Clare Daly (Dublin North, United Left) | Oireachtas source

When she comes back, she will want to speak about some of the issues I will be raising. It is difficult to comment sufficiently on everything covered by such a wide-ranging Department. We have to hone it down.

I would like to develop some of the points raised by Deputy Caoimhghín Ó Caoláin. I will concentrate almost exclusively on the issue of maternity care. We have to accept that maternity care in Ireland is expensive and wasteful. In many instances, it has proved to be damaging to maternal and foetal outcomes. We have seen a number of tragic cases. The approach to research in this area has not been based on evidence and we are at an absolutely critical juncture. Some of these points have been made previously. The country's rate of Caesarean sections is completely out of kilter with the rate in other countries. Eight of the country's 19 maternity hospitals have recorded Caesarean rates of over 30%. There is blanket use of electronic foetal monitoring in all units. The level of Caesarean sections and unnecessary interventions can be attributed to the failure to deliver a nationwide strategy of midwife-led units as the best way forward. The country's maternity practice - the combined model of ante-natal care, in which a woman gains access to a general practitioner and a consultant obstetrician - has not been reviewed for 60 years. The GP aspect of the system alone costs approximately €17 million. If we were to stand this on its head by looking at having the service led by midwives, it would be far better for everybody. All European and international countries came to that conclusion a long time ago and we are really behind the bar on this one. The issue needs to be addressed now.

While we cannot discuss the case of Philomena Canning and nobody is doing so, it has brought the issue centre-stage. Every woman is supposed to have the right to access a home birth facility in a low-risk scenario. The effect of the State's action - the HSE's decision to remove Philomena Canning's indemnity cover, which was made without explaining the matter to her or speaking to the two women involved - has been to leave 29 women without this option. While we cannot discuss it, we can say that what happened next really shows the failure of the HSE in its duty of care to women. As Deputy Caoimhghín Ó Caoláin said, there are 29 clients of Philomena Canning, one of whom was in touch with us this morning. She is 35 weeks pregnant. 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 to themselves. Obviously, women who do not have private insurance cover could not envisage taking such action.

The HSE was able to expend a huge amount of money on what, in some ways, was an unnecessary legal action. During those court proceedings it was said that Philomena Canning would be allowed to continue under the supervision of another midwife. Now they are saying to the people who have been left out that there are no other midwives to cater for those women. Clearly, therefore, the evidence given in court must have been a little bit suspect, if that is the case and if no services can be provided. We know that no services have been provided because the women have told us.

I would like the Minister to take note of the women's dossier outlining their concerns. They wish to waive their anonymity and would be happy to have their stories told here. I do not have enough time to do so, however, so I wish to give the Minister the dossier. I think he will be crying at the end of it.

Heavily pregnant women had developed a rapport with their midwives, which is the whole benefit of midwifery-led services. It is highly traumatic for them to have their pregnancies interfered with in this way. It is just not good enough, so I would like to see an inquiry into the HSE's handling of this matter. I would like the Minister to tell us why the Nursing and Midwifery Board of Ireland is not involved in this matter. It is the role of that board, rather than that of the HSE. I am not sure why it has not been involved, but the situation is absolutely unacceptable. I echo Deputy Ó Caoláin's point that this matter needs to be dealt with now. Those women are entitled to midwives. If the State is saying they are not available here in Ireland, women should be entitled to access that service from Britain. It should be paid for, because it is their entitlement. The issue has not been dealt with appropriately since it emerged.

I wish to raise two other linked issues. One is the Protection of Life during Pregnancy Act, the guidelines for which we have seen since the last meeting.