Dáil debates
Thursday, 18 January 2024
Ceisteanna Eile - Other Questions
Health Services
10:10 am
Violet-Anne Wynne (Clare, Independent)
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11. To ask the Minister for Health his views on the availability of homebirth services; and if he will make a statement on the matter. [1839/24]
Violet-Anne Wynne (Clare, Independent)
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I would be very grateful if the Minister could give me his view on the availability of homebirth services across the country with specific reference to my constituency of Clare.
Stephen Donnelly (Wicklow, Fianna Fail)
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I thank the Deputy very much. I put women's healthcare services front and centre in this Government in terms of investment and expansion. I believe we have to make up for many decades of lack of investment. The House broadly agrees that thanks to the work of our healthcare workers there has been important progress over the past three years. We will launch a new women's health action plan later on this year for the next two years. The first two years – 2022 and 2023 - are done.
Specifically in response to the Deputy's question about maternity services, there was investment of €16 million in 2021 and 2022, which got the national maternity strategy going again. Core to that strategy is the question raised by her of choice for women in terms of whether they want a consultant-led approach in the hospital, a midwife-led approach in the hospital or a midwife-led approach in the community and at home. Choice for women in terms of options for birth is core to all of this.
There is a disagreement between the consultant body – maybe not all of them but I am speaking in generalisations here – and the midwives. I met with a fantastic group of midwives at the INMO conference some time ago. Their view is that the time to the hospital – the current policy is set at 30 minutes – should be longer and they gave very good reasons for that. I also met very experienced obstetricians who said why they believe that 30 minutes is the right way to go from a patient safety perspective. Obviously I am not qualified to comment on that. There is an ongoing discussion on whether it should be 30 minutes or longer and what resources need to be in place for that to happen. I can tell the Deputy what I and the Government want to facilitate from the perspective of the direction of travel. It is the greatest possible options for women, but with an obvious caveat that those services need to keep women and their babies safe.
Violet-Anne Wynne (Clare, Independent)
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I thank the Minister for the information. I raise this matter with him today on behalf of my female constituents in County Clare. He may be aware of the case of one particular lady, as I have previously written to him about her. She is due her second child in July and as he may be aware there are already extremely limited options for birthing in the county. She wrote me a letter and I am going to share some of it with the House this morning:
While trying to organise a homebirth it transpires that the midwives who previously served and wish to serve in our area, have been forced to private practice. This service, provided by the organisation Private Midwives, costs around €6,800. The national maternity strategy highlights choice as a key priority for low-risk women. It identifies homebirth as a choice. [As the Minister would know] An alongside birth centre does not exist in our area. Homebirth is the only alternative to the maternity hospital. This is a women’s healthcare prerogative that needs to be addressed.
While delivering her first child, active labour lasted less than one hour so she is a perfect candidate for a homebirth. The current reality is that my constituent can register as a patient in University Maternity Hospital Limerick, UMHL, our closest maternity hospital then pay privately for a homebirth and transfer to UMHL during labour, if needed. For her family to pay privately would put them in financial hardship. UMHL's suspension of homebirth services in the Limerick-Clare-north Tipperary region, leaves less privileged women in the area without access to a service that is provided by all other maternity hospitals.
Stephen Donnelly (Wicklow, Fianna Fail)
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I cannot comment on the individual case. I am not familiar with it. However, as the Deputy referenced, there was an incident in June 2022 when the HSE notified my Department of a maternal death in the mid-west following a home birth. At that time those services were then stopped. A review is being commissioned, which needs to happen quickly. I discussed this with a group of very experienced midwives who made the following point on exactly this to me: they said there are also maternal deaths in acute settings and we do not shut down the hospital maternity services. Their view was that they felt pretty strongly about that. Again, I am not qualified to make judgments on patient safety. We need this review to happen and to be concluded to take the expert advice. to listen to the voices of the women who want these services and to get to a point where we can provide the greatest possible choice while ensuring there is an appropriate level of patient safety there as well.
Violet-Anne Wynne (Clare, Independent)
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I again thank the Minister. I appreciate what he has stated. The stipulation of 30 minutes would really restrict services in County Clare because of the distance involved, which would limit the service to very small pockets of the county from which women would be able to get to UMHL within that timeframe. It is important to mention that to the Minister. There is a major concern that there would be a two-tier system within maternity healthcare.
The HSE recommendation to limit homebirths to women who live 30 minutes from a maternity hospital will restrict the options for women and families in County Clare, in particular for those in rural parts of the county. It is also contrary to the national maternity strategy's priority to ensure "women have access to safe, high quality, nationally consistent, woman-centred maternity care". It is important to note that this recommendation was developed with no input form midwives, clinicians, or women's health advocates. I firmly agree with the midwives association's call for a reconsideration of this policy by engaging all stakeholders. Will that be included in the review? Women were second-class citizens in this State for long enough. We should not be further restricted. Instead, we should be supported in making our own informed choices about our maternity care.
Stephen Donnelly (Wicklow, Fianna Fail)
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We have discussed the issue of homebirth and we need an answer to this that works for women in terms of choice and safety. While that is being progressed, significant improvements are happening across maternity care. Through the strategy we have hired an additional 465 staff who were very badly needed and who are making a big difference.
I have been in many of the maternity units and I have seen the upgrades to the birthing suites. There are pools there now, for example. The midwives are saying that things that might be considered small, cosmetic changes are making a huge difference to women and the experience they have. The clinical outcomes are getting better and better. A very comprehensive system is in place. One of the areas where we actually do well in e-health is in the maternity services.
Just last year, five new postnatal hubs opened at hospitals in Cork, Kerry, Sligo, Ballinasloe and Carlow-Kilkenny. While we will, therefore, resolve the issue the Deputy has quite rightly raised, he should rest assured that we are going to continue to invest in growing all of the maternity services to ensure they really can be seen as some of the best around the world.