Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)

I remember when this Bill was first mooted. My recall is that it did not include any reference to midwifery but dealt only with nursing. The Nurses and Midwives Bill was a later development. Going back to the Health and Social Care Professionals Act 2005, I always viewed - and still view - midwifery as a stand-alone profession deserving full recognition. This Bill has been awaited for a long time, and I welcome the new Government's decision to fast-track it in the first weeks of the new Dáil. We have all waited for the opportunity to get to this stage. I always hoped the midwifery committee would substitute for the need to establish a separate board for midwives. I have no doubt the Bill and the Minister's amendment fall far short of what is required. If the Bill is passed in its current form, we will have ongoing problems.

I have already made a point about the growing number of Caesarean sections in various hospitals. The 2008 KPMG report mentions that 28% of all live births in the Rotunda Hospital in 2008 were by Caesarean section, and I am told that is just marginally above the State average. We are talking about at least a quarter of all births across the State. This is not what women would opt for first, and if the child had a voice, it might not be his or her choice either. Such a level of intervention has implications for sustainability as well as patient safety.

There is also the further consideration, in a time of serious economic constraint, that a Caesarean section costs three times more than a normal birth. The Government is exercised about every possible saving, but by not conferring binding responsibility on the midwifery subcommittee it will allow the perpetuation of practices that are costing every contributing taxpayer more than they should. Partly on cost grounds, the KPMG report also emphasised the need for significant enhancement of primary and community care. Moving care out of hospital and into the community is key to the HSE's alleged transformation programme, although I have mixed experiences of that in my constituency and region. Such changes, where they are happening, will require midwives to develop autonomous practices. This is another reason for a midwifery committee that will act on behalf of midwives in a knowledgeable and decisive way, not only by giving recommendations and advice for others to decide on but by overruling, setting aside or introducing measures.

If we consider international experience, we will see that modern midwifery legislation has empowered midwives in a variety of settings. The examples I cite are Canada, New Zealand, France and the neighbouring island of Britain. To amend subsection (3) as I propose would help to address the situation. Again I urge the Minister for State, not only to accept the arguments of binding effect but also to accept that amendment No. 7 seeks only to increase to eight the draft legislation's recommendation of at least five members. I take some encouragement from the fact we are using terms like "at least". In amendment No. 8 I ask for at least ten. I sought to achieve that number in amendment No. 9 but it was knocked on the head because if another couple were put in, God forbid the expenses that might be involved. The State surely could not carry this number and we are all far too busy bailing out the banks with billions of euro. God forbid we should have another midwife coming along to decide how the profession's outlook for the future might be improved.

I ask again that that element also be addressed but if it comes to a situation where the figure stands at eight, at least, I hope the Minister of State would use her influence to ensure the Minister for Health and Children, Deputy James Reilly, is as generous and facilitative in ensuring the greatest possible representation. That was the reason for many of my amendments.

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