This article in the Irish Medical Organisation’s journal is nothing more than anti-midwife bias masquerading as scientific "fact". No statistical basis exists for it: the mortality rates it quotes are grossly inaccurate and seriously misleading.

Pressure is mounting for public controls on hospital practice. With a government inquiry mooted into Dr Neary’s practice, complaints against another Drogheda obstetrician under examination by the North Eastern Health Board, and the discovery that symphysiotomy - an operation long abandoned in developed countries as too risky - continued to be practised in Ireland until the 1980s - the spotlight is firmly on obstetrics. Add to this three major cases taken by home birth mothers looming in the courts, and the timing of the publication of this "research" looks more than coincidental.

The "study" is based in part on a non-existent database, namely, the Regional Interactive Child Health System in the Southern Health Board. Authoritative sources at the Board’s Cork headquarters say no such system exists there. This has now been conceded by one of the authors. Neither does the Regional Interactive Child Health system exist within the South Western Area Health Board of the Eastern Regional Health Authority.

Biased definitions, shifting classifications and cherry-picked data have deeply skewed the results. This spurious work is based on the intended place of birth: no data exist on mothers' intentions in this area. The "study" classifies intended home births as hospital births and vice versa. The 4-year time period taken by the authors is completely unrepresentative, and well out of line with established norms for valid research studies in populations of this size. By reference to results that are valid, the mortality rates quoted in the article understate maternity hospital deaths for normal-weight babies by a multiple of 9-15, while community deaths are magnified by a factor of 3 at least.

The unwarranted focus on deaths during labour, due to hypoxia, serves to artificially reduce the count of relevant deaths that occurred in hospitals. Even allowing for these distortions, we do not know which deaths in hospital were counted, or not counted, for the purposes of the "study". But Dr Tom Matthews admission on "Morning Ireland" that the database attributed to the Southern Health Board does not exist there casts doubt on whether or not these deaths have been correctly allocated. Even within the "study’s" invalid time frame, of the five deaths attributed to hypoxia during labour at home, at least three are wrongly included, reducing the community death rate to, at most, two-fifths of that claimed by the authors.

One of these wrongly counted deaths is awaiting final determination by a coroner, whose inquest into a stillbirth at home was derailed ten months ago when he introduced as evidence figures bearing a remarkable resemblance to those recently published in the Irish Medical Journal. Is it a coincidence that these so-called death rates have just been published at a time when a High Court challenge to the coroner’s action is pending?

Home birth is a very safe option for healthy women, as numerous international studies in recent years demonstrate. McDorman and Singh’s survey of 4 million low-risk births in the United States, for example, demonstrates that midwife-attended birth is safer than physician-managed delivery. In Ireland, valid and reliable statistics produced by O’Connor, Cronin, Miller, McLoughlin and the Southern Health Board all testify to the safe, high quality, client-centred care provided by independent midwives.

Independent midwifery practice has a strong future in Ireland. According to the Economic and Social Research Institute, there has been an increase of 59 per cent in the numbers of women seeking our care over the past ten years.

Midwifery is as regulated as obstetrics: all midwives in clinical practice, irrespective of location, are regulated by An Bord Altranais. Independent midwives are obliged to notify the health board every year in whose area they intend to practice; health boards have a legal duty to supervise the services they provide. Like general practitioners, midwives are entitled to set up their own clinical practices in the community, and this right - now apparently under increasing attack by Irish doctors - is enshrined in European law.

To draw any valid conclusions on home birth, a retrospective national study is needed, that conforms to established norms in quantitative research, unlike the one just published. Work on this survey has already begun. We are very confident that it will, once again, confirm the safety of home birth, not only in the eastern region, but in the whole of Ireland.

If its authors are as concerned about safety as they suggest, perhaps they would revisit their ban on supplying blood tests and ultrasound scans to home birth mothers during pregnancy, whose only disqualification for such tests appears to be their choice of service provider. They might also consider what steps they should take in their own area of operations that would serve to improve Ireland's perinatal mortality statistics which, at present, according to the most recent perinatal statistics from the Economic and Social Research Institute, are the worst in the European Union.

Philomena Canning MSc., RM, RN

Dolores Staunton, RM, RN

Kate Spillane, RM, RN

Cliona McLoughlin, RN, RM