Yes Minister, it’s time for a closer look at maternity care

This State would appear to have little time for anybody who stands apart from the herd. Time and again, whether it’s the musings of economist Morgan Kelly or the revelations of a number of whistle- blowers, organs of the State tend to close ranks and shut out dissonant voices.

Philomena Canning may be one such example. Her current plight is unsettling and raises a whole host of questions about our health service, and particularly maternity care. More than anything though, her case is disturbing in what it appears to say about how power can be used to silence those who discommode major organs of state.

Canning is a midwife with 31 years’ experience in homebirths. In this country, homebirths do not have the status, or popularity, enjoyed in other developed countries. For instance, there are no birth centres — which effectively offer a homebirth away from home — while there are around 100 in our neighbouring jurisdiction. There may be cultural reasons for this. There may be perceptions about safety. One way or the other, those who work in the area say that the practice receives little support or commitment from the HSE.

Canning is just one of 18 midwives who work under the HSE’s homebirth scheme.

While around just 1% of babies are born at home, the demand is probably stronger than ever.

Some of this is down to societal changes in the last two decades, but some is also attributable to the tragic incidents in hospital maternity care in recent years.

Canning is a leading practitioner, who has an exemplary record in nearly 500 deliveries.

Canvass opinion on her work — there is acres of testimony available on websites — and the praise tends to be effusive.

However, her work is her passion and as a result she would not make the grade as the kind of political animal who knows when to massage egos, and when to maintain a buttoned lip.

She has frequently been in the media discussing homebirths, and never shies away from highlighting the lack of commitment from the HSE.

Last year, she was prominent in supporting Aja Teehan, who brought a High Court action against the HSE which had deemed her unsuitable for a homebirth.

In theory, if one was a mandarin in the health infrastructure, who was ill-disposed towards dissonant voices or corporate criticism, one might well regard Ms Canning as a pain in the neck, irrespective of her lauded professionalism or contribution to maternity care.

On August 11, Canning submitted plans to open two birth centres in Dublin. She sourced appropriate premises and was understood to have accessed financial backing. All she required was the go-ahead from the HSE, a move which would recognise the role of birth centres in maternity care for the first time in this country. On September 12, she received word the HSE was withdrawing her indemnity cover. This, she was told, was due to an incident at a birth in early August, and another in April. No findings have been made against her. No complaint has been made about her.

In the two cases, the mothers are reported as being fulsome in praise of the care they received and are supporting Canning’s efforts to have her cover reinstated.

The August incident involved the mother being admitted to hospital after birth because she was feeling dizzy. She was sent home after 10 hours.

On Monday last, High Court judge Max Barrett dismissed Canning’s application for an injunction preventing the HSE withdrawing her cover. When the hearing opened the previous Friday, up to 50 women and children held a protest outside the Four Courts in support of Canning. Some of them were among the 25 who had booked her to provide maternity care in the coming months.

Judge Barrett refused the injunction.

That’s the judge’s opinion of the law. Justice, however, is a different matter. The ruling has effectively put her out of business until the full hearing, and what might well be a further delay thereafter before a ruling is issued. She has been offered the option of continuing under supervision from the HSE, but she refuses to submit to that. The kernel of the matter are the investigations the HSE says it is conducting. One of these incidents is five months old, the other nearly two. There is no tragedy involved. There was no complaint from the mothers, far from it. There is no requirement to interview dozens of personnel and access realms of medical notes and reports, spanning days or weeks. These are very straightforward matters for which contemporaneous reports would have been compiled.

Yet, the High Court was told, both incidents are still under investigation, and as long as the investigation persists, Canning’s life and career is darkened by a cloud. You don’t have to be a fan of Yes Minister to observe how handy an ongoing investigation can be if other matters are in play.

Public health concerns were cited by the HSE in the legal case, but public health can cut both ways. Canning’s clients are also entitled to know urgency is being attached to investigations being conducted. Irrespective of how you hold it up to the light, it’s difficult to see how investigations have not been long completed and the findings made known.

Perhaps because of the relative rarity of homebirths, the case has not floated the boat of the body politic.

Independent TD Clare Daly is the only one to have brought the matter to the floor of the Dáil. She referred to the case in a debate about the findings of the coroner’s court last Monday on the death of Dhara Kilvehan.

“I find it sickening that on the same day that the verdict of death by medical misadventure was given against Sligo hospital, an independent midwife with 31 years of stalwart experience, Ms Philomena Canning, had her State indemnity insurance withdrawn consequent to a decision handed down in the courts,” she said, addressing Minister for Health Leo Varadkar.

She went on: “This is really serious, particularly when one notes the list of fatalities in hospitals under the direction of the HSE. Nobody was suspended, let alone fired. Ms Canning has devoted her life to women and proper birthing in which women have a choice.”

Varadkar replied that he wasn’t fully briefed on the case and went on to claim that the HSE “supports and provides cover for a number of community midwives”, a contention that would be liberally interpreted by those working in the area.

In his previous portfolio, Varadkar brought independent thought to the matter of the garda whistleblowers and, in doing so, helped shine a light on that which many wanted to remain in the dark. He should take a proper, independent, look at this case even if it discommodes any elements in the HSE who might prefer to see some dissonant voices silenced.

You don’t have to be a fan of Yes Minister to observe how handy an investigation can be if other matters are in play

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