Rolling back the
Bonner and Kinder Reports
© Marie O’Connor

Further ominous thunder clouds signalling storms in Monaghan and Louth have been sighted in Dublin, this time in Fenian Street.

Comhairle na n-Ospideal, a body that will shortly turn to dust within the Department of Health and Children, is about to publish a report leaked strategically this week to the Irish Medical Times. The document recommends, according to Conor Ganley, that maternity services in the North East should be restricted to those hospitals where maternity services already exist.

You may have to read this again. Slowly. To those that have, more shall be given: to those that have nothing, nothing.

Monaghan Hospital, as Comhairle sees it, should in future provide only emergency maternity care, when a mother’s life is at risk. The agency has indicated that its report will not be published for “a week or two”. Why leak it on the same day that Dr Neary’s deregistration was confirmed by the High Court?

The rationale apparently advanced by Comhairle’s “North-Eastern Health Board Maternity Committee”, a committee of two, for its stance is that midwifery services should only be provided where 24-hour obstetric, paediatric and anaesthetic services are available, as in Cavan and Drogheda. The notion that safe maternity care can only be provided in hospitals offering a full spectrum of high-tech medical care in childbirth is a false one. Such services are often needed, not to deal with the outcome of physiological birth, but to remedy the complications created by unnecessary medical intervention during childbirth.

Comhairle is now attempting to interfere in the functions of the North-Eastern Health Board, and to lay down the law on midwifery, a profession that is wholly outside their jurisdiction, by seeking to draw up ground rules for midwifery practice.

Comhairle’s view of the matter seeks to roll back both the Bonner and the Kinder Reports, to a point where, travelling backwards in time, we reach 2000, the year the discredited Condon Report was published.

Kevin Bonnar and Patrick Kinder both recommended that midwife-led units be established in Monaghan and Dundalk after such units had been piloted in Drogheda and Cavan. This paper thunderbolt from Comhairle seeks to make redundant these proposals.

It should be referred to the Competition Authority, as Comhairle apparently seeks to control the means of supply and distribution of services in maternity care, restricting the operations of competitors to outlets controlled by its members, or their colleagues.

The message, intentional or otherwise, is that female midwives cannot be trusted to work on their own, and that, for their services to be quality-controlled, the supervision of male medics is required. What stuff and nonsense.

The National Council for the Professional Development of Nursing and Midwifery would hardly agree. Created on foot of a statutory order made by the Minister for Health and Children in 1999, the Council was set up “to promote and develop the professional role of nurses and midwives in order to ensure the delivery of quality nursing and midwifery care to patients/clients in a changing healthcare environment”. But while Comhairle apparently wished to give the Council a starring role in Monaghan’s changing healthcare environment, the Council has declined the offer.

According to the Irish Medical Times, Comhairle claimed nursing and midwifery support for its outrageous recommendations in the North East, alleging that the National Council was “not in favour” of stand-alone midwifery units.

This must be the first time in recorded history that Comhairle na n-Ospideal has hidden behind the skirts of nurses and midwives in order to issue recommendations on maternity care. Florence Nightingale would have been pleased.

The Council, however, has confirmed to this newspaper that no such view has ever been expressed by them, now or at any time. Georgina Farren, Professional Development Officer at the Council, has pointed out that the Council would never comment on infrastructure in maternity care; its remit is professional development. Community midwifery, or midwifery in primary health, is where the future of the profession lies, in her view.

But even if Comhairle has no plans for stand-alone midwifery units, why should this impede their development, which is none of their business? Clearly, Comhairle has surpassed its brief, which is to regulate the appointment of consultant staff in hospitals providing services under the Health Acts, and to specify qualifications for such appointments. Midwives are not consultants.

Neither is midwifery a medical profession. Despite doctors’ best efforts to force midwives to work as obstetric nurses, midwifery is an autonomous profession, recognised as such in European law. Doctors’ orders do not rule.

In an economic environment increasingly marked by the dismantling of monopolies, it is extraordinary that attempts at market dominance by Comhairle on behalf of its members go unchallenged. The notion that competing service providers who offer safe, high-quality care are not to be trusted unless under medical management is simply too ludicrous to be credible. Imagine the genetic food developers, Monsanto, telling us that organic food is not to be trusted, and you get the picture. Perhaps we should begin to think of Comhairle and other consultant bodies as "industry sources".

The safety of midwifery practice at home or in low-tech community settings, such as birth centres or freestanding midwife-managed units, is well established in the literature.

To cast aspersions on the safety of midwifery practice, at a time when pressure for a public enquiry into the bizarre obstetric practices of Dr Neary needs to be maintained, smacks of diversionary tactics. Can we expect another red herring next week?

©Marie O’Connor
Northern Standard on 5 September 2003

© National Birth Alliance
An Chomhghuallaiocht Naisiunta Breithe