Midwives' role curtailed

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An interesting letter below. As midwifery professionalises around the world, we begin to see two distinct outcomes: one is the idea of restriction of women's birthing options; and the other is the increasing acceptance and validation of midwifery as a profession.

Whenever a professional group claims its rightful place as a profession, certain codes and guidelines come into effect, such as codes of ethics and conduct and guidelines for practice that establish accepted standards of care upon which the public can rely as a statement of safe and responsible care.

These standards can be viewed positively, but as the author of the letter below indicates, there is also the consequence of restricting women's birthing options. An interesting ethical dilemma that has not been resolved to date.



... Irish midwives face up to 10 years if they breach HSE’s onerous terms and conditions. Now at Report Stage in the Dáil, the Nurses and Midwives Bill makes it unlawful for midwives ... to practice without indemnity.

Making insurance mandatory is key to compliance with state bureaucracy: lurking underneath Section 40 of the Bill 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 are also 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.

... 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; their indemnity lapses ...

We are headed for a similar situation in Australia if homebirth is ever indemnified and funded. Progress on the one hand, for those women who are low-risk enough to birth at home; but some will also view this as an infringement on the rights of all women to birth at home, low or high risk.

In a separate article, "New law does not threaten midwives", the author explains why midwives' roles are not being curtailed and how this is a process of professionalising midwifery.

I READ with interest Marie O'Connor's letter ... regarding midwifery practice. Unfortunately, however, her letter contains a number of factual errors.

Firstly, the ... legislation will enshrine the position of midwifery as a profession, as evidenced by the proposed change of name from An Bord Altranais (the Nursing Board) to the Nursing and Midwifery Board.

It will establish for the first time a statutory midwifery committee to deal with midwifery matters, as well as providing statutory protection for the midwifery division of the register.

... It is worth noting that there is nothing in the proposed legislation prohibiting midwives attending at home births.

Ms O'Connor refers to a time 60 years ago when most women had their children at home. That was a time when perinatal rates were six times higher than they are now.

The safety of both the mother and child is of paramount importance in the new legislation. It is therefore right and proper that midwives attending at home births are accountable to their regulatory body for their professional conduct.

It is also fair to insist that they have the appropriate professional indemnity.

Melissa Maimann, Essential Birth Consulting 0400 418 448