Sir, – Midwives and obstetricians are right to reassure pregnant women that childbirth has never been safer than it is today. A maternal death is rare but devastating for her family and for her birth attendants. Such tragedies remind us that birth, in hospital or out, is still somewhat risky.
However only the death following home birth has resulted in the withdrawal of midwifery services by the Health Service Executive. Why this stark difference in approach?
The National Maternity Strategy recognises that for many women, a home birth, supported by a midwife within a national home birth scheme, is the most appropriate care.
The HSE has chosen, in a knee-jerk response and in an evidence vacuum, to withdraw the national home birth midwifery service. It has not decided or even suggested closing an obstetric hospital service. This action against home birth reveals the true philosophy underpinning the HSE’s governance of birth: that women, and in particular, midwives, cannot be trusted.
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The principle of women’s bodily autonomy, supported in the recent constitutional amendment has still not been cemented into Irish maternity services.
Midwives support choice, but also accountability, risk assessment, good governance and due process of inquiry. We want the HSE to fulfil its responsibilities in all these regards. We want them to recognise the fear underpinning its withdrawal of home-birth services and the abuse of power in doing so without due process. We want the HSE to understand the disrespect this action shows not only to women and home-birth midwives, but to Irish midwifery as a whole.
Every woman deserves the right care, in the right place supported by the right person. For many women that is still a midwife attended home birth. We must remember that it is her life, her birth and her baby.
It is her risk decision, and it is for her to choose where to birth and with whom.
– Yours, etc,
Dr COLM O BOYLE,
Assistant professor
in midwifery,
Trinity College
Dublin.