Women challenge home births policy of health board

In a case highlighting conflicting views about the clinical management of childbirth, four pregnant women have taken a High Court challenge to a health board's failure to provide them with home birth services.

The plaintiffs are Ms Sara Clarke, Ballyvass, Castledermot, Co Kildare; Ms Anne T. Brannick, Quill Road, Kilmacanogue, Co Wicklow; Ms Caroline O'Brien, Ballinclea, Glen of Imaal, Co Wicklow, and Ms Melissa Lockhart, Craddockstown Road, Naas, Co Kildare.

An independent midwife, Ms Philomena Canning, complained that the South Western Area Health Board, and other boards that formerly comprised the Eastern Health Board, "appear to have adopted a more and more restrictive approach to mothers who seek to give birth in their homes rather than in hospitals".

These boards now seemed to have a policy of not facilitating such deliveries except for women who lived near the major Dublin maternity hospitals and where the delivery was to be in hospital, she said in an affidavit.

The reason for this, she added, was an assertion that a home delivery presented a significant danger to mother and child in most circumstances. This, she suggested, was a "pretext for some other agenda and the most eminent medical authorities have confirmed to me there is no scientific basis whatsoever for the boards' attitude". Most other health boards were quite supportive of home births, she added.

Ms Canning also referred to "increasing tension" between the medical model of maternity care, based on obstetrics" and the "social model", based on midwifery.

In Ireland, the medical model had been further refined by an approach to childbirth known as "active management" or "aggressive obstetrics". She said active management of birth was highly controversial. "Its benefits remain unproven," she added.

In their proceedings, the four plaintiffs want a declaration that the failure of the South Western Area Health Board to provide them with home birth services, either through directly providing these or defraying part or all of the costs of hiring a private midwife, contravenes its obligations under section 62 of the Health Act 1970.

They are also seeking damages or an order requiring the board to cover their costs in hiring independent midwives.

Yesterday, Dr Michael Forde SC, for the women, told Mr Justice Ó Caoimh that the net issue was whether Section 62 imposed an unequivocal statutory duty on the health authorities to provide midwifery services. He was contending it did. All four women had written to the board seeking domiciliary midwifery services and had been refused. The board was not performing its statutory duty.

Dr Forde then opened the case of Ms Sara Clarke who, the court heard, is aged 33 and due to give birth to her second child in September.

She applied to the board for home birth services but, on being told the board did not employ domiciliary midwives, engaged the services of Ms Canning. Last April, the board told Ms Clarke it would not provide any financial assistance for her home birth.

In its letter of refusal, the board stated its decision was taken "in the overall interests of patient safety" and that the criteria for suitability for home births, as set out in the Expert Group on Domiciliary Births report, stated women seeking such services should live within five miles of the nearest maternity hospital.

It also said the decision bore in mind "legal advice" available to the board at present.

Ms Clarke asserts she lives some 20 minutes away from her nearest maternity hospital at Portlaoise while the board asserts the fastest journey time, in ideal conditions, is between 47 and 53 minutes.

The board denies it has an obligation to provide the service sought and pleads that, within its area, there is an adequate medical, surgery and midwifery service for mothers and their unborn children.

It pleads it has a discretion in relation to the extent of such services to be provided and must also have regard to resources available and Government policies.

The board says its policy and that of the Minister for Health and Children is to provide delivery services in consultant staffed maternity hospitals. It says the question of whether a home birth service, provided by independent midwives, should be established and funded by the board is a complex matter of public health policy and not an issue for determination by the court.

In an affidavit, Ms Bríd Clarke, assistant CEO of the board, said the distance of Ms Sara Clarke from the nearest consultant staffed maternity hospital introduced an "unacceptable risk" in providing a home birth service.

Ms Clarke added that the provision or funding of home birth services on demand had financial and resource implications not just related to the cost of paying a midwife. If a child was injured and an allegation of negligence was upheld, the cost implications were very significant.

The hearing continues today.