David Cullinane (Sinn Fein)

I move amendment No. 22:

In page 38, subsection (1)(a), lines 10 and 11, to delete all words from and including "who" in line 10 down to and including "rules" in line 11.

I welcome the Minister of State to the House. She was not in the House during the debate on Second Stage of this Bill when I let the Minister for Health know that my party had some concerns about indemnity. We tabled this amendment which seeks, on page 38, subsection (1)(a), lines 10 and 11, to delete the phrase "who maintains adequate clinical indemnity insurance in accordance with the rules".

In our view section 40 is the most contentious and problematic section of the Bill. My colleague in the Dáil, Deputy Caoimhghín Ó Caoláin, tabled a similar amendment which was voted down by the Government. We urge the Minister of State to reconsider this because if she does not, we will be forced to put the matter to a vote and we will vote against the Bill, which is unfortunate. I agree with much that is contained in the Bill and supported changes to section 8 in regard to criteria and rules. We support most of the content of the Bill but we have an issue about indemnity. We support most of what is in the Bill. We have an issue in relation to indemnity. The problem with this section of the Bill, as it stands, is that it could severely curtail the ability of women to access midwife-led childbirth. I want to make it clear that we are keen to ensure childbirth is safe. We accept it is essential that those who provide care and assistance to women during childbirth are properly qualified and registered and are accountable. We also accept that indemnity is necessary and vital. We have argued in favour of that. We have also argued that it should not be a statutory requirement, as it is in this Bill. It would be better to make indemnity a requirement of service level agreements such as the current memorandum of understanding that governs the services provided by self-employed midwives.

In our view and in the view of many midwives and some organisations that advocate for midwives, section 41, as drafted, could pave the way for the criminalisation of autonomous midwifery practice. It provides for the imposition of terms of imprisonment of up to ten years for midwives who break the extremely restrictive rules that underpin indemnity. It has been noted that the threat of such penalties has not been imposed on doctors, for whom insurance is not legally compellable. In our view, it does not serve the public interest to make midwifery indemnity a statutory requirement. Section 41, as drafted, would enable the insurer - the State, in this case - to dictate the terms and conditions of childbirth for maternity service users. This is because of what has been described by the community midwives association as the "inflexible" conditions attaching to this insurance. One of the organisations that advocates on behalf of midwives is arguing that this Bill could ensure that inflexible conditions are attached to this insurance, which is unobtainable after a mother has turned 40 and once obtained is capable of lapsing at any moment during labour. The section, as drafted, restricts self-employed midwives from accepting various categories of mothers as clients. It further obliges self-employed midwives to abandon their clients in mid-labour if they exhibit some change in their condition that is prohibited by the terms and conditions of their indemnity. Some Senators on the other side of the House are shaking their heads, but what I have said is an absolute fact.