Thomas Pringle (Donegal, Independent)
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405. To ask the Minister for Health the reason midwife-led care options, including homebirth, midwife-led hospital units and birthing centres were not included as part of the national maternity strategy creating a better future together 2016 to 2026; if his attention has been drawn to the inequalities facing pregnant women in County Donegal forced to birth in exclusively obstetric led units in Letterkenny or Sligo hospitals; and if he will make a statement on the matter. [50299/17]

Simon Harris (Wicklow, Fine Gael)
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Ireland's first National Maternity Strategy - Creating A Better Future Together 2016 - 2026 - recognises pregnancy and birth as a normal physiological process. It aims to ensure that appropriate care pathways are in place in order that mothers, babies and families get the right care, at the right time, by the right team and in the right place. Similarly, it recognises that, while all pregnant women need a certain level of support, some will require more specialised care. Accordingly, it proposes an integrated model that delivers care at the lowest level of complexity and encompasses all the necessary safety nets in line with patient safety principles.

The Strategy makes it clear that women should be offered choice regarding their preferred pathway of care, in line with their clinical needs and best practice. The model consists of three care pathways - supported, assisted and specialised. The Supported Care Pathway is intended for normal-risk mothers and babies, with midwives leading and delivering care within a multidisciplinary framework. Care will be delivered by the community midwifery team, with most antenatal and postnatal care being provided in the community and home settings. The woman can exercise a choice with her healthcare professional with regard to the birth setting, which may be in an Alongside Birth Centre in the hospital, or at home. The Assisted Care Pathway is intended for mothers and babies considered to be at medium risk, and for normal-risk women who choose an obstetric service, while the Specialised Care Pathway is intended for high-risk mothers and babies.

With regard to birth settings, the Strategy proposes Alongside Birth Centres for the Supported Care Pathway and Specialised Birth Centres (current labour ward) for the Assisted and Specialised Care Pathways. Freestanding birth centres are not recommended in the Strategy as it is considered that it will first be necessary to monitor and evaluate the implementation of Alongside Birth Centres in an Irish context.

In relation to the terminology used to describe the new model of care, the Strategy, unapologetically, places mothers at the centre. Therefore, profession-centric terms such as "consultant led" and "midwifery led" have been avoided, as far as possible, as they incorrectly place an emphasis on the profession. As I have outlined already, in future, maternity care in Ireland will be provided in an integrated manner, by a multidisciplinary team, with women seeing the most appropriate professional, based on their individual need.

Finally, I should mention that the Strategy will be implemented on a phased basis over the coming years and this work will be led by the HSE National Women & Infants Health Programme. Last month, I was pleased to launch the Programme’s detailed Implementation Plan for the Strategy. That plan seeks to ensure that each maternity network will have all three care pathways in place and operational in 2018. The Plan also provides that by early 2019, a minimum of 20% of pregnant women presenting at our maternity hospitals/units, including those units in the north west, will have access to the supported care pathway.