I welcome the Minister of State to the House. The matter I am raising on the Adjournment concerns the future of the domiciliary birth service, which is more commonly known as the home birth service, in this country and, in particular, the immediate threat that indemnity cover will be removed for independent midwives who really provide the home birth service to women who choose to birth their children in their own homes.
The model of maternity care in this country has changed significantly over the past 100 years or so. We have moved from what was largely a system of home births to one which is now largely a hospital-based service. In 2001, which is the last year for which I have complete figures, fewer than 1% of births occurred at home. There is a need to reorient the maternity care services to provide a woman-centred model of maternity care which facilitates choice among women and also continuity of care.
Independent midwives have been told that indemnity cover will be removed from them at the end of this month. This will leave them with a choice between operating without indemnity cover, which would not be desirable, or ceasing to practise. I am sure the Government would not like to see this situation arise. I call on the Department of Health and Children to provide at least an extension of cover until the issue can be resolved. I know there are certain issues relating to clinical governance and so on which need to be resolved, but I ask that this would happen.
Looking back at what the Government has done, I know an expert group on domiciliary or home births was set up in January 1997 and that three pilot projects were set up. In 2003, a domiciliary births group was established which made recommendations arising from an evaluation of the outcomes of those pilot projects. The evaluation confirmed the feasibility and safety of home births and stated that when these home births were adequately resourced, there were high levels of satisfaction for clients and staff.
There are issues relating to home births. They are most suitable for low-risk women and there is an issue about identifying women for whom home births are most suitable. The recruitment and retention of experienced and competent midwives is another issue that arises. Unfortunately, the profession of midwifery is suffering a collapse of morale because of the lack of recognition of the expertise that midwives have, particularly in terms of providing woman-centred care in the community. The role of the midwife is integral to models of care which promote normality in the birth process. This is the major objection some women have to the hospital-based model of care towards which we have increasingly moved. They believe birth is medicalised and almost industrialised rather than being a natural, normal process that occurs in the most natural way possible which supports women in the process of giving birth.
It is important that any home birth service that is provided nationally is backed up by a modern hospital system in case a transfer proves necessary. Unfortunately, independent midwives who operate in the community frequently complain about a lack of co-operation from local general hospitals in terms of providing scans or tests for women whom they are preparing for home birth.
A range of maternity services could be provided in the community, including home birth services but also including midwife-led units which are very close to that and which are either attached to or part of general hospitals. We need an expansion of community-based midwifery-led services. I asked the Government today to clarify what its vision was for the future development of home birth services. Judging from the situation the domiciliary birth service is in at the moment, it appears the Government may be neglecting it to such an extent that it will disappear and the choices available to women will be restricted to hospital-based choices.
I mentioned clinical governance. An Bord Altranais has a competency framework which governs the practise of midwifery but there is a need for clinical governance structures which should be established at national, regional and local levels to support the development of new models of maternity care.
There appears to be no statutory basis for the provision of domiciliary births. The Nurses Act 1985 requires health boards to supervise midwives who practise outside health care institutions. However, there are no regulations to implement this provision. There are a variety of arrangements in different Health Service Executive areas throughout the country concerning the payment of grants for home or domiciliary births. This is unfair. A woman living in one part of the country might find it easy to access a grant for a home birth while a woman in another area might find it difficult to do so. This practice needs to be standardised throughout the country. I have mentioned how indemnity cover is a problem for independent midwives who are largely involved in supervising and carrying out home births.
As a party in Government, the Green Party is asking for evidence that the Government has thought through and is proactively pursuing a policy to develop and support domiciliary births and other models of maternity care that are not exclusively hospital-based in order to provide choice to mothers of the most natural possible systems of maternity care, which in the long run will be in the interests of the mother and child. It would also be considerably less expensive than hospital births. There are increasing fears of litigation leading to considerably more intervention in the birth process, including the use of caesarean sections, etc. If we had more natural birth processes that were supervised and with the right supports available if necessary, it would be considerably more economical for the State. The Government must address this issue. If action is not taken now and a clear vision is not articulated and pursued by the Government we will see home births die out and we will see independent midwives disappear, and the country would be poorer for it. I look forward to the response.
