Kathleen Lynch (Cork North Central, Labour)

Before I respond to the points that have been made, I wish to inform the House that the Minister, Deputy Reilly, intends to amend the Medical Practitioners Acts to ensure all medical practitioners will have indemnity insurance. That is long overdue. I take Deputy Ó Caoláin's point about general practitioners, gynaecologists and other health professionals not being required to have insurance. The Minister's proposal will introduce such a requirement.

I believe being pregnant and having a baby is not a medical condition. I hope as many women of a particular age as possible can meet with the joyous experience of this natural condition. We need to make it clear that it is not something to be terrified of. Although I do not believe our maternity services are in crisis, having had some interaction with them recently I accept they may be a little overstretched. That can happen when there is an influx of people having babies at a particular time, for example. It is dangerous to use the word "crisis", especially when one is talking about people who are vulnerable as they prepare to have babies. I do not think we should encourage women to panic. I believe in telling them the truth, but not in causing them to panic.

Deputy Ó Caoláin and I have a great deal in common in our attitudes to this country's maternity services. We need to ensure our community midwives are insured. That is something we absolutely must have. We have been very fortunate up to now, but all it takes is one incident for things to change. When one considers the calibre of the people who are offering women the choices they want, one has to accept that luck plays no part in it. I have always said that life is about choices. It is equally important to have a number of choices and to be informed about those choices. I do not think it is fair to midwives or those they serve to allow them to work without being insured. Midwives are very well trained. They are intuitive people. Most women would tell one that they would prefer a midwife to a gynaecologist any day of the week. The intuition and ease with which midwives approach childbirth is very important to women who are in labour.

We need to get some things straight. This indemnity does not prohibit midwives from providing post-natal or antenatal care. It is clearly and strictly about the birth. We all know things can happen before or after the birth. The high point of this process is the birth itself. That is what this piece of insurance is about and that is what we should concentrate on. It is a question of patient safety. We all know people who offer valid and worthwhile services to women who would prefer to have their babies at home. We need to ensure such people are insured. It is not a matter of prohibition - it is about insurance and ensuring the health and safety of the mother and the baby. It is hugely important that community midwives who have signed service level agreements can connect into the local maternity service and have that as a back-up if something starts to go wrong. These things can happen. That support is important for the safety and security of the person being served by the midwife and it is equally important for the midwife. I can only imagine the trauma experienced by the midwife and the mother who is delivering when something begins to go wrong.

We need to ensure we cover all the bases. We should move beyond particular interests. I agree with virtually everything the midwives say. One woman told me a gynaecologist told her she was early, but she replied by telling him he was late. The presence of the midwife who has taken the woman through virtually the entire pregnancy is important. This is about protecting both sides. If there is disagreement about what constitutes an area of low risk, for example, we need to discuss such matters. What determines low risk? What additional resources can we invest to ensure women in the medium risk category can avail of the same choices as women in the low risk category? We need to talk about such things. We cannot move away from indemnity. If something goes wrong and there is no insurance in place - we are fortunate that no such case has arisen to this point - those who are not insured will expect the State to pick up the tab. I must admit that if something happens to a mother or a child in such circumstances, I would not have a difficulty with the State picking up the tab. It is much better that we do this in an upfront manner. It is a question of looking at best international practice and saying "this is the best way to do this". If issues of risk need to be ironed out, we can do that as well. I am sorry I cannot accept Deputy Ó Caoláin's amendment. We disagree on very little, but this is an area of disagreement.

I would like to inform the Deputy that a national steering committee of home births has been established by the HSE to review the implications of the memorandum of understanding between the HSE and the self-employed community midwives regarding the provision of safe, evidence-based home birth services for low risk, healthy women. As I have said, this may also have application to women who are deemed to have a risk in the medium range. That is something we will have to examine. A wide range of stakeholders, including officials from the Department of Health, are represented on the national steering committee. The inclusive nature of the steering committee will facilitate discussion on the key areas of concern and will inform future guidelines and developments. That is where we are eventually going. If women who are deemed to have a higher risk than others wish to have their babies at home, it is a legitimate choice. We need to provide for additional services and supports to make that happen. Most definitely, we cannot allow people to operate in this area without having indemnity.

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