Thursday, 9 October 2014

Midwife-Led Birth is Safe Birth

Midwife-Led Birth is Safe Birth. At Home, Hospital or Freestanding.
Safe for women and babies. Better outcomes for women and babies
Cost effective for health services.

Read the latest evidence:...

NICE recommendations re home births in England and Wales, Intrapartum Care, May 2014:

Low-risk women (women without medical conditions or other factors that put them at increased risk) who have given birth before should be advised to plan to give birth at home or at a midwifery-led unit (freestanding or alongside).


Findings from the National Perinatal Epidemiology Unit, Oxford, Birthplace Cohort Study, 2011

For women having a second or subsequent baby, home births and midwifery unit births appear to be safe for the baby and offer benefits for the mother


HSE Mid-U Report:

The 'MidU' ('Midwifery Unit') study showed that midwifery-led care, as practised in these units, is as safe as consultant-led care but uses less intervention in pregnancy and childbirth.

Women's satisfaction with the facilities was apparent in the study and 85% of those attending the MLUs said they would recommend the care they had received to a friend, compared with 70% of those having usual care. Although facilities in the MLUs were quite luxurious, the cost of care for each woman was €332.80 less than in the usual hospital system

Wednesday, 8 October 2014

A Midwife for Every Woman: Open Letter by one of Philomena's Clients, 38wks pregnant, to the HSE - Re: failures to date.

Open Letter by one of Philomena's Clients, 38wks pregnant, to HSE - Re: failures to date. #isupportphilomenacanning #Midwife4EveryWoman #WomenFirst

One of the women who was booked in with Philomena Canning has written this brave, honest, open letter and asked AIMSI to publish it on our page based on her experiences with the HSE to date, on trying to access a replacement midwife, the failures she has encountered thus far, and th...e blatant disregard for patient safety. The woman has asked for her name to be included but to remove identifiable references of the replacement midwife.

We feel this letter highlights the failures of the HSE to provide these 25 women with appropriate care solutions following the removal of Philomena Canning's indemnity.

Dear Ms Clarke,

Further to our conversation yesterday I wish to clarify some details of my care.

You called me yesterday to inform me that you had sourced me a midwife, and that this midwife was immediately available to me for the duration of my pregnancy. This is something I clarified with you again when you arrived to my home to drop off a home birth pack.

I have since spoken to the midwife (name provided) which you said was available to me.

On our first phone call (Midwife's name) did not know who I was, had never heard of me and was very apologetic that she couldn’t take me on as a client. As I am sure you can understand, this was very distressing for me. On a later phone call with (Midwife's name) she thought perhaps a mistake had been made and she had been given a wrong name and she could attend to me up until the 20thth October when she is due to go on night duty.

I am 100% completely dissatisfied with this ‘solution’ to the unlawful removal of my midwife Philomena Canning. The replacement midwife cannot provide me with continuity of care, as she is not available for the full duration of the 37-42 week window. This is completely unsafe and puts myself and my baby in danger. You told me yesterday that if I went into labour I could call this midwife and she would come to me. Again completely unsafe, as I have never met this woman, she has never met me and I still don’t have any prescription for the emergency drugs needed if I have a PPH. If I went into labour and followed your advice then the HSE would be liable for the bad management of my care should something go wrong. Furthermore, as per your own protocol under the heading ‘Issues to be discussed in pregnancy’, as I have not had a visit from any SECM midwife in more than four weeks, the following have not been discussed with me.

- Monitoring in Labour
- Third Stage Management
- PPH/Shoulder Dystocia
- Vitamin K
- PKU test
- Preparation for Breastfeeding
- When to Call

In fact, none of these issues have been discussed.

This is YOUR protocol and yet You are not following it.

Just to reiterate the facts here.

I have not had an antenatal appointment with a SECM midwife in 4 weeks and 2 days.

Your own protocol has not been followed with regards to Issues to be discussed during pregnancy.

You have assigned me a midwife who is not available for the duration of my pregnancy.

This midwife is taking clients on under duress.

This midwife is not as experienced in homebirth as Ms Canning.

This midwife does not know me or has ever met me to date.

You have advised me to call this midwife should I go in to labour. Which could be today.

Some other issues I would like to clarify. The replacement midwife is not trained in water birth and is not as experienced in homebirth as Ms. Canning due to her only taking on approximately six clients per year and also due to the fact that she is in employment at the (names an Irish maternity unit). This again in my opinion is unsafe. In order for a homebirth to take place there must be a build-up of trust and care between the midwife and client. This has not happened here. In fact, even though I spoke to the midwife yesterday, no antenatal appointment has been organised at all.

I find it extremely distressing that you have removed my midwife at this stage of my pregnancy, I am now entering my 38th week. I find it absolutely unacceptable that you are using the removal of insurance against Ms Canning and yet expect (Midwife's name) to take on the responsibility of my care, which would break many of the rules of the memorandum of understanding. You are creating an environment that would leave both myself and (Midwife's name) vulnerable. (Midwife's name) vulnerable to the removal of insurance in similar circumstances to Ms Canning, and myself vulnerable to an unsafe birth and dangerous outcome if a homebirth were to go ahead under these circumstances.

Lastly, I want to make it very clear, that should I decide to take the HSE up on its ludicrous offer of a midwife that appears to be unavailable. Should anything adverse happen to me or my baby, I will be holding the HSE fully liable.


Lesleyann Wylie
Kilpedder, Co. Wicklow.

A Midwife for every Woman: A well evidenced letter by a 32wk pregnant woman affected by the Philomena Canning Case.

A well evidenced letter by a 32wk pregnant woman affected by the Philomena Canning Case.
#isupportphilomenacanning #WomenFirst #Midwife4EveryWoman

 The decision of the High Court to uphold the suspension of SECM Philomena Canning’s indemnity insurance highlights a number of important areas around maternity service provision in Ireland - the treatment of women within the maternity services, particularly those seeking homebirths, ...the treatment of self-employed community midwives, and the HSE’s non-adherence to its own protocols of investigating clinical matters. The rhetoric of the HSE is about safety and public health, yet developments in maternity care policy has consistently ignored the findings and recommendations of research reports, including the 2008 KPMG Report and the 2013 HIQA Report into the death of Savita Halappanavar. The HSE would do well to base its understanding of the concept of safety on the vast body of national and international research in favour of developing midwifery-led services, including home birth, instead of shutting down the practices of SECMs in the absence of evidence, and in doing so forcing women into a non-working hospital system.

There remains in Ireland a deeply entrenched social perception that pregnancy and birth are inherently dangerous, and that hospital-based care equates to safer care, regardless of the circumstances or women’s risk status. Women who want to have a home birth are often seen as reckless; the midwives who care for them as mavericks. The reality could not be further from this belief: the vast majority of women who decide to have a home birth are extremely well informed about the risks and benefits of both home and hospital birth, and the midwives who care for them are without exception highly skilled and experienced, and committed to providing excellent clinical care.

A growing body of high quality research in favour of home birth supports the view that planned home birth among low risk women is closely associated with significantly reduced interventions, and no increased risk for perinatal outcomes. Recent research in the UK, Holland and Scandinavia found that for women having their second or subsequent baby, birth in a non-obstetric unit significantly and substantially reduced the odds of having an intrapartum caesarean section, instrumental delivery or episiotomy; a large scale longitudinal study into the association between planned place of birth and severe adverse maternal outcomes which reviewed the data for over half a million women found that low risk women with planned home birth had lower rates of severe acute maternal morbidity, postpartum haemorrhage, and manual removal of placenta than those with planned hospital births. Further, there was no evidence that planned home birth among low risk women leads to an increased risk of severe adverse maternal outcomes in a maternity care system with well trained midwives and a good referral and transportation system. The issue of a wider supportive structure for home birth services has also been emphasised: midwives who were integrated into the health care system with good access to emergency services, consultation, and transfer of care provided care resulted in favourable outcomes for women planning both home or hospital births. These key elements – the existence of good communication and infrastructure between health professionals, and the creation of a safe environment that enables supportive relationships between women and caregivers – are foundational to good clinical outcomes. Philomena Canning’s commitment to communication, collaboration and transparency is clear in how she conducts her practice, including in relation to the current case in which she reported a woman’s transfer to hospital in accordance with HSE procedures. In contrast, the HSE has displayed no such commitment to collaboration, either with women, or with SECMs, and appears pitted against them at every turn. The track record of the HSE does not inspire confidence: the findings of the HIQA report on the wider maternity care services emphasised its lack of responsiveness and accountability, an institutional resistance to change, and an inability to learn from service users’ experiences. Greater home birth provision requires development of infrastructure to support integrated services: the lack of such services in Ireland are cited as the barrier to home birth development, yet the centralisation of maternity care services in large urban areas has resulted in many women living significant distances away from maternity units, and increasing numbers of babies being born on the way to hospital. In other words, existing infrastructure supports neither home nor hospital birth, nor does it support the women who are supposedly at the centre of service provision.

Any claims that the HSE may make that e.g. the woman is respected as the primary decision maker cannot be seen as anything other than a sham. Policy documents that are peppered by terms like “choice” and commitment to a “woman-centred care”, yet any autonomy that women are claimed to have is trammelled by the fact that her role as primary decision maker is conditional on those decisions being the “right” ones, according to the criteria laid down by the HSE, and based on the interpretation of evidence that strengthens its position. This places the HSE in a virtually impregnable position of power, not only as the primary decision maker in care, but as the body who can decide the criteria upon which those decisions are drawn.

The women in Philomena’s care are now in the position of having to decide what to do next. Many of her clients have not been contacted by the HSE at all. I received a text message asking whether I had any queries about the home birth service: I did indeed, and when I rang I had a number of queries – what are my options now? What the implications of the suspension of Philomena Canning’s insurance for my care and the care of my baby? What is the HSE doing to expedite this issue? Why has the HSE not contacted me in writing to inform me of any developments? I did not receive satisfactory answers to any of my questions; I was told that a text message is technically speaking, “written correspondence”, and that if I wanted to find out more details about the implications of the High Court decision, I should consult the national media. I was also told that I would be contacted by Wednesday evening with the details of replacement midwife. It’s Friday, I have not yet been contacted by the HSE.

There is no national home birth service, despite HSE claims that “The National Domiciliary Midwifery service is available to eligible expectant mothers who wish to avail of a home birth service under the care of a self employed community midwife”. There are currently fewer SECMs providing a home birth service than there are counties in Ireland. Why? Largely because the HSE has intimidated SECMs to the extent that few midwives are willing to put themselves in a position where their practice is under continual surveillance and where their professional autonomy is compromised and undermined at every turn. For the majority of Philomena’s clients, there are no other SECMs available at short notice, because they are in such high demand. Hospital-based Domino Schemes that provide a home birth service are equally over-subscribed, and the geographical inequity of home birth services means that women’s choices of care model are limited to whatever is available in their area. For most women in the area covered by Philomena, this means going into hospital. The most recent guidelines issued by the National Institute for Health and Care Excellence (NICE) in the UK recommend that low-risk multiparous women be advised to give birth at home or in a midwifery-led unit (free-standing or alongside a maternity hospital). Obstetric Units are considered inappropriate to the needs of women considered low risk, as they increase the likelihood of caesarean section and other interventions. These recommendations echo those of the 2013 HIQA report in Ireland which states that all women should have access to the right level of care and support at any given time. Since all women deemed eligible to access home birth services in Ireland are by definition low-risk, this suggests that the only option now available to us is the least appropriate, and therefore the least safe.

AIMS Ireland Statement (Sept 24, 2014) Philomena Canning

AIMS Ireland statement published to social media September 24, 2014

Philomena Canning #isupportphilomenacanning

AIMS Ireland is disappointed to learn that while grieving families struggle to get information from authorities about how their partners, mothers and children have died, the HSE has chosen to illegally pursue a midwife who has followed protocol and appropriate practice guidelines set out by the HSE themselves.

In the same week of the long campaigned for inquest of Dhara Kinlevan, we also learn that an independent midwife has had to seek an injunction against the HSE who have broken their contract with her without implementing their own due process.

Philomena Canning has been prevented from practicing following transferring a woman to hospital, whom was discharged 10 hours later. We note that the HSE are quick to close down the evidence based practices of independent midwives with no full inquiry yet rely on a cattle prod from the media to launch investigations into continued bad practice and questionable maternal deaths under obstetric care.

Minister Varadkar and the HSE need to take a long, hard, objective look at where their priorities are in maternity care. It is clearly not with women and babies.

Women First: A Midwife for every Woman.

#Midwife4EveryWoman #WomenFirst #isupportphilomenacanning

The HSE have broken their contract with women booked in for homebirth. It is of no fault of the women that Philomena Cannings indemnity has been suspended. You have read their powerful stories on the AIMS Ireland facebook page.

No contact. No antenatal care in the final stages of pregnancy. Poor communication.
No appropriate care solutions.

These women meet HSE criteria for Homebirth under the MOU. These women choose homebirth.

The HSE are 100% responsible for finding these women a midwife.

Suggesting to these women that they attend an obstetric led maternity unit is NOT an appropriate solution.

HSE, the onus is on you.
Women first.
We demand a Midwife for every woman.

Tuesday, 7 October 2014

Breaking News: Maternity Group calls for review into Maternity Services in budget 2015: Appropriate Maternity Care could save Exchequer 18.6 million per annum.

Maternity Group calls for review into Maternity Services as Budget 2015 continues to ignore Patient Safety and appropriate care options.


Appropriate Maternity Care could save Exchequer 18.6 million per annum.

The Association for Improvements in the Maternity Services Ireland (AIMS Ireland) are demanding an immediate response from the Government in budget 2015 on calls for a review into patient safety and appropriate care models in Irish maternity services.

AIMS Ireland’s calls follow fresh reports following the judgment of medical misadventure into the death of Dhara Kivlehan, the approaching inquest into the death of Sally Rowlette, investigations into the death of a baby in Mullingar, and failures by the HSE to provide appropriate care solutions and clinical care to 25 women following the removal of indemnity of Philomena Canning.

Krysia Lynch of AIMS Ireland “We are not using our Budget effectively in our maternity services. Our insistence of an obstetric care model has had profound effects on costs and patient safety. Ninety percent of women have no option than to book into obstetric led care, which is more expensive and is shown to have greater rates of intervention. These interventions are very costly in human and financial measures.”

She Adds, “We are not getting value for money. We are not getting widespread access to full service provision. Most importantly, we are not reaching the bar in terms of offering safe maternity services.”
Ireland’s obstetric-led model of care is outdated and is of very little benefit to the majority of women. While there may be an estimated 10% to 15% of women and babies who are in need of obstetric-led care, this care model is not recommended for the majority of women and babies, is shown to increase risk factors and adverse events to mothers and babies, and costs significantly more than hospital and community based midwife-led care options.

Austerity budget measures have increased these risks to patient safety in recent years. Irish obstetric led units are significantly understaffed to unsafe levels. Safe Childbirth recommends midwife to woman ratios of 1:28 for high risk case loads and 1:25 for low risk case loads; the majority of Irish units do not meet these standards of care with some units exceeding midwife to woman ratios of 1:50. Midwives express their concerns to AIMS Ireland, describing clinical care under these extreme pressures as ‘fire-fighting’.

The HSE’s Mid-U study found that the same birth, for the same woman, costs over €300 MORE for women in hospital based Obstetric led care options compared to Midwife-Led care. Midwife led care options use less interventions, are safe, and have high satisfaction ratings from women. Ireland has the highest birth rate in the OECD with roughly 73,000 births per annum. Subtracting the 15% of births where obstetric led care may be warranted, this leaves just over 62,000 births where midwife-led continuity of care would be best practice and safest for mothers and babies. This adds up to a potential cost savings of over 18.6 million euros.

Krysia Lynch ends, “Why is the Government failing to address these issues? This is the question we should all be asking. Why is our Government insisting on continuing with a care model which is not evidenced, is consistently struggling to provide safe clinical care to women and babies, and puts severe pressure on the public purse with no added benefit?”
AIMS Ireland contacts:
Krysia Lynch PRO: 087 754 3751
Jene Kelly 087 681 9095