Tuesday, November 17, 2009
A BABY born at home attended by a self-employed midwife died from natural causes, a Cork coroner found (November 6).
This unavoidable tragedy predictably elicited negative 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 under consideration 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 the control of institute members.
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 free-standing midwifery clinics and birth centres.
Our super-centralised and hyper-interventionist maternity system, which dates from 1976, has failed to deliver safe, high-quality care for women.
Ireland’s perinatal mortality rates are among the highest in the EU. The bill for past adverse events incurred by Irish obstetricians reached €400 million 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
Rathdown Road
Dublin 7
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