A happy ending for the Midwife's Tale

A slight, mild-mannered figure, Ms Ann Kelly was almost speechless with distress and shock when she first spoke to The Irish Times almost two years ago. She had just been suspended from practising as a domiciliary midwife by an injunction brought in the High Court by An Bord Altranais, the regulatory body for the nursing profession.

This followed a complaint against her from the Master of the National Maternity Hospital in Holles Street, alleging undue delay in bringing to hospital a mother undergoing a long labour. That complaint went to the board's Fitness to Practise Committee, where it is still being heard.

Ms Kelly had almost 30 years' nursing experience, much of it as a domiciliary midwife. She had delivered some 2,000 babies in three continents. With the exception of two instances where the foetus suffered from pre-birth deformities which would have made survival outside the womb impossible, she never lost a baby.

Her professional competence had never been questioned before and it was clear she did not know how to deal with this challenge. However, the parents of children she had helped deliver rallied to her support and a legal team was found to represent her.

Solicitor Mr Colm McGeehan and senior counsel Mr Michael Forde were no strangers to David and Goliath contests - among the cases they had won was the McKenna case, which prevented the government from funding one side in the divorce referendum. They brought in British barrister Ms Barbara Hewson, who had already won important cases in Britain challenging compulsory Caesarean sections.

There then began what seemed like a war of attrition in the courts, involving 17 High Court hearings.

The first success was to get permission to have individual variations of the injunction. These allowed women who wanted Ms Kelly's services to apply to the court for them. Over the past 18 months, 60 mothers have done so and Ms Kelly has helped deliver 47 healthy babies.

The next issue was whether the Fitness to Practise hearing should be heard in private, excluding even expert witnesses. This went all the way to the Supreme Court, which found in favour of Ms Kelly, allowing her witnesses in on the hearing.

Her lawyers also challenged the taking out of the injunction on the grounds that she had not been allowed state her case to the court. That issue has yet to be decided by the Supreme Court.

However, earlier this week, the President of the High Court refused an application from An Bord Altranais to make the injunction permanent, thereby lifting it. Effectively, Ms Kelly's ordeal was over. While she still faces the Fitness to Practise hearing on the specific complaint, there is now no High Court ruling that she is a danger to the public and should not be allowed to practise.

However, she was not in court to hear it. She was with a woman who was in her fourth day of labour.

Curiously, it resembled the case which had brought her to the attention of the Fitness to Practise committee in the first place. This was an older mother, pregnant with her first baby after 14 years of marriage.

"It was the first time since the injunction was granted that there was a long labour and a difficult-shaped head," she said. "She was making a lot of noise over the three days. The police were called," she laughed.

HOWEVER it all ended well with the safe delivery of a healthy boy who weighed over 11 lbs. Almost at that moment, the injunction was being lifted in the High Court. At first Ms Kelly could not take it in. "When Colm [her solicitor] rang me I hadn't had any sleep for four days."

This graphically illustrates what she, and her supporters, feel was at stake in the case - the right of a pregnant woman, if she so chooses, to have continuity of care so that the same person helps her through her whole pregnancy and birth however long it takes. Their critics, however, feel that a determination to deliver babies at home at all costs can put the health and even life of the baby at risk.

Ms Kelly acknowledges that some mothers have to be brought to hospital when problems arise during labour, though she stresses that problems are more likely to arise in pregnancy. But she does not accept that hospital deliveries are necessarily safer than home deliveries.

"You're dealing with creation. It's 98 per cent perfect, but it's not 100 per cent perfect. There are deaths, there are handicaps. You cannot give women the impression that there will be 100 per cent perfection. In Western society, because women only have a few children, they expect everything to be perfect. A hospital does not make it perfect either and there is no guarantee."

Now that the injunction has been lifted she speaks with quiet confidence about her skills. This comes from years of practice where there were no hospitals and she had to rely on her own skills.

Born in Co Wicklow 49 years ago, she followed the well-trodden path of many young Irish women into nursing in Britain, qualifying as a midwife with both hospital and domiciliary training.

She never married and has no children herself. "I never met the right lad and I always wanted to travel. I firmly believe some people have children and some don't. I accept that."

Her travels first took her to the US, where she worked in the high-tech obstetrics department of the Methodist Hospital in Fort Worth, Texas. From there she went to Canada, where she trained as a public health nurse. She then worked as a public health nurse with native Americans and Inuits in the North Western Territory for 10 years.

"There were no doctors there. The doctor came once a month. I did everything - murders, plane crashes, dental work, obstetric emergencies. That's where I got my skills. You got used to diagnosing things like meningitis and foetal distress.

"Give me a plane crash to deal with any day instead of this case. You can do something. I could not do anything about the case - I felt powerless."

She became a Canadian citizen and never thought she would return to Ireland. However, she missed things like theatres and the cinema, then her father became ill and she decided to come home, thinking she could slot her skills into the public health system in Ireland as she had in Canada.

"I didn't understand our health system. Then I set up on my own." But working as a self-employed person was difficult, so she left again, this time for Africa, where she worked on behalf of the Department of Foreign Affairs for two years with public health nurses in northern Zambia.

She returned in 1988 and set up as a domiciliary midwife. While in the mid-1980s the majority of her clients were medical card holders, the residue of the old working-class tradition of home deliveries, in the 1990s they were increasingly middle class, well educated, often older mothers.

Among them were doctors, lawyers, the wives of professional people - in short, those who provide the bedrock of private practice for obstetricians. Some of her supporters feel that this lies at the root of what they see as a campaign against her.

She dismisses this. "I don't think so. It will always be a minority who choose home births, at least in my time. But I believe in an open market approach to healthcare. People should know about each obstetrician's statistics and each midwife's statistics so that they can make an informed decision."