Aja Teehan take court case over right to home birth.

ash23

LittleBook wrote: »

Do you mean professional insurance? Any midwife in the INMO has professional indemnity insurance. Isn't this about the difference between what a public and a private patient are entitled to? Sorry if I've misunderstood that.



Again, I thought this was more to do with public versus private and what the HSE will cover for the patient, not what the midwife expects from the HSE.

Well that's what I'm asking. If this midwife performs a home birth and something goes wrong and she is liable, who ultimately ends up paying damages?

If she has her own insurance and the pregnant person is the one paying for her services (as opposed to the HSE paying for the home birth, paying for the midwifes insurance and being financially responsible in the case of a lawsuit) then I don't see the problem. Let the burden of risk be borne by the pregnant person and the midwife.

However if the HSE are in any way, shape or form financially supporting the home birth or are in any way responsible if something goes wrong, then they should be able to dictate the terms of the home birth.

ash23

Just to clarify, is this the fact that the HSE won't pay for this person to have a homebirth and that if she wants one, she has to pay for it herself. As opposed to a woman who is not VBAC who has the cost covered by the HSE?

I've read the article but I'm not even sure what their cause is to be honest.

lazygal

I think all midwives doing homebirths have to be HSE approved though, to get insurance. Is that a correct reading of the situation? Otherwise the midwife is operating without insurance, and that's a risk too far for my liking. You can have a homebirth and be attended to by a midwife, or anyone else for that matter, but insurance wouldn't be in place should anything go wrong, is that the case?

I'd imagine the insurance costs would be horrendous for someone operating outside the HSE system with no backup from the state medical services.

Corkbah

Tlachtga wrote: »

Makes sense to me. While it is of course possible to have a successful natural birth after a section, there is a higher risk of complications, which is why it makes sense to have the birth in a hospital - where the mother and baby can be monitored much more closely, and any medical intervention necessary can be done much faster. It wouldn't seem fair to leave a midwife responsible for a home birth where there's an increased risk of complications, as she wouldn't have the necessary equipment and resources immediately available should things go wrong.

Offering midwives for home births is a nice luxury, but I wouldn't see it as am automatic right of expectant mothers, and I'd agree that it should only be considered in the most straightforward uncomplicated pregnancies.

surely this is the whole crux of the issue ...the HSE want to take that option away ...regardless of peoples opinions they wish to make the decision for everyone, everyone who has a home birth knowing the increased risk after a C-section then knows the risks ....and want to have the option to choose this or not.

Corkbah

meeeeh wrote: »

Plus whatever we think of HSE they are probably better qualified to evaluate someones abilities and work practices than insurance companies. I would be even surprised if insurance companies actually insure people without HSE indemnity. It just seems too risky.

to be fair ...some people in the HSE know their stuff ... but .... I think the HSE in general conforms to the general consensus of opinion against them (based on the multitude of errors made in the past....and present)

lazygal

But I think the problem is the risk to the baby, not just the woman. I'm as prochoice as they come, but I'm not willing to agree to every woman's preference for everything to do with birth. There are some times in life where you don't get to control everything, and pregnancy, labour and birth is a prime example. Imagine something did go wrong, and there's no insurance in place. How would a child suffering the consequences of that be dealt with? To be brutally honest, children with injuries from birth cost a lot of money to deal with, and its up to the State to minimise the costs and chances of that happening. I had the risks of VBAC outlined to me at my first appointment, and they have been repeated when other issues arose. The state sometimes has to regulate people making choices which can cause risk to others, like foetuses.

Corkbah

lazygal wrote: »

But I think the problem is the risk to the baby, not just the woman. I'm as prochoice as they come, but I'm not willing to agree to every woman's preference for everything to do with birth. .......

but would you agree that they should have the option instead of being told they simply cannot have a home-birth.

one of the supporters outside the Four Courts said that the risk of complications is actually very low. (guessing its a very biased opinion but someone out there might have statistics)

LittleBook

ash23 wrote: »

I've read the article but I'm not even sure what their cause is to be honest.

Here's more details Ash but to be honest I'm more confused now ...

http://www.independent.ie/incoming/babies-show-their-support-for-mum-in-high-court-battle-29462261.html

Under the Nurses and Midwives Act, it is a criminal offence to attend in childbirth outside of the [HSE] MOU.

http://www.rte.ie/news/2013/0731/465665-homebirth-court-aja-teehan/

The HSE has told Ms Teehan she has the right to have her baby at home. However it cannot provide indemnity cover for any midwife attending the birth because of HSE guidelines.

lazygal

Corkbah wrote: »

but would you agree that they should have the option instead of being told they simply cannot have a home-birth.

one of the supporters outside the Four Courts said that the risk of complications is actually very low. (guessing its a very biased opinion but someone out there might have statistics)

I'm going against my prochoice bones here, but no, I don't think they should have the option because its not just about the woman when it comes to deliver, and what the consequences are for her, there's also the risk to the baby. I would not think its okay for the state to not have a policy in place like this, where a home birth is regulated by the state's health service.

Who would pay the costs if something did go wrong, and the person who attended the birth was not insured?

The risks associated with VBAC in general are very low, but so many complications can arise with no warning at all during labour and birth.

meeeeh

Corkbah wrote: »

but would you agree that they should have the option instead of being told they simply cannot have a home-birth.

one of the supporters outside the Four Courts said that the risk of complications is actually very low. (guessing its a very biased opinion but someone out there might have statistics)

And my point was that the risk is very low because there is very strict criteria and only low risk pregnant women are allowed. Plus I would say there are also other socioeconomic biases present. Home birth stats can be indication, the only indicator can be risk after you already had c-section. It might not be that much higher but it's worth to point out that if something goes wrong there could be fairly expensive consequences. I have no opinion on the actual case but I do dislike when stats are being used out of context.

ash23

Corkbah wrote: »

surely this is the whole crux of the issue ...the HSE want to take that option away ...regardless of peoples opinions they wish to make the decision for everyone, everyone who has a home birth knowing the increased risk after a C-section then knows the risks ....and want to have the option to choose this or not.

But the whole thing with medication and treatment is that the HSE have to decide if the benefit outweighs the risk. So even though lets say, chemotherapy, brings it's own risks, the benefits (treating cancer), outweigh those risks.

They feel the benefits of a natural birth outweigh the risks of a VBAC in a hospital. But they do not agree that the benefit of natural birth outweigh the risk of a VBAC at home.

In certain instances they give the person the risks and benefits and let them make up their own mind as to how to proceed. But they won't do this in all instances. I can't insist on a drastic treatment for a minor ailment for example. If the risks outweigh the benefit, it won't be an option.

ash23

Ok so from reading more on it, the self employed midwives and the HSE came to an agreement where the HSE would indemnify the midwives, as long as they adhered to the agreed conditions. One of those conditions is that the woman is not having a VBAC.

It is illegal for a midwife to go against this agreement as it means she will not be indemnified by the HSE and is basically uninsured. It's a criminal offence for a midwife to go against this agreement.

The HSE are saying that a review of the agreement is underway.

So, if that is the case (and I could be totally off) then I still say that the HSE should be able to dictate the terms seeing as they are the ones responsible if something goes wrong.
If the HSE are absolved of that responsibility and the midwives put the onus on themselves, then they should be able to perform VBACs at home.
If the midwives want the HSE to indemnify them, then they should adhere to the agreed risks.

eviltwin

We're only hearing her side of the story here too. We don't know the reasons why she ended up needing a section, maybe there was a complication which could, if it happened again in a home setting, could be fatal to one or both of them. Its a huge risk to take.

lazygal

eviltwin wrote: »

We're only hearing her side of the story here too. We don't know the reasons why she ended up needing a section, maybe there was a complication which could, if it happened again in a home setting, could be fatal to one or both of them. Its a huge risk to take.

Good point. If there were underlying medical conditions that led to the section last time that is a risk factor this time. My section was because of the position of the baby, had she been head down, all other things being equal, I would have had a 'normal' birth. This time however, the very fact my uterus has been cut open is a risk factor for uterine rupture - as it would be for this woman.

LittleBook

So, essentially, VBACs at home (or HBACs as they are known) are not allowed in Ireland and this woman and her midwife are challenging that.

Found some more information on the history of the subject:

From the INMO

In 2007, the INMO (like the RCM in the UK before them) reported that because of the potential cost of damages claims associated with birth, their underwriters would no longer sanction indemnification of midwives for attendance at home birth. The HSE quickly convened the Domiciliary Birth Group to develop a State-sanctioned, indemnified home birth scheme. In the report ‘Delivering Choice’, a memorandum of understanding between SECMs and the HSE was devised to enable a working relationship between them. Such was the urgency to provide for home birth and midwifery indemnification that the MOU was never wholly agreed by the multidisciplinary contributors.

I had no idea the statistics for home birth were so low in Ireland but I can see why now.

eviltwin wrote: »

We're only hearing her side of the story here too. We don't know the reasons why she ended up needing a section, maybe there was a complication which could, if it happened again in a home setting, could be fatal to one or both of them. Its a huge risk to take.

To be fair ET, she's challenging a rule that applies to everyone, not a decision taken directly in relation to her or her circumstances. She could be a perfect candidate for an HBAC in another country but is not permitted that option here because of a "blanket policy".

ash23

So basically the midwives cannot get cover for home births unless it's provided by the HSE. Sooooo, case closed I would think.

If the HSE are effectively insuring the midwives for home births, then they can pretty much have whatever clauses and conditions they want.

They are not stopping her from having a home birth but they are saying that they won't indemnify the midwife who performs it and basically, if she wants a qualified, insured midwife, she can't have one.

It's not a breach of her human rights imo. Nobody is stopping her from having a home birth. But they are saying that it's on her own head, totally and completely and they won't take any responsibility for it, which I would imagine they are in their rights to say.

pwurple

LittleBook wrote: »

So, essentially, VBACs at home (or HBACs as they are known) are not allowed in Ireland and this woman and her midwife are challenging that.

Found some more information on the history of the subject:

From the INMO



I had no idea the statistics for home birth were so low in Ireland but I can see why now.



To be fair ET, she's challenging a rule that applies to everyone, not a decision taken directly in relation to her or her circumstances. She could be a perfect candidate for an HBAC in another country but is not permitted that option here because of a "blanket policy".

So, bottom line. It's all about the money.

The HSE is regularly paying damages cases for pregnancy and birth related issues. There are at least 3 this year from what I can see on claims.ie.

Minimising the events which lead to these damages is their aim, and to be fair, I agree with them.

That's speaking as both a taxpayer, and a currently pregnant woman who already has experienced both a healthy birth, and a loss. I can't fathom why anyone would choose a higher risk birth. It's risky enough as it is.

Morag

Home birth as a luxury?
That is hilarious.

Both my grandmothers had home births. One for all her 8 children, all of which were born in her bedroom which was also the room she passed away in, making it really the family home.
The other had 7 home births and then when there were issues with her heart the last 3 were in Holles st.

Giving birth in hospital was considered a luxury back when my mother had me esp as the norm for first time mothers was 5 days lying in after the birth. By the time I had my first, we had the start of the population growth and maternity hospitals are far from restful places.

It is funny how in just those 3 generations things have changed so much, both in terms of home birth being the norm all over the country and with breast feeding also being the norm as well.

LittleBook

Yes and no. Under the Nurses and Midwives Act 2011. The midwife MUST be indemnified and since insurance companies refuse to indemnify independent midwives they can only be indemnified by the HSE who will only indemnify within the terms of the MOU. If they went ahead with the homebirth, the midwife could be jailed for 5 years. Basically the insurance companies decided the policy.

pwurple wrote: »

I can't fathom why anyone would choose a higher risk birth. It's risky enough as it is.

Is it though? Research has shown that there are less complications during home birth than a hospital birth for low-risk women, perhaps the argument here is that she is not a "high-risk". Women have worked hard to make VBACs the norm (90% in the US), so why wouldn't this be the case for a home birth? Perhaps they just want the same criteria as is applied to permitting a VBAC to apply to a home VBAC.

I dunno, I have no involvement in home births (and no plans to be involved in ANY type of birth ) but it seems to be worth looking into.

pwurple

Morag wrote: »

Home birth as a luxury?
That is hilarious.

Both my grandmothers had home births. One for all her 8 children, all of which were born in her bedroom which was also the room she passed away in, making it really the family home.
The other had 7 home births and then when there were issues with her heart the last 3 were in Holles st.

Giving birth in hospital was considered a luxury back when my mother had me esp as the norm for first time mothers was 5 days lying in after the birth. By the time I had my first, we had the start of the population growth and maternity hospitals are far from restful places.

It is funny how in just those 3 generations things have changed so much, both in terms of home birth being the norm all over the country and with breast feeding also being the norm as well.

My grandmothers had home births as well. And neither, when alive, could understand why, when they and their fellow women fought and campaigned for YEARS for the standard of monitoring and care we have now, that anyone would choose not to take those services.

It truely is a first world problem when we have these amazing equipment like ultrasounds, and clean hospitals with 24 hours services, that people start thinking about birth as a lifestyle experience.

Women in developing countries would nearly kill for what we have.


A risky home birth is an expensive luxury, because it can cost the rest of us millions in damages when a brain damaged child is born, who we have to support for the rest of its days.

Morag

pwurple wrote: »

It truely is a first world problem when we have these amazing equipment like ultrasounds,

Which we don't have enough of so often women only get 1 or 2 scans for the duration of their pregnancy. Some of which are old and some of which are faulty to the point a couple in galway were told that there was no heartbeat when it was a fault ultrasound.

pwurple wrote: »

and clean hospitals

Clean?

When was the last time you were in an A&E, or any of the maternity hospitals? The rates for MRSA here are shocking. I did not find the maternity hospitals to be safe or clean.

pwurple wrote: »

with 24 hours services,

I gather you have not been left waiting for hours as the on call anesthesiologist can't be found and there is only one as it's the weekend.

pwurple wrote: »

A risky home birth is an expensive luxury, because it can cost the rest of us millions in damages when a brain damaged child is born, who we have to support for the rest of its days.

Home births are not inherently more risky.
Giving birth in this country has become dictated by policies and procedures which are about insurance and live babies then about the well being of the mother and child.

ash23

Morag wrote: »

Home birth as a luxury?
That is hilarious.

Both my grandmothers had home births. One for all her 8 children, all of which were born in her bedroom which was also the room she passed away in, making it really the family home.
The other had 7 home births and then when there were issues with her heart the last 3 were in Holles st.

Giving birth in hospital was considered a luxury back when my mother had me esp as the norm for first time mothers was 5 days lying in after the birth. By the time I had my first, we had the start of the population growth and maternity hospitals are far from restful places.

It is funny how in just those 3 generations things have changed so much, both in terms of home birth being the norm all over the country and with breast feeding also being the norm as well.

My gran gave birth at home but it was a local woman, a neighbour, who delivered the babies. Most people had home births but they usually weren't attended by a qualified midwife. And mortality rates were higher. And often if a baby was deprived of oxygen and survived, it wasn't apparent straight away. When it became clear a lot of disabled people were put in institutions.

There's no point comparing homebirth then with now. The litigious nature of childbirth means a midwife can't be insured privately so the hse has to indemnify them. And therefore they will manage the risk to ensure that the majority of home births are free from risk or as close as they can be.

lazygal

How should children who have lifelong injuries as a result of birth be cared for and how should it be funded? Surely its the duty of the State to minimize a) the risk of pregnancy, labour and birth to anyone, woman or child, and b) the cost to the state of births and injuries as a result thereof. That sounds very mercenary, but I don't know who should pick up the tab if something happens in a homebirth where the midwife isn't covered by a state indemnity plan. Obviously the state has a duty of care to those living in it, but what if the choices made by a woman in terms of the location of labour and delivery lead to a disastrous outcome?

I fully accept that people might want a homebirth and have a perfectly safe experience, but there are risks when you've had a c section, or have any other medical conditions, or are a certain age, or have a weight problem etc, etc. You don't always get to call the shots when it comes to medical issues. And when you're relying on your body to birth a child, its not just about your choices anymore.

I fully respect the right to informed choice, BUT when it comes to something as potentially dangerous as labour and birth I don't think everyone gets to chose what they want, regardless of the risks.

pwurple

Morag wrote: »

Which we don't have enough of so often women only get 1 or 2 scans for the duration of their pregnancy. Some of which are old and some of which are faulty to the point a couple in galway were told that there was no heartbeat when it was a fault ultrasound.

And the HSE having to spend extra on insurance claims solves that how exactly?

Clean?

When was the last time you were in an A&E, or any of the maternity hospitals? The rates for MRSA here are shocking. I did not find the maternity hospitals to be safe or clean.

Last time.... Let me think, Friday in the maternity hospital. And two weeks ago in A&E. And I'll be in again this friday for another pregnancy scan. I was very happy with the standard of cleanliness of the facilites and of the staff.

I gather you have not been left waiting for hours as the on call anesthesiologist can't be found and there is only one as it's the weekend.

Nope, I have not, my epidural was administered 20 minutes after I requested it. Not sure what that has to do with a higher risk home birth though. It's even harder to access one in that situation surely.

Home births are not inherently more risky.
Giving birth in this country has become dictated by policies and procedures which are about insurance and live babies then about the well being of the mother and child.

I didn't say they were inherently more risky, but that this one has been deemed to be higher risk. The woman has been refused insurance, because she is taking this risk. The insurance she is being refused is the insurance that covers her long term health and that of her childs, ONLY because of this higher risk. Home births are available here for low risk births, fully insured. I have a few friends who have had home births.

It's a financial risk the govt doesn't want to take. If she is willing to go ahead without that insurance, she is more than welcome to do so.

And I don't think anyone would apologise for the system prioritising babies being born alive rather than the experience of the birth.

Morag

pwurple wrote: »

It's a financial risk the govt doesn't want to take. If she is willing to go ahead without that insurance, she is more than welcome to do so.

She can't any midwife that attends her will face a criminal charge with a possible jail sentence and up to a 60,000 euro fine.

pwurple

Morag wrote: »

She can't any midwife that attends her will face a criminal charge with a possible jail sentence and up to a 60,000 euro fine.

Nice to see you ignored the rest.

You mean any registered insured midwife of course.

Any uninsured one won't face anything at all.

Morag

pwurple wrote: »

Nice to see you ignored the rest.

Because I can accept that women's experiences in maternity hospitals vary,
I feel no need to try and undermine your experience, glad you have good ones, not everyone has.

pwurple wrote: »

You mean any registered insured midwife of course.

Any uninsured one won't face anything at all.

Criminal law applies to all midwives.

meeeeh

Morag wrote: »

She can't any midwife that attends her will face a criminal charge with a possible jail sentence and up to a 60,000 euro fine.

And what is the opposite? Somebody who is high risk deciding they want to have home birth and midwife who is not covered by insurance in that instance attending it and something goes wrong? Who picks up a tab?

I had one bad miscarriage, I was losing blood to beat the band and fainted in the shower due to blood loss and had to be brought to hospital by an ambulance. My bf was later talking about that to an older family friend and he told him that was how his mother died. She bled to death while waiting for a doctor to come.

I was perfectly healthy and never considered high risk before. The two pregnancies that went to therm were without any problem. Yet I would never allow someone like me to have home birth and I think no midwife should facilitate that.

Morag

meeeeh wrote: »

And what is the opposite? Somebody who is high risk deciding they want to have home birth and midwife who is not covered by insurance attending it and something goes wrong? Who picks up a tab?

I had one bad miscarriage, I was losing blood to beat the band and fainted in the shower due to blood loss and had to be brought to hospital by an ambulance. My bf was later talking about that to an older family friend and he told him that was how his mother died. She bled to death while waiting for a doctor to come.

I was perfectly healthy and never considered high risk before. The two pregnancies that went to therm were without any problem. Yet I would never allow someone like me to have home birth and I think no midwife should facilitate that.

If someone is at high risk they should not have a home birth, the case in the high court is a low risk case in which a blanket ban is effect.

pwurple

Morag wrote: »

Because I can accept that women's experiences in maternity hospitals vary,
I feel no need to try and undermine your experience, glad you have good ones, not everyone has.



Criminal law applies to all midwives.

Not according to the RTE news who just reported the case. The HSE defense said she is free to get her own private midwife. They just won't pay for it.

Sounds fair to me.