Thursday 29 May 2014

MINISTER "My department respects an individual's choice in childbirth and their right to have a home birth"

AIMSI have received the following transcript relating to a PQ to the Minister for Health regarding NICE guidelines and the Implementation of Midwife Led Care options to women in Ireland.


Please see Question with Response in full below.




QUESTION NO:  739
    DÁIL QUESTION addressed to the Minister for Health (Dr. James Reilly)
    by Deputy Caoimhghín Ó Caoláin
    for WRITTEN ANSWER on 27/05/2014  

     
     *  To ask the Minister for Health if his attention has been drawn to the findings of Britain's National Institute for Health and Care Excellence (details supplied) that women with uncomplicated births should have greater access to midwife-led care outside of hospitals; the steps he will take to increase such access in Ireland; and if he will make a statement on the matter.

                                                                                             Caoimhghín Ó Caoláin T.D.

    Details Supplied: Details:
    http://www.theguardian.com/lifeandstyle/2014/may/13/pregnant-women-home-births-midwives-baby

     
    REPLY.
    My Department and the Health Service Executive respect an individual's choice in childbirth and their right to have a home birth.
    Currently in Ireland there is a National Domiciliary Midwifery service available to eligible expectant mothers who wish to avail of a home birth service under the care of a self-employed community midwife (SECM).  This service is provided by the self-employed community midwife on behalf of the Health Service Executive who signs a Memorandum of Understanding (MOU) with the Health Service Executive.  Each self-employed community midwife who agrees to be bound by the terms of this Memorandum of Understanding, is covered by the Clinical Indemnity Scheme (CIS), operated by the State Claims Agency for clinical negligence or medical malpractice arising from the provision of community midwifery services. The criteria for eligibility for the home birth service provided by the self-employed community midwives on behalf of the Health Service Executive were drafted by a group of experts including midwives and obstetricians.
    There are currently two midwifery-led units in existence: one in Cavan and the other in Our Lady of Lourdes Hospital Drogheda. My Department is developing a maternity strategy which will involve a literature review of obstetric and midwife-led care models. The strategy should inform the development of different types of midwifery-led care so that women have greater choice nationally.






    Please take particular note of the following:


    1)
     
    "My Department and the Health Service Executive respect an individual's choice in childbirth and their right to have a home birth." 


    And Yet,


    "Each self-employed community midwife who agrees to be bound by the terms of this Memorandum of Understanding, is covered by the Clinical Indemnity Scheme (CIS)"


    And,


    "The criteria for eligibility for the home birth service provided by the self-employed community midwives on behalf of the Health Service Executive were drafted by a group of experts including midwives and obstetricians"


    Wait.. but...you just said you respect an individual's choice to homebirth and their right to have a homebirth. So, individuals have the right to choice in childbirth, ONLY , under the terms of the HSE?


     That would be a big NO on respecting an individual's right to choice in childbirth and their right to have a homebirth then.


    Also worth a note is regarding the 'professional expert group' who drafted the eligibility criteria.... which included "midwives", did not collaborate with, nor take direction from the professionals with the highest expertise on homebirth in Ireland..... the very midwives providing community clinical care. Bit odd, no? To alienate those who are supplying the service and know the issues best?


    Minister, what did your group of experts base the criteria on? Systemic reviews of evidence based research and best international practice? Because we seem to be on our own here compared to other European countries.


    Funny how the tables used by the expert group for eligibility mirror nearly word for word those in the NICE guidelines. Only, in the UK, the final decision is the woman's choice. Even if she's high risk she is the ultimate decision maker, she just needs a midwife to support here. The Irish experts decided to take out that bit.








    2)


    "To ask the Minister for Health if his attention has been drawn to the findings of Britain's National Institute for Health and Care Excellence (details supplied)"


    We note that the Minister does not respond to the reference of the NICE guidelines or if he has referred to them.


    If he had, the Minister would have seen this,


    "Advise low-risk multiparous women to plan to give birth at home or in a midwifery-led unit (freestanding or alongside). Explain that this is because the rate of interventions is lower and the outcome for the baby is no different compared with an obstetric unit. [new 2014] [3]" 


    And this,



     "Advise low-risk nulliparous women to plan to give birth in a midwifery-led unit (freestanding or alongside). Explain that this is because the rate of interventions is lower and the outcome for the baby is no different compared with an obstetric unit, but if they plan birth at home there is a small increase in the risk of an adverse outcome for the baby. [new 2014] [4] "



    And this,

    "Commissioners and providersa should ensure that all 4 birth settings are available to all women (in the local area or in a neighbouring area). [new 2014] [8] "


    this,




    "there are no differences in outcomes for the baby associated with planning birth in any setting. [new 2014]"




    And also this,

    "planning birth in an obstetric unit is associated with a higher rate of interventions, such as instrumental vaginal birth, caesarean section and episiotomy, compared with planning birth in other settings "




    And most importantly, THESE,


    "Explain to the woman that she may choose any birth setting (home, freestanding midwifery unit, alongside midwifery unit or obstetric unit), and support her in her choice of setting wherever she chooses to give birth. [new 2014] "




    "Providers, senior staff and all healthcare professionals should ensure that in all birth settings there is a culture of respect for each woman as an individual undergoing a significant and emotionally intense life experience, so that the woman is in control, is listened to and is cared for with compassion. [new 2014]"

    "When discussing the woman’s choice of place of birth, do not disclose personal views or judgements about her choices. [new 2014]"




    Minister, the concept of respecting an individual's right to choice in childbirth is either fully inclusive, or non-existent. Removal of choice is never best practice. Your administration - the current Labour/Fine Gael Government - in enacting the Nurses and Midwives Bill have removed a women's right to choice in childbirth and the right to homebirth.


    Respect rights? No. You violate rights.




    You can read the full NICE Guidelines here: http://guidance.nice.org.uk/CG/WaveR/109/Consultation/DraftGuidance/pdf/English

    No comments:

    Post a Comment