Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)

We are on Committee Stage. The Minister of State is wrong, namely, that the midwifery committee, which is to be established from Bord Altranais agus Cnáimhseachais, cannot have binding decision-making over all matters other than fitness to practice where its role and engagement with the board are concerned.

There is a need to accept that, in the passage of the Health and Social Care Professionals Act 2005, there has already been a recognition of 12 specific health professions. Why would midwifery be excluded? I remember dealing with that legislation and I do not doubt that the Minister of State and the Minister probably reflected in the same way. The Act covered such professions as occupational therapists, speech and language therapists, physiotherapists, psychologists, social workers, dieticians etc. We argued about why midwifery had not been included. I remember that particularly. I can see ongoing resistance to giving midwifery its due recognition and respect across all the disciplines in the health professions. That is very unfortunate and the issue should be grappled with. I would have argued for a separate board for midwifery if I did not believe the arguments for the establishment of a midwifery committee with similar powers were sustainable. This is a joint board relating to nursing and midwifery, two very separate disciplines and professions. It is very important that we do not perpetuate the failure to give midwifery its due respect and regard for those who practice the profession.

The Minister can improve on amendment No. 7, which has now been recommitted. I have presented real changes that will make a significant improvement to the Minister's text. It is an attempt on the part of my colleagues and me to give real powers to this midwives' committee. The powers in this legislation and with the Minister's amendment are inadequate for the profession into the future. There are very serious concerns among mothers and maternity groups, as well as midwives and their associations, over the way in which midwifery is and has been dealt with in the presentation of this Bill. Correctly, they feel that the role of midwives has not been given due recognition.

The point has been well made in the oft-quoted fact - rather than view or opinion - that the terms under which midwives are legally required to work are also the conditions under which women are obliged to give birth. If we return to the premise and accept it, there can be no doubt in our minds as to what we must do in this regard.

The Community Midwives and others point out that if section 24(3) is passed as drafted, midwifery will be the only health care profession - of which I have named a number - without the ability to govern itself. That is a major deficiency in the legislation which perpetuates the almost second-class view of those in midwifery. It is one of the oldest professions and it is highly thought of and respected by the greatest number of our populace.

The right of midwives must have equal respect to the other professions catered to under the Health and Social Care Professionals Act 2005. We must recognise that there are major crises in midwifery and the delivery of maternity care across the State. Every effort should be made to strengthen legislation to arrive at the best possible outcomes. There is currently a serious shortage of midwives running at approximately 30% in Dublin's maternity hospitals. The hospitals are down in excess of 250 midwives in the service for the city and its wider hinterland.

The KPMG report stated in 2008 that Dublin maternity services are at risk "of serious untoward incidents" as a result of the serious under-resourcing for midwifery in terms of staff employed across the three hospital sites. These hospitals cater for approximately 40% of births across the State, which is a significant responsibility. As a result of the shortage, midwives in Dublin are currently delivering nearly double the number of babies that they should be obliged to according to expert guidelines. In other words, each midwife within the system in this city is working twice as hard as he or she should be. That potentially impacts negatively on the quality of maternity care and makes medical intervention to accelerate births much more likely. Statistics bear out increases in Caesarean sections and support that view.

These front-line service providers do not want such a position to continue and midwives are the first voices and advocates for the best possible service to women before births, those in true childbirth and those needing post-natal services. I record my support for the case they put. We should make no mistake that women presenting today are less likely in overworked labour wards to be allowed to go through natural slow-birth procedures. They will almost be fast-tracked in achieving, to use an industrial term, delivery systems. That is unacceptable with all the consequences that can be involved. Normal birth numbers are clearly declining and that does not meet women's choices at this time, which must be paramount in our consideration of the matter.

The arguments for the improvement of the language are encompassed in amendment No. 8, which seeks to establish a midwifery committee "to advise the board, with binding effect other than in respect of fitness to practice matters, in relation to all matters pertaining to midwifery practice under this Act". I commend that alternative to the Minister of State and believe it to be her natural inclination. I urge her and her colleagues to assert their views on the matter and not allow a continuation of what is likely a male-dominated preparation of this legislation inherited from the previous Government.

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