Dear Editor,
The recently-reported horrors endured by home birth midwives in Hungary are but a pale shadow of those planned for midwives in Ireland.
Agnes Gereb faced five years in jail for assisting at a home birth: Irish midwives face up to 10, if they breach the HSE’s onerous terms and conditions.
Now at Report Stage in the Dáil, the Nurses and Midwives Bill makes it unlawful for midwives (but not for nurses or medical practitioners) to practice without indemnity.
Making insurance mandatory is key to compliance with State bureaucracy: lurking underneath Section 40 lies an invisible undercarriage of rules and regulations binding independent midwives hand and foot. Surveillance is tight: the HSE requires midwives to surrender client files before issuing payment.
Sixty years ago in Ireland, childbirth was women’s business. Having a child at home was the norm. Midwives were self-governing, albeit via a London board. Today, so powerful has the health bureaucracy become that women have lost their power over birth. Midwives have lost the freedom to practise autonomously, and women have lost a fundamental liberty: the right to decide how and where their child will be born; the terms under which midwives are legally required to work; and the conditions under which women are obliged to give birth.
However, there are signs of hope. The European Court of Human Rights recently ruled that denying women the freedom to give birth at home denies them their human rights.
The Court ruled that the circumstances of giving birth incontestably form part of one’s private life and that, under Article 8 of the European Convention on Human Rights, prospective mothers have the right to choose those circumstances. Only an independent midwifery profession can enable that choice.
Subordinate to a nursing board, midwives in Ireland have lost the freedom to rule themselves. They have all but lost the right to offer the services of their choosing in the community.
They can no longer decide whom to accept as a client, or when a pregnancy ceases to be normal. And when a mother exhibits some change in her condition, however minute, that is deemed a disqualifier for home birth and their indemnity lapses.
Care is to be withdrawn from the mother at home, even during the height of labour. New draft guidelines suggest the calling of ‘relevant stakeholders’, such as the guards.
This is the appalling vista that the Nurses and Midwives Bill will lock in, unless it is amended.
Marie O’Connor,
Rathdown Road,
Dublin 7.
Author:
Emergency: Irish Hospitals in Chaos
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This is becoming a global raid on the rights of women to give birth and/or unmedicalised. If we stand strong together we will overcome this profit-driven takeover of women’s bodies and birth. Here in Australia we support you.
I work as an SHO in Obstetrics and Gynaecology at the moment. I am on a GP training scheme. I was amazed to learn that I am expected to do suturing of episiotomies and vaginal tears within a week of starting the job. I had never done this before and the training provided consisted of being shown some basic suturing techniques on a well-worn sponge. Of course, I refused to do this job unsupervised so I would call the registrar for supervision (and most of the time, they would take over the job midway through). The registrar would often complain loudly about being called in from home to help even though he/she was being paid in-house rates. Of course, if they took the time to train us, there would be no problem but perhaps it is beneath them.
What amazed me further is that most midwives in Ireland are trained in the art of obstetric suturing but refuse to do it due to “policy”. So, I am expected as a new Obs/Gynae SHO WITH MINIMAL TRAINING to do suturing on the perineums of ladies who have just delivered while the midwife writes up her notes (exhaustively describing what the patient had for breakfast as well as how long it took for the SHO to answer the bleep) and the registrar lies at home in bed being paid to be in-house. Of course, in this job, particularly on night call, one is often expected to simultaneously be in theatre for a C-section, admit a patient to the ward, take a referral from a GP, take a referral from the E.D. and examine a patient who has developed abdominal pain post-hysterectomy. I shouldn’t forget to mention that an average of 20-30 IV venflons and sets of bloods will need to be taken and a dozen first doses of antibiotics or antihistamines will need to be given and apparently the SHO is the only one who can’t say “It’s not my job” despite a complete lack of evidence to support this outmoded practice -another job that the midwives and nurses are unable/unwilling/not allowed to do.
When I asked one Gynae nurse if she had done the IV cannulation course, I was informed that the ward sister will not allow her the 2 hours off to do the course.
This is the kind of hospital-based birthing system that all women are being forced into.
Wow JP, I left the UK and the NHS 16 yrs ago… its unbelievable that things haven’t improved. Whats great is that you recognise the deficiencies and demand more supervision – I’m sure a lot of new Obs/Gynae staff just muddle through, and many women possibly have ongoing perineal pain because of it.
Here in Australia, the maternity system definitely has problems too – especially where it comes to the choice of homebirth. The main thing I guess is to keep standing up for what is right and fair – and not get caught up in the ridiculous ‘risk-based practice to the point of idiocy’ philosophy that seems to pervade hospital environments nowadays. Many women who choose homebirth are terrified of the hospital system and see that the risk of being so terrified in that environment is a far worse thing than the small risk of adverse events happening at home, where at least she will be relaxed and more comfortable. There is a lot to do to improve hospital maternity systems and make them woman-friendly, make the power base on a more equal footing and help women (sometimes those who have higher risk pregnancies) feel OK about the place. Continuity of midwifery care is the key… and this has been researched a lot.
In the meantime JP, good on you for demanding a better deal – not just for yourself, but ultimately for the women you care for.