David Cullinane (Sinn Fein)

My amendment is designed to reduce the risk posed by the current arrangements. We believe these HSE terms and conditions are operated in such a way as to prevent midwives exercising their clinical judgment and what we see as their duty of care to mothers and babies. For example, self-employed midwives who feel ethically bound to continue to assist a home birth mother whose labour does not conform to insurance rules now face jail under this Bill. That is a recipe for unsafe care.

We must examine the facts in this regard because awards against midwives in the community have been few and far between. In the past 30 years, payouts in respect of self-employed midwives have amounted to less than €250,000 in total. By criminalising midwives who practise outside the State's onerous terms and conditions section 40, as drafted, denies women the right to opt for a gynaecological service that is low tech and drug free. That is a right that has been recognised and accepted by the European Court of Human Rights. Section 40 even prevents midwives offering services such as breast-feeding advice in the community which amounts to cutting women off from their services. Community midwives' clients' breast-feeding rates are among the highest in the European Union while national rates are among the lowest. Midwifery-based care leads to better health outcomes for mother and baby and greater client satisfaction it also reduces costs and making midwives the main care givers in the majority of births could save millions of euro.

I have repeated the reasons we are opposed to this section. The Minister should not presume what any individual may or may not say in any circumstance or in the context of any Bill. I have put on the record our view that there must be indemnity, support and an increased duty of care for the patient, the child and the midwife but I repeat that making indemnity a statutory requirement is the problem. I mentioned the service level agreements which we believe is a better way to proceed rather than the statutory requirement.

I assume the Minister and the Government have made up their minds that they are not accepting the amendment and on that basis I will press it and call for a vote.