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E-mailA baby born at home attended by a self-employed midwife died from natural causes, a Cork coroner found (6 November). This unavoidable tragedy has predictably elicited high-profile coverage. Yet similar events routinely occur in maternity hospitals without fanfare.
A Cork consultant obstetrician maintains that home-birth mothers should live within 20 minutes' drive of a hospital, while his Dublin colleague says 30 minutes is acceptable. Can they not agree? And how to factor in the traffic – heavy, medium or light? What about hospital-birth mothers, now that smaller maternity units are set to close? These closures will leave some women two hours' drive and more from their nearest maternity unit.
Such closures have been in gestation at the Institute of Obstetricians and Gynaecologists since 1999. Yet the institute refuses to countenance the idea that midwives, the specialists in normal birth, might run these units in their absence. Dr Peter Boylan has once again stressed the need, as he sees it, for home-birth services to be provided only by hospital midwives, that is, under his control and that of his colleagues.
Yet in countries with more advanced systems of maternity care, such as Germany and the Netherlands, self-employed midwives are central to the services, as are freestanding midwifery clinics and birth centres.
Our super-centralised and hyper-interventionist maternity system has failed to deliver safe, high-quality care for women. Ireland's perinatal mortality rates are among the highest in the European Union. The bill for past adverse events incurred by Irish obstetricians reached €400m in 2004.
Irish maternity care needs a new direction. The medical prejudice towards autonomous midwifery care appears to reflect an unconscious drive to eliminate the competition. Self-employed midwives challenge the (male) medical monopoly over the services for birth. The market for private obstetrics is worth well in excess of €50m annually in Ireland. Just over 100 consultant obstetricians share the spoils.
Marie O'Connor,
42 Rathdown Road, Dublin 7.
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I am sure that, if the list of deaths occurring in our maternity hospitals were to be highlighted, even half as much, as when these tragedies occur in home birthing people would be more informed.
They would realise too, that there has been a concerted effort to discredit and discourage home births in Ireland for at least 20 years. While all the time saying people should have the right to have them. Why is this? Well it is about power! There is no power greater than a consultant scorned, ignored or inconvenienced. They need to stop attacking these brave people who want to give birth at home, they need to sit down with them and help them to deliver (pun intended) this invaluable service. Life is more than just about money and they should realise that at this stage and offer their services at reasonable rates.