She died on February 5 last year in Sligo Regional Hospital after suffering complications in the aftermath of the birth of her fourth child. The inquest returned a verdict of death by medical misadventure.
Last week’s proceedings were marked by the heart rending scenes of her bereaved husband Seán attending in pursuit of answers. Mrs Rowlette is the sixth woman to have died in controversial circumstances in recent years during or soon after childbirth in Irish maternal hospitals.
On Wednesday, another story of maternal care featured on the front page of the London Times. It concerned a new report that concludes it is now safer for healthy women to have babies either at home or in a birth centre, rather than a hospital.
The report, by the National Centre for Health and Care Excellence, reverses the thinking of a whole generation that the safest place to give birth is in a hospital. Its findings were regarded as so significant that they featured prominently in organs such as the New York Times. Curiously, in light of the controversy surrounding maternal services in this country, the report was largely ignored by the Irish media.
This brings us to Philomena Canning, whole plight was recorded on these pages a few months ago. She is a prominent midwife who had dedicated herself for over 30 years to delivering babies in the natural environment of the home. Currently, this form of birth is availed of by around 1% of mothers, which is way out of line with most other developed countries. In the UK, for example, there are over 100 birth centres, a midwife-led facility that provides birth in a home-away-for-home environment.
Canning is currently suspended from operating her practice while she is being investigated by the HSE, because her indemnity have been withdrawn. The investigation arose from two incidents last year in which clients were briefly hospitalised when routine complications arose soon after birth. Both of the mothers in question were effusive in praise of Canning’s care, but a midwife within the HSE made a complaint that led to an investigation. (The mothers in question were not even spoken to about their care before the investigation was opened, and only contacted months later.) Canning was informed in August her indemnity was being withdrawn while the investigation was ongoing. This put her out of business. It is noteworthy that in none of the tragedies in Irish maternal hospitals in recent years has a doctor or midwife been suspended while investigations were ongoing. Yet, in Canning’s case, where there have been no adverse outcomes for mothers or babies, where the mothers are 100% happy with Canning’s care, and where there have been absolutely no findings against her, she is regarded as a danger to mothers, pending the outcome.
One might imagine that having taken such drastic action, the HSE would expedite any investigation. Not on your life. Canning has been told the investigation wouldn’t be completed before next March at the earliest.
In the meantime, 29 clients who had booked Canning, have not attracted much in way of attention from the HSE. At an Oireachtas Health Committee meeting on October 23, independent TD Clare Daly said one of the pregnant women had been in touch with her.
“She is 35 weeks pregnant,” Daly told the committee. “She was told last week, after five weeks of trying to get answers, that a replacement midwife had not been found for her and that she would, therefore, have to go to a hospital.
“Another woman had to go to the Coombe Women’s Hospital. In four cases women had to privately access the British neighbourhood midwives scheme at a cost of thousands of euro. Women who do not have private insurance cover could not envisage taking such action.”
It may well be that maternity care and safety are the sole guiding lights of this extraordinary investigation into a midwife of 30 years standing. But other ancillary matters leave an uneasy feeling, particularly in light of the report from the UK during the week.
In 2012, Canning approached the HSE with a plan to establish a birth centre, in line with the UK model, to be made available to clients of the public health system. The HSE rejected the plan. Attitudes to homebirths in this country are not as enlightened as in the neighbouring jurisdiction, or the rest of western Europe. Apart from that, Canning is not a popular figure in some corners of the HSE. She has been a passionate advocate for women who want homebirths, and sometimes that has brought her into conflict with the powers in maternal care.
Having been stymied in her efforts to provide a birth centre under the public health system, she went about setting up a private facility. By last August, she had sourced a premises and had funding in place. This was the same month that somebody in the HSE deemed her worthy of investigation, and felt it necessary to effectively put her out of business until any probe was completed.
It may well be a coincidence. But would Canning have presented some form of a threat if her venture had got off the ground? At a time when questions are being raised about standards of maternity care, would this new facility have provided women with a choice that was theretofore absent?
The report by the National Centre for Health and Care Excellence (NCHCE) in the UK has not elicited much opposition from the medical establishment there. In the UK, maternal services are provided entirely under the National Health Service.
Dr Mark Baker of the NCHCE was quoted in the New York Times outlining why under the exchequer funded UK system, there would be no vested interests opposing a move to birth centres.
“There are no financial incentives in the UK for doctors to deliver in a particular setting because there is no personal gain,” he said. By contrast, there would be plenty to lose for some interests if a mid-wife-led setting was to gain popularity in this country. Any drift away from a consultant-led method of delivering the services would lead to a loss of both power and money in some quarters.
It may well be that such considerations have absolutely no bearing on how the HSE is treating Philomena Canning. But questions need to be answered about why it was deemed necessary to effectively put out of business the leading person in the delivery of alternative maternal services. Everything about the handling of this case gives rise to suspicions that agendas other than the safety of maternal care are at play.
There is a tradition in this country of a refusal to listen to those who stand apart from the herd. Usually, years later, a retrospective view comes to the conclusion that the outrider had been correct all along, should have been listened to, and had been treated appallingly.
Let’s hope we’re not witnessing another example of that in the case of Philomena Canning.