Róisín Shortall (Dublin North West, Labour)

It is either a legal requirement or it is not. The State would be remiss in not insisting on provision of indemnity as a legal requirement. The women who want to have home births, who want to have community midwives assisting them in those births need to be given assurances as to the quality of care being provided and, in the unlikely event that something goes wrong, that there will be adequate cover. We cannot preside over a situation where those kinds of safeguards are not in place.

The second point is that up to 2008, cover was provided by the INMO but this cover was withdrawn in 2008. The HSE is setting out standards of safety requiring practitioners to have clinical indemnity and providing a scheme of indemnity with certain conditions. If we were to do otherwise, it would mean giving open-ended cover. The HSE developed this scheme in order to facilitate community midwives in doing their very important work and to ensure safeguards were in place but this is not an open-ended scheme and it has to set down conditions. The assessment of the level of risk is clearly an important element of the scheme.

Community midwives are not required to avail of the State scheme; they are free to arrange their own clinical indemnity. However, in a high-risk or a potentially high-risk situation, they would find it exceptionally difficult to achieve that indemnity cover if it were possible at all. The HSE is acting with all reasonableness in this situation and also responsibly. It has to set down conditions under which a view is taken as to what constitutes safe circumstances and what circumstances pose too great a risk for the mother and the child concerned.

Senator Cullinane referred to the work done by community midwives such as encouraging higher levels of breast-feeding and I agree this is very important work which is highly valued. I wish to be clear that the question of indemnity only arises for the actual birth and it does not apply to any other services involved either before or after birth. I hope the Senator would accept our bona fides in this regard. We want to ensure highest standards and the safest possible circumstances for women who choose to have home births. We support that right of choice but we must also be reasonable and responsible in terms of identifying potential risk. This is the Government approach and I hope the Senator might reconsider.