Tuesday, 1 April 2014

The National Committee for the Elimination of Home Birth (NCEHB)

This National Committee has been in existence for several decades. It came into being some time in the 1960s when Ireland first bought into the medicalisation of childbirth and the only acceptable birthplace became a centralised obstetric-led maternity unit. Control over birth started to move into the domain of the obstetrician; a specialist in abnormal labours and birth. Traditionally, normal births had been attended in the community by midwives; the specialists in normal birth. Their place of work was either in local maternity homes or in the women’s home. The BBC TV series “Call the Midwife” captures the spirit of these times well

Membership of the Committee.
The Committee has had many members over time, and membership changes as and when demand arises. So for example, sometimes it would appear that the committee is only made up of HSE personnel, whereas other times it would appear that the judiciary, social services, regulatory bodies and the media are also opted into the committee as ad-hoc members.

Some members have of course been given honorary life membership for their great and tireless devotion to Committee business. They have been outspoken on home birth within their hospital units, within the media and even sometimes as expert witnesses in the country’s Coroner’s Courts or High Courts.

Accessing the Minutes of the Committee.
In true HSE style the Minutes of NCEHB meetings are difficult to access or find and may require an FOI. Sometimes when Minutes are found they bear no real reflection of what actually happened at the meeting, with meeting events spuriously added in by key individuals to suits the Committee’s central agenda. As with all committees the real work is done is secret working groups and subcommittees that do not maintain minutes, so the best stuff is probably recorded on someone’s mobile phone!

Furthermore, since the Committee’s membership is so fluid and not officially noted anywhere it is hard to know how often they meet and who attends never mind what decisions have been reached. It is assumed that these meetings take place in the dark corners of the HSE, in Department of Health corridors and in the by-ways of the nation’s Maternity Units, not to mention golf clubs and dinner tables of the medico-media-legal triumvirate. Some Committee members do not even realise that they are members of the Committee believing themselves to actually be part of the home birth supporters club.

Key achievements of the Committee

  1. Eliminating the term independent midwife.
  2. Removing autonomy from the midwife to make clinical assessments and judgements for their client
  3. Insisting on indemnity insurance for midwives in the cynical knowledge that this was not available on the open market yet legislate that other medical professionals can attend childbirth without such indemnity
  4. Creating a set of exclusion criteria that eliminates the choice of home birth for women without even allowing them individual assessment
  5. Requiring that obstetricians who are not experts in the field of home birth decide on whether women can avail of a home birth service or not
  6. Insisting that women whose babies are not in clinical distress transfer to a hospital setting in labour where they will probably be subject to a rigorous set of interventions
  7. Ensuring that women transferring from a home birth to a hospital setting do not get to transfer with their primary care giver.
  8. Insisting on two midwives present at every birth, in the cynical knowledge that there are not enough second midwives available in certain areas to perform this role.
  9. Refusing to engage in the recruitment of more midwives in order to provide midwives for the second midwife service. This is a particularly notable achievement of the NCEHB as there is no evidence anywhere to show that having a second midwife present at the birth improves outcomes for mother or baby.
  10. Tell women who are booking into hospitals for their bloods and scans that there is no national home birth service
  11. Ensure that the wage paid directly to self employed community midwives is very low and ensuring that any unaccompanied transfer to hospital, even in the woman’s best interests incurs a reduction of up to €1000
  12. Ensuring that newly qualified midwives cannot act as second midwives in a community setting until they have had three years experience in a maternity hospital. This is a great committee achievement especially considering that there is absolutely no evidence anywhere to suggest that second midwives improve outcomes for mothers and babies at all, neither is there any evidence to suggest that experience in an obstetric dominated maternity setting prepares newly qualified midwives for work in the community. Leaked Subcommittee Minutes tell us that this particular decision was based on a number pretty much plucked out of thin air and agreed upon based on the personal experience of individuals present in the room at the time.
  13. Striking independent midwives off the register following in-camera hearings in which it would appear evidence from midwifery professors currently practising in home birth is ignored in favour of evidence from those not currently involved in home birth.
  14. Subjecting SECMs to a different set of professional practice evaluation criteria than those reserved for other maternity care professionals. The country has been shocked in the last year by so many revelations of failure in our hospital maternity services, but so far none of the individuals involved have been subjected to any disciplinary action blame or reproach. In fact do we even have a guarantee that they are not still doing the same thing? Thankfully, due to the Committee’s ever vigilant and tireless pursuit of self employed midwives they get a public lambasting at best should they merely be within a whiff of an event the Committee doesn’t like, and if they were present at such an event the FTP card pops up like a jack in the box..
  15. Ensuring that mothers who disobey the Committee’s rules are punished. What is the best way of punishing a new mother? The best possible way of torturing a new mother is to take her baby way from her. The NCEHB have been carrying out some interesting experiments in this area by suggesting to social services that mothers who insist on birthing at home are unfit or unsafe parents, who therefore need to have their newborns removed from them.
  16. Forbidding midwives to attend women who do not wish to transfer to hospital care, thereby putting the woman her baby and her family at greater risk and putting midwives in the invidious position of having to relinquish their commitment to duty of care.
  17. Refusing to acknowledge the woman’s right to choose the circumstances by which she becomes a parent. This is carried out despite a European Court of Human Rights ruling to the contrary.
  18. Creating research that is deliberately statistically biased to try and prove that home birth is dangerous. The committee is aided and abetted in this regards by journals, which the committee control, that are willing to print such poor research.
  19. Citing the 8th amendment as a justification as to why a mother should not be permitted to proceed with a home birth.
  20. Eliminating home birth as an option for women who have had previous cesarean birth. This, despite the fact that she may have had previous babies at home in Ireland. Given the country’s extremely poor VBAC rates (despite the existence of national guidelines too promote it) this means that such women are basically being forced into repeat sections even though this is not in their baby’s or their best interest and is not best practice.
Congratulation to the NCEHB, you are doing a great job. The only fly in the ointment are the women’s advocacy groups that seem to be opposing Committee business; harping on about such irrelevant issues as human rights in childbirth, the right to choose, evidenced based care and the right to bodily self autonomy. Some of these groups have even exposed the high quality research that shows home birth to be safer than hospital birth in an obstetric unit, with both mothers and babies having better outcomes and fewer interventions. Whilst the Committee are aware of such evidence, the general modus operandi (as with any other evidence that does not align itself with any accepted clinical practice in our maternity system) is to simply ignore it.

1 comment:

  1. I am shocked to learn that there is such an organisation in Ireland, I had no idea that it existed and yet it doesn't surprise me one bit, in fact it contextualises a lot of the goings on over the last few years. The "achievements" of this committee are a shameful testimony as to the abysmal state of maternity "care" in Ireland. The bottom line is the human rights of women are being abused (and not to the betterment of children being cared for i.e. what the 8th amendment is supposed to advocate for) and this is having serious repercussions on the health, both physical and psychological, on women, children, and men. And this will only get worse, and cost the state more in the long run, if it continues. It seems to be the case that underlining and highlighting costs has a convenient way of making the powers that be sit up and take notice. So take note Ireland, the way things are going will cost more, maybe that will change things for the better, even if the motivation is not what many would hope for; the courage to do the right thing.