Making the case for the ‘baby catchers’

Until recent times in Ireland, it was the community midwives who were entrusted as the ‘baby-catchers’, their hands welcoming almost everyone into the world.

Since their inception in 2004, Clare Birth Choice have been actively involved in making the voices of mothers and midwives heard at local and national level to ensure that the traditional birthing knowledge and skill sharing of community midwives does not become a thing of the past.
While Clare Birth Choice are often dubbed the ‘homebirth’ group, they insist that the organisation is more about giving mothers – and fathers – choice.
Martina Hynan of Clare Birth Choice, said, “Women’s choices have become limited. When I moved to Clare in 2004 and discovered there were no maternity services here I was amazed. We’re about raising awareness about where you can give birth, who is involved, who your primary care-giver is. No matter where a woman gives birth, whether at home or in a hospital, whatever way she is happy, they should have the choice. I made the choice to have a home birth where the midwife was my primary carer and I found it an amazingly powerful and beautiful experience. We want to support parents in their choices for birthing.”
While Armella Karas Doyle, another member, added, “Clare is in a unique situation in that we have no maternity hospital and due to our geographical location, we’ve had mothers who, while not choosing a home birth, have given birth on the road. It’s not just about choice, it’s about having service available to allow you to make a choice.”
However, according to Clare Birth Choice, the future of community midwifery is now uncertain with proposed new legislation, the Nurses and Midwives Bill 2010.
They say the proposed legislation will make it nearly impossible for community midwives to continue with their practice.
“There is a Memorandum of Understanding, a contract between the Self Employed Community Midwife and the HSE, which has an exclusion criteria for many women in all communities. Due to its rigidity, many women are having their choice of place of birth taken from them and this leaves community midwives in a very vulnerable position,” Martina explained,.
The exclusion criteria includes women with a BMI over 30, the woman’s age and whether or not it is their first birth.
She commented that the new bill should instead be seen as an opportunity to give midwives professional status. “I believe that midwives should be the primary carers of women throughout pregnancy and birth because they have both the medical expertise and practical skills needed to support women during this time. Birth is not an illness, it is a natural event in a woman’s life and deserves appropriate support and continuity of care. That most women now give birth in hospital should not preclude them from such support and care.
“It is clear from other countries experience that when midwives are supported in legislation then the quality of care is far better and safer. Holland is a case in point, midwives there have been affirmed as the legitimate and appropriate providers of care at birth in law since 1818.”
As part of their aim to raise awareness Clare Birth Choice recently showed a new film ‘Natural Traditions’ about the transition of midwifery in Ireland. The film showing was a fundraiser for the Community Midwives Association and Clare Birth Choice, with discussion afterwards.
Natural Traditions charts the changing role of the midwife in Ireland from independent community-based midwives in the early years of the State to hospital-based from 1950s onwards.
“It is full of incredible birth stories and insights from mothers, midwives and academics. At present, Ireland has 17 community midwives who offer women the choice of a home birth. The community midwife provides ongoing continuous support for women during pregnancy that engenders confidence and this confidence helps when it is time to give birth,” said Martina.
She added that much can be learned about birth and midwifery from looking at the traditions and experiences of the past.
“There is something eternal about the wisdom of experience. Drawing on the experience of other mothers and midwives, both past and present, is surely a secure route out of our present anxiety and around birth?”
In relation to the bill, and the concerns of Clare Birth Choice, the Department of Health and Children have responded by saying that midwifery is recognised as a separate profession by the Nurses and Midwives Bill and that the regulatory body for nurses and midwives will be called Bord Altranais agus Cnáimhseachais na Éireann – the Nursing and Midwifery Board of Ireland.
“The board is accountable for all decisions in relation to the regulation of the professions of nursing and midwifery. A midwives committee will be estboard in relation to all matters pertaining to midwifery practice.”
The department insisted, “The Minister for Health and Children supports choice for women. However, the option of home births must be provided in a safe manner. Home births can be a safe option for low-risk, healthy women. Low-risk means no history of medical or surgical problems that might affect pregnancy and no present or previous pregnancy complications.”
The spokesperson for the department commented that a number of developments have occurred over the last number of years to provide more choice for pregnant women.
The Memorandum of Understanding, is “constructed on the basis of appropriate forms of governance, clinical supervision, clinical care pathways, performance management and audit frameworks being in place,” states the department. “Part of the Memorandum of Understanding outlines conditions and factors, which indicate increased risk. There is a need to ensure that, where the State is providing clinical indemnity, a midwife adheres to the standards set by the Health Service Executive.”
The department states that a National Steering Committee of Home Births has been established by the HSE which will review the implications of the Memorandum of Understanding between the HSE and self-employed community midwives on the provision of a safe, evidence based home-birth service for low-risk women.
This committee is also drafting policy guidelines for cases which do not meet the inclusion criteria. The committee consists of representatives from a wide range of stakeholders including AIMS Ireland and self-employed community midwives as well as the Department of Health and Children.
“The inclusive nature of this committee will facilitate discussion around the key areas of concern and will inform future guidelines and developments. Effective communication is key in supporting women in childbirth. In a planned home birth, communication between the mother, the midwife and the maternity hospital is necessary to provide guidance, support and advice when concerns arise,” the statement concluded.
For more information on Clare Birth Choice contact Armella Karas Doyle at armellakd@gmail.com.