? Does he agree that people who have medical cards and are on low incomes do not have the financial resources available to them to be able to have a choice about whether they will have a home birth? Does he know that home births save the Exchequer much money in that in most cases they cost about £500, while hospital treatment for an expectant mother amounts to about £1,500? Will the Minister make representations to the VHI board that home births cover be made available for couples?
That should be sufficient, Deputy Deenihan.
I have one final question. Under the Health Act, 1970, provision was made for support services for home births. The information received subsequently is that couples are actively discouraged by health boards from having home births. Will the Minister comment on that?
There are three home births per 1,000 births here at present, which, as the Deputy will realise, is a very small number. The issue is not a simple one. First, it is difficult to provide the necessary expert staff for home births. In the main, general practitioners do not deliver babies in homes and the old post of midwife has been done away with in most health board areas, so the expert staff required is not readily available. The Deputy should look at the 1976 report of all the expert groups. Comhairle na nOspidéal, in their report in 1976 stated that if the basic aims of ensuring safe delivery and giving the infant the best chance of optimum health and normal development are to be achieved, every expectant mother should have ready access to care at a consultant-staffed obstetric neonatal unit. That strong recommendation was made by that authority.
Secondly, in relation to the point made by the Deputy about cost, there is no way that the question of cost could enter this issue, it is a fundamental right of every mother and child to have the very best care and attention — antenatal care, care during the delivery and post natal care. Cost is not an issue in this.
On the matter of cost, surely if proper services are to be provided for couples who wish to have a home birth £54 is a derisory figure and could go no way towards meeting the cost.
Deputy, you have already made that point.
Yes, but I am pointing out to the Minister that that sum cannot meet the cost of the services required.
I am pleased to hear that there is a review of overall policy in the Minister's Department. Will the review take into account the growing trend for mothers to want to have a subsequent child — not their first child — in their home? Five or six years ago that trend did not exist. I ask the question fully cognisant and aware of the Minister's concern for safety factors. The reality is that many mothers now want to have subsequent children at home. Would the Minister consider it prudent and sensible to seriously consider changing the policy, given the huge pressure — certainly in the Dublin area — on maternity hospitals and the enormous cost involved? I am not saying that cost should be a deciding factor, but several factors should be taken into account. I should like to know whether the Minister is seriously considering changing the policy operated by the Department for a number of years.
All aspects will be taken into account, including the views of couples who wish to have their babies at home. However, as I pointed out in reply to Deputy Deenihan, the issue is not simply about increasing the £54 fee to a midwife. There are not the expert staff available to undertake the work, and that is a very important consideration. We also have to have regard to what Comhairle na nOspidéal, an expert body, had to say about the need for access to a good, well-staffed consultant unit for the benefit of both mother and baby. The review will, of course, have regard to the views of the parents and what they want.
Again I come back to the question of cost. Cost does not enter into the matter. We will continue to provide the very highest level and quality of care for mothers and their babies. The pressure on Dublin hospitals is nowhere near as great as it was years ago. As the House is aware, there was a reduction in the birth rate from 74,500 in 1982——
It is growing again.
——to 51,500 in 1989. While the decrease has steadied, that did take much pressure off the Dublin maternity hospitals.
Will the Minister consider the possibility of maternity hospitals providing the necessary back-up staff, particularly in the light of the decline in the number of births? If, as the Minister says, that money is not at the root of the issue, how can he say that £54 honours a person's statutory right to a home birth when home births, as I told the Minister in private correspondence, cost at least £280?
I have dealt with the question of cost. Cost is not an issue.
The Minister should increase the fee.
The House will realise, in relation to a question by Deputy Deenihan, that it might not be practical for a maternity hospital in Tralee to provide a home birth service in south Kerry because a delivery will often occur at an unexpected time and it might not be practical to give the quality service we would want to provide.
I am amazed at the Minister's brazen response when he says it is not a question of money. The Minister will not have satisfied Deputies Richard Bruton and Deenihan. Certainly he has not satisfied me in his response, because it costs within the Eastern Health Board £300 to have an at-home delivery service provided by the private sector.
The Deputy is imparting information rather than seeking it.
Would the Minister not agree that £54 is not adequate compensation for this service and that it is a nonsense to say that cost is not a factor?
We are having repetition.
The Minister will not answer the question.
I will answer the question if the Ceann Comhairle allows me. The Deputy is misinterpreting what I said; that is what he is doing.
Would the Minister speak clearly?
I will speak clearly to the Deputy. What I am saying is that cost is not a factor. I am not going to ask women to have their babies at home purely to save the cost of a delivery in a hospital.
The Minister is deliberately misinterpreting what we said.
That is what was being said by Deputy Garland. I respect the views of parents who want to have their babies delivered at home. We must ensure that the essential services are provided for them in so far as that can be done. But because there are only three deliveries at home in every thousand it is not possible to put the level of expertise in every parish in Ireland. In the olden days when I began in practice I delivered babies regularly, but now in the main general practitioners do not do so, although there may be a very small number who do. The first thing one must do is ascertain how one can provide the necessary level and quality of expertise to women and their babies, because that is fundamental.
