Ireland's Home Birth Services: MOU and Nurses and Midwives Bill 2010

UPDATE: Winter 2010/ 2011

AIMS Ireland NO LONGER WISHES TO HOLD THE BILL until a further date. AIMS Ireland and many other birth groups have submitted amendments to sections 24 and 40 which enable a woman's and midwife's rights and autonomy. Please see the amendments supported by AIMSI and others here:

Factfile on why sections 24 and 40 need to be amended: http://aimsireland.com/phpbb/viewtopic.php?t=1291

14 Reasons to Amend sections 24 and 40: http://aimsireland.com/phpbb/viewtopic.php?t=1290

One Midwife, One Woman, One Birth: http://aimsireland.com/phpbb/viewtopic.php?t=1322

PLEASE TAKE 5 MINUTES TO CONTACT YOUR LOCAL TD'S, SENATORS, AND SPOKESPERSONS FOR HEALTH AND TELL THEM TO SUPPORT AMENDMENTS TO SECTIONS 24 AND 40!!

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UPDATE - November 3rd

Thank you to all the babies, women, men and midwives who came out for the picket at the Dáil this morning to witness this petition being handed over to Minister for Health!

The Bill goes against the Committee tomorrow.

We are expecting this to be a long journey. The ground is always shifting. Things are changing by the minute.

We are keeping the petition open - please continue to support this campaign and share this petition!

Contact AIMS Ireland chair@aimsireland.com for more information or find us on Facebook for updates.

UPDATE: November 5th
The Bill passed Committee stage in full yesterday morning. The meeting only lasted 1hr 45min and only Minister Harney, S O’Fearghail (chair), James Reilly, Margaret Conlon, Rory O’Hanlon, and Kathleen Lynch were present. No amendments relating to our concerns were discussed.

For current updates on the next stage of this campaign please refer to the AIMS Ireland website or facebook page.

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Please join us in signing this petition in order to protect the human rights of women and the professional autonomy of midwives.

This petition expresses the concerns of The Association for Improvements in the Maternity Services, Ireland (AIMS Ireland) and co-signing individuals/organisations regarding the consequences the proposed Nurses and Midwives Bill would have on home birth in Ireland and broader aspects of maternity care choices for women giving birth in Ireland.

Background; Memorandum of Understanding (MOU)

The current situation which has been in place since September 2008 is that Independent Midwives, now known as Self Employed Community Midwives (SECMs), who agree to practice within the terms of the MOU and its schedules will have the care they offer home birth mothers covered by the State's Clinical Indemnity Scheme (CIS), operated by the State Claims Agency (SCA). This arrangement came about following the withdrawal of individual insurance cover for SECMs by the Irish Nurses Organisation (INO). The proposed new legislation, the Nurses and Midwives Bill 2010, will in effect make it illegal for a SECM to provide antenatal, intra-partum or post partum care if the pregnant woman’s circumstances do not meet criteria set by the MOU. Failure to comply with the new legislation will result in the criminalisation of midwives. Penalties for convictions range from €5,000 and/or 6 months imprisonment to a maximum fine of €160,000 and/or 10 yrs imprisonment.

Many of the women being excluded for home birth under the current MOU and proposed legislation are women who would have previously been able to avail of a home birth. The Home Birth Association of Ireland estimates that some 40% of women who have opted for a homebirth in Ireland in the past have done so because of a previous traumatic experience in a hospital setting. Most of these women will now be excluded.

We the undersigned highlight several key concerns in relation to the new legislation.

1. Human Rights and Autonomy for Women
2. Evidence-Based Recommendations from NICE
3. Professional Rights and Autonomy for Self Employed Community Midwives (SECMs)
4. Adverse Effects to the Current Maternity System

1. Human Rights and Autonomy for Women. The fundamental human right to bodily integrity is enshrined in Article 40.3.1 of Bunreacht na hEireann and in Article 3 of the European Convention of Human Rights. Under Article 3 of the European Convention on Human Rights, free and informed consent is the cornerstone of medical treatment. For consent to be free and informed, it must be based on information and choice, neither of which feature in the proposed legislation.

2. Evidence-Based Recommendations from NICE

The Irish maternity system, the MOU and the proposed Nurses and Midwives Bill 2010 purport to follow internationally recognised best practice and the recommendations of the National Institute for Health and Clinical Excellence (NICE) in the UK. These evidence-based standards state explicitly that women should be offered the choice of planning birth at home, in a midwife-led unit, or in an obstetric-led unit (NCCWCH, 2007). Further, NICE adds "The woman should be fully involved in planning her birth setting so that care is flexible and tailored to meet her needs and those of her baby."

The right to make an informed decision with regard to care and place of birth is central to the concept of “woman-centred care”. The NICE guidelines have been developed with the aim of providing guidance to assist in the decision making process around appropriate treatments for specific conditions. In relation to planning place of birth, a number of tables are provided which outline conditions or situations which either “suggest planned birth at an obstetric unit” or "indicate a woman should be assessed on an individual basis" taking into account her history and current pregnancy.

These guidelines clearly state that while women who fall into these tables are considered at higher risk, and suggest that birth take place at an obstetric unit; this is a recommendation, not a command. Crucially, the NICE guidelines propose that regardless of clinical opinion, the final decision be left with the individual woman so long as she is fully informed of her increased risk at home in these instances.

Yet, the current MOU, raised to statutory footing by the proposed Nurses and Midwives Bill, excludes from home birth all women with conditions or situations listed in the NICE tables. The MOU intends to adopt these tables as un-negotiable exclusion criteria, which flies in the face of the evidence-based NICE recommendations.

Under the proposed legislation, women will be excluded from making an informed choice on place of birth if they fall outside extremely tight criteria. The new legislation, while appearing to only affect the small percentage of women in Ireland who choose to birth at home, will actually set the precedent in Irish legislation for all women’s rights to make informed choices in childbirth.

3. Professional Rights and Autonomy for Self Employed Community Midwives

In order for SECMs to practice in Ireland with insurance, they must sign a Memorandum of Understanding (MOU) with the HSE. Through the Clinical Indemnity Scheme, the midwife’s practice (not the midwife) is insured; so long as (s)he follows the criteria in the MOU. SECM’s who choose to practice outside of the MOU criteria or who fail to transfer women who suddenly fall outside the criteria are subjected to either a fine or prison, or both. For example, if a SECM attends a woman in labour whose waters have been gone for more than 24hrs and the midwife fails to transfer to hospital even though there is no danger to the mother or baby (or if the woman refuses to go in to hospital), the midwife faces financial fines or prison time under the MOU. AIMS Ireland and Co Signatories recognise SECMs and the profession of midwifery as an autonomous and highly skilled profession. We believe that midwives are the experts of normal birth and that midwives must retain their professional autonomy in order to meet the needs of their clients in the community.

4. Adverse Effects to the Current Maternity System

The maternity services face significant challenges in the current context. The number of births registered in 2009 was 74,278 (CSO, 2010), and figures for 2010 reveal similarly high figures. There is widespread fragmentation of the maternity care services, which includes huge variability in the type and standard of care available to women, a lack of continuity of care, poor communication between healthcare professionals and women in their care, and underfunded, overcrowded, understaffed centralized care units. In addition, recent scandals within the maternity services including the scans misdiagnosis scandal, have resulted in the erosion of women’s trust in a system which has let them down repeatedly, through systemic failures on the part of the HSE.

The Irish system gives women very little choice, childbirth in Ireland is highly medicalised, and fails dramatically to be cost efficient and cope well with Ireland’s high birth rate. It is our belief that further impediments on birth choices and care options through the current employment of exclusion criteria in the MOU and proposed legislation in the Midwives Bill will put further stress on an already failing system.

Home Birth and Midwife-Led Care are the recommended care options for the majority of women.

A Home Birth and Midwife-Led Service means:

 Saving money and bed days.

 Preventing over-crowding and securing more time with consultants for women who choose or need consultant led care.

 providing evidence based and safe care.