Family doctors have been advised that it is unwise for them to get involved with home births because of the increasing rate of litigation in obstetric cases. The advice is carried in an editorial in Forum, the official Irish College of General Practitioners magazine.
The editorial highlights the 88 per cent increase in the cost of insurance cover for Irish obstetricians since last year to £68,665 per practitioner. In a recent year the Medical Defence Union paid out £4.6 million in settling its four most expensive obstetric cases in the State.
Forum's medical editor, Dr Leonard Condren, writes that several more cases in the "medico legal pipeline" would push the cost of medical indemnity even higher.
"These events will have a direct effect on obstetric practice and may have the most serious implications for the practitioners and advocates of domiciliary obstetrics," he writes. Dr Michael Saunders, chief executive of the Medical Defence Union, which indemnifies Irish doctors, said that a number of large awards had been made in obstetric cases in Ireland, some of which had exceeded £2 million, causing the "landmark" increase.
He said that obstetricians represented only 2 per cent of the MDU's total membership in Ireland but it had to allocate 45 per cent of its case reserves for prospective obstetric and gynaecology claims.
Rates for hospital doctors, other specialists and GPs range from £6,000 to more than £25,000. Hospital consultants who treat public patients have between 65 and 85 per cent of their insurance premium paid by the Department of Health, amounting to over £20 million a year.
Dr Condren said that in recent months the media had highlighted the demand for home births. Celebrity home births were bound to increase demand even further, he said. "Health boards, doctors and midwives are going to come under increasing pressure to provide such services. However, this demand will have to be weighed against the high cost of professional indemnity."
If the home-birth rate increased it was inevitable that the incidence of complications would also rise. "Cerebral palsy is one of the most distressing of possible outcomes. Should such a tragic event occur in the context of a home delivery it would be virtually indefensible in an Irish court," said Dr Condren, a Dublin GP.
"While not wishing to cause offence to people or even to tempt fate, imagine the hypothetical scenario of a child with cerebral palsy having being born at home with the assistance of a community midwife and GP.
"The doctor could not rely on supportive expert testimony from a consultant obstetrician since they are not in favour of home deliveries. The case would probably attract wide media attention, including video footage of a heartrending nature. The tabloid press would assume the role of advocate on behalf of the stricken family."
He said that assuming the defence organisation decided to "tough it out" the case would enter the High Court. "Given the massive lifelong costs of caring for a seriously disabled person, society expects that the funds will be provided. Inevitably this means that the doctor loses the case. The media highlight the victory and society is satisfied that justice has been done."
Following this, the annual subscriptions for indemnity would rise and cover for home births would be refused. "I sincerely hope that this scenario never unfolds, but I challenge any colleagues to dispute the likely chain of events once the initial catastrophe has happened."
Those who advocated home births claimed that with proper case selection the delivery could be made very safe for mother and baby, he said. "It is a major irony that the person most at risk in a home delivery is the doctor."