Martin Conway (Fine Gael)
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I raise the matter of home births and related midwife indemnity issues because I have been contacted by a number of constituents. The Minister is familiar with the issue and I am interested to hear his reply.

Leo Varadkar (Dublin West, Fine Gael)
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I thank Senator Conway for raising this matter.
Subject to overall Government policy, staffing of the health service is primarily a matter for the Health Service Executive, HSE. However, there are issues concerning the provision of midwives for home births and I welcome the opportunity to comment on these.
There are a number of areas of the health service where staffing shortages exist, including certain categories of consultants and non-consultant hospital doctors, NCHDs, theatre nurses and community midwives. The fact that there may be shortages of certain staff categories does not mean that the HSE is not committed to providing the relevant service. Regarding home births, I have recently stated and wish to reaffirm my view that pregnancy is not a disease but a physiological condition. There was a time when practically all births took place at home. There is no reason why women with a normal low-risk pregnancy, should not have their baby delivered at home by a community midwife or in a midwife-led unit. It should be a mother's choice within safe guidelines. It is the policy to respect an individual's choice in childbirth.
Currently in Ireland there is a national domiciliary midwifery service available to eligible expectant mothers who wish to avail of a home birth service. This service is provided by self-employed community midwives on behalf of the Health Service Executive. The midwives concerned enter into a contract or memorandum of understanding with the HSE. Each self-employed community midwife who agrees to be bound by the terms of this contract or memorandum of understanding is covered by the clinical indemnity scheme, operated and paid for by the State Claims Agency. This scheme covers clinical negligence or medical malpractice arising from the provision of community midwifery services.
The latest memorandum of understanding came into operation on 1 March 2014. The criteria for eligibility for individuals to provide a home birth service on behalf of the Health Service Executive were drafted by a group of experts including midwives and obstetricians. The new governance arrangements for the home birth service are designed to provide a safe service for both mothers and babies availing of this service and provide clarity in the contractual arrangements between the HSE and midwife. There are currently 18 self-employed community midwives who have signed a contract of employment with the HSE. The delivery rate by these midwives reduced from 288 births in 2002 to 161 births in 2012. The figures for 2013 have not been published yet. Their work is supported by designated midwifery officers in each HSE region. These officers act as advocates for women opting to have home births and provide professional support for self-employed community midwives practising on behalf of the HSE.
Ultimately, midwives choose whether or not to become a self-employed community midwives and many have chosen not to take up this role, preferring security of employment with the HSE. The expansion of midwife-led units and greater availability of home births as an option is among the issues that the general review of maternity services being carried out over the course of the next twelve months will consider.

Martin Conway (Fine Gael)
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I thank the Minister for his comprehensive reply on a matter that we will return to in this House in due course.