David Cullinane (Sinn Fein)

At a time when we are closing a number of accident and emergency wards and maternity units across the country, it does not make sense to prohibit emergency care by retired midwives, for example. According to our interpretation of the Bill, that is exactly what will happen. Section 41, as drafted, significantly narrows the terms and conditions in which midwifery can be practised. We believe the existing memorandum of understanding is anti-competitive because it significantly restricts the client base of self-employed midwives. This, in turn, restricts women's access to the services of such midwives. Self-employed midwives are, and seek to be, insured. They all want to be insured. Other people in the sector agree with the community midwives that safeguarding mothers against uninsured practitioners is easily achieved within a birth community that is relatively small and tight-knit. The effect of section 40 of the Bill, as drafted, would be to deny women choice in maternity care. In our view, this is not in the public interest. Hospital maternity services are at risk all over Ireland. Plans are advanced to close some of the countries maternity units. Community services must be developed to take the place of those services and the Bill as it stands restricts that possibility.

An issue also arises concerning women who live in non-urban areas who have childbirth needs that must be addressed. Some face journeys of two hours in labour to access inpatient care, often ending with a medical induction or an elective caesarian. In effectively stifling midwives' rights to offer services in the community, section 40, as drafted, denies women the right to access community care from midwives.

One of the problems is that self-employed midwives have been unable to access insurance in the private market in recent years. The only indemnity currently available to them comes from the State, and that is based on a narrow Health Service Executive home birth service. Section 40 as drafted prevents midwives from providing various services in the community such as post-natal care. Post-natal care levels in Ireland are among the lowest in Europe. Section 40, unless amended, will deny large numbers of women the freedom to give birth at home and could lead to a rise in the number of unattended births. Mothers who do not fit the State's terms and conditions are already opting to give birth at home unattended. That is happening. No mother should have to give birth at home without professional assistance. Section 40, as drafted, locks in an insurance package based on a HSE contract that ensures that indemnity can lapse from moment to moment depending on the progress of a woman's labour.

We have many concerns about this Bill and I ask the Minister to take on board those concerns in good faith. Senator Gilroy said that some of those concerns were raised on Second Stage and claimed that they are dealt with in section 41. I do not believe they are, neither does the organisation which advocates on behalf of midwives. We have real concerns.

I will listen to what the Minister has to say but if she does not accept our amendment because of all the risks I have outlined we have no choice but to vote against this section because we have real concerns in terms of what is coming down the tracks, so to speak, for many local and regional hospitals. Many of those maternity units have been downgraded, and some of them closed, across the country. We all want the highest standards and to make sure that women are protected but there are inherent risks in what we are doing here that could limit the possibility of some women giving birth at home, which is their choice. That is our difficulty with the Bill and unless the amendment is accepted we will not be in a position to support the Bill.