Nurses and Midwives Bill Campaign

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    Dear All,

    The Bill passed Committee stage in full yesterday morning.

    The meeting only lasted 1hr 45min and only Minister Harney, S O’Fearghail (chair), James Reilly, Margaret Conlon, Rory O’Hanlon, and Kathleen Lynch were present. No amendments relating to our concerns were discussed

    Please join us in a Letter Campaign to support a joint Amendment for the report stage of the Nurses and Midwives Bill.

    The N&M Bill has to go through report stage in the next week or two. This stage also accepts amendments.

    The Home Birth Association of Ireland, The Community Midwives Association, Clare Birth Choice, National Birth Alliance, The Doula Association, AIMS Ireland have acted with legal direction and created the following amendment which we are seeking to be supported by TD’s and Senators at the Report Stage level and in the upper house.

    In order to push our amendment, we are seeking help from our member-base and supporters in a letter campaign to your local TD’s & Senators as well as the following 4 spokespersons for health.

    We will include a form letter below but please try to make this as personal as possible – let them know how this Bill will affect you and why.

    This Bill will prevent thousands of women from accessing midwife led care at home. The HSE has already implemented similar blanket bans on midwife led care in hospital-based options. It is much easier to change HSE policy from a legislative position than through the HSE internally.

    For example, regardless of previous birth the following women are denied Midwife led care in hospital and will be affected by the Proposed Bill for home birth :

    BMI is over 29
    women turning 40 before day of birth
    women whom have had IVF
    previous big baby (regardless of how delivery went)

    These woman have no choice. These women have been given no opportunity to make an informed decision. These women have been denied the option to access evidenced based care by blanket policy. These women’s midwives have been denied the professional autonomy to make an individual assessment.

    Make sure they understand – Your Vote and Your concerns count!

    Emails for 4 spokespersons for Health:

    1. Minister Harney minister’

    2. Labour’s Jan O’ Sullivan :

    3. Fine Gael’s James Reilly:

    4. Sinn Fein’s Caoimhghin O’ Caolain:

    Form Letter


    Nurses and Midwives Bill 2010


    Please support the following amendment regarding the Nurses and Midwives Bill 2010 from The Home Birth Association of Ireland, The Community Midwives Association, Clare Birth Choice, National Birth Alliance, The Doula Association, AIMS Ireland and the thousands of members they represent, as well as nearly 4000 voting signatories on the following petition: … tures.html

    Thank you.


    The Nurses and Midwives Bill 2010

    SECTION 24

    1 In page 30, subsection (3), lines 28-9: to delete ‘to advise the Board in relation to all matters relating to midwifery practice’, and substitute:

    ‘to advise the Board, with binding effect other than in respect of fitness to practice matters, in relation to all matters pertaining tomidwifery practice under this Act’.


    If Subsection (3) is passed as drafted, then midwifery will be the only health care profession in Ireland without the ability to govern itself. The Health and Social Care Professionals Act 2005 gives 12 professions the power to rule themselves. The Act covers such professions as occupational therapists, speech and language therapists, physiotherapists, psychologists, social workers and dietitians. Each profession is to have its own board and each board is to have wide-ranging powers.

    Midwives’ right to autonomy or self-government should be recognised before it is too late. Midwifery is in crisis and has been for several decades. Turnover in the Dublin hospitals is unsustainable: overall turnover from 2002-2005 was 17 per cent. The current shortage of midwives is now running at around 30 per cent in Dublin’s main maternity hospitals, which, between them, are down 262 midwives or more.

    The haemorrhaging of midwives threatens public safety. A 2008 KPMG on the Dublin maternity services says the risk of ‘serious untoward incidents’ has increased significantly in all three hospitals, which, between them, cater for 40 per cent of all births.

    The current ratio of births to midwives in Dublin is nearly double what it ought to be, according to expert guidelines. This impacts negatively on the quality of maternity care and makes medical intervention accelerating labour more likely, as women are less likely to be allowed to opt for ‘slow birth’ in understaffed labour wards.

    Normal birth is declining, and with it, women’s choices in childbirth.

    Caesarean section rates continue to rise: KPMG reported a rate of 28 per cent in the Rotunda in 2008, not far above the national average. Such high rates have implications for sustainability as well patient safety. Caesarean section costs three times more than normal birth.

    Partly on cost grounds, KPMG emphasises the need for ‘significant enhancement of primary and community care’. Moving care out of hospital into the community is key to the HSE’s transformation programme. This will require midwives to develop autonomous practice. KPMG recognises the need to develop the autonomy of the midwifery profession ‘to provide the type of service women want and to be in line with international best practice’. Modern midwifery legislation has empowered midwives in countries such as Canada, New Zealand, France and Britain.

    Amending Subsection (3) as proposed would end the dominance of nursing that, for over half a century, has restricted midwives’ professional development. This is in line with Section 2(2), which declares and recognises midwifery to be a separate profession from nursing. Recognising midwifery as a separate profession implies that the Board should be bound by the advice of the Midwives Committee.

    While a separate Midwives’ Board would be more in line with the Bill’s recognition of midwifery as a separate profession, this amendment achieves the same result in a more cost effective way, by using the staff and infrastructure of a single Board as provided by the Bill. Amending Subsection (3) as proposed would bring midwifery in Ireland into the 21st century: it would give midwives the capacity to develop their profession to the full and give mothers hope that the maternity services––so long unresponsive to their needs––might, over time, be transformed.

    SECTION 24

    2 In page 30, subsection (3), line 30, to delete the number ‘5’ and substitute the number ‘10’.

    3 In page 30, subsection (3), line 32, to delete ‘a registered midwife who is a member of the Board’, and substitute:

    ‘two registered midwives who are members of the Board’.

    4 In page 30, subsection (3), line 33, to delete the number ‘4’ and substitute the number ‘8’.

    5 In page 30, subsection (3), to delete lines 35-6, and substitute:

    ‘4 midwives, including one who shall be a self-employed community midwife’

    6 In page 30, subsection (3), between lines 40 and 41, to insert:

    ‘(iii) a registered nurse who is a member of the Board’.

    7 In page 30, subsection (3), to delete lines 41-45, and substitute:

    ‘(iv) two persons who, in the opinion of the Board, are representative of the public interest who are not and never have been a registered nurse or a registered midwife in the State or a nurse or a midwife in another jurisdiction.’


    These amendments are necessary to give effect to the recognition of midwifery as a separate profession. Giving midwifery the ability to govern itself requires a bigger Midwives Committee, realistically. The numbers in most of the categories set out in Section 24(3) as drafted have simply been doubled.

    8 In page 32, subsection (15), lines 19-20, to delete ‘or the Fitness to Practice Committee’ and substitute:

    ‘, the Fitness to Practise Committee or the Midwives Committee’.

    9 In page 32, subsection (17), line 27, to delete ‘‘or the Fitness to Practise Committee’ and substitute:

    ‘the Fitness to Practise Committee or the Midwives Committee’.


    These amendments are necessary to give effect to the recognition of midwifery as a separate profession. Section 24(17), as drafted, for example allows the Board to dissolve the Midwives Committee.

    Section 40

    10 Subsection (1) (a) lines 23-24, to delete ‘who maintains adequate clinical indemnity insurance in accordance with the rules’.


    While indemnity is necessary, it should not be made a statutory requirement. The better alternative is to make indemnity a requirement in service level agreements, such as the current Memorandum of Understanding (MOU) governing services provided by self-employed midwives.

    Section 40 (1), as drafted, paves the way for the imprisonment of midwives, as happened recently in Hungary, criminalising autonomous midwifery practice by setting terms of imprisonment of up to 10 years for midwives who break the extremely restrictive rules (as per the MOU) that underpin indemnity.

    Such a provision is unjust, disproportionate and discriminatory: doctors –– for whom insurance is not legally compellable ––face no such threatened penalties.

    Making midwifery indemnity a statutory requirement does not servethe public interest. Giving indemnity the force of statute puts insurers in the driving seat. In this case, the insurer is the State, which adds to the Bill’s coercive power.

    Section 40 (1), as drafted, would enable the insurer (in this instance the State), to dictate the terms and conditions of childbirth for maternity service users. This is because of the minute and inflexible conditions attaching to this insurance, which is unobtainable if a mother turns 40, for example, or, once obtained, is capable of lapsing at any moment during labour.

    Section 40 (1), as drafted, restricts self employed midwives from accepting various categories of mothers as clients; it further obliges self-employed midwives to abandon their clients in mid-labour, should they exhibit some change in their condition that is prohibited by the terms and conditions of their indemnity.

    Making indemnity a statutory requirement threatens women’s safety in childbirth. Section 40 (1), as drafted, obliges the mother whose midwife’s insurance has just lapsed with 2 alternatives: giving birth at home without professional attendance or facing unwanted medical treatment in hospital. Women who do not fit the indemnity criteria are already opting to give birth at home without professional attendance.

    Section 40 (1), as drafted, prohibits attendance by uninsured midwives even in cases of sudden or urgent necessity. At a time when many of the country’s maternity units are threatened with closure (see a 2010 Royal College of Physicians of Ireland/ Health Service Executive report on acute medicine), prohibiting emergency care by, for example, retired midwives, does not make sense.

    Section 40 (1), as drafted, significantly narrows the terms and conditions on which midwifery can be practised. The existing MOU is anti-competitive in that it significantly restricts self-employed midwives’ client base, and this in turn significantly restricts women’s access to the services of such midwives.

    Self-employed midwives are, and seek to be, insured: safeguarding mothers against uninsured practitioners is easily achieved within a birth community that is relatively small and tightly knit.

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