After more than three decades of a professional life delivering children in their mothers' homes, midwife Philomena Canning can no longer practise and is at the centre of a highly charged controversy.
For devotees of home births, Ms Canning has become a martyr to the cause since the Health Service Executive (HSE) removed her indemnity insurance last month and effectively put her out of business.
Former clients have collected more than 3,000 signatures for a petition handed in to Minister for Health Leo Varadkar.
The HSE has stayed silent since the High Court rejected her application for an injunction to prevent the withdrawal of her indemnity insurance.
Officials continue to investigate two cases involving women who Ms Canning referred to hospital after their home births and who were found, according to the HSE, to have suffered major bleeding.
Although she failed in her attempt to injunct the HSE, Ms Canning plans to go ahead with a substantive case which she hopes will come before the court before the end of the year.
Behind the scenes, there have been attempts to reach a compromise. The HSE offered to restore her indemnity if she consented to supervision by a second midwife but agreement could not be reached over the duration of that supervision – whether it would cover the entire period from onset of labour or just the delivery.
Investigation
Independent TD Stephen Donnelly has asked Mr Varadkar to ensure that the HSE finds alternative arrangements for the 25 women who were on Ms Canning's list at the time her cover was withdrawn.
At least two have since given birth at home in the presence of a substitute midwife, while another went to hospital.
The Wicklow TD is also pressing for the HSE investigation to be carried out quickly.
Ms Canning says the two mothers whose deliveries feature in the HSE investigation were delighted with the service she provided and are distressed at the approach of the health service. One, who gave birth last April, has given her public support to the midwife and has accused the health service of using her against Ms Canning.
The midwife says she referred a woman who gave birth in August to Midland Regional Hospital in Portlaoise, which has had its own share of maternity controversies in recent years, when she complained of after-pains and dizziness. "She was admitted at 5am, saw a consultant, was administered paracetemol and was home by lunchtime."
Duty of care
Nonetheless, Ms Canning’s cover was withdrawn, with the HSE also citing the case in April in which a woman was referred to a Dublin maternity hospital after the midwife delivered her child at home.
A HSE spokeswoman points out it has a statutory duty of care to the public and people to whom it provides care, both directly and indirectly. It is policy to investigate all safety incidents. “As this investigation is ongoing it would be inappropriate to comment further.”
For many of her supporters, who believe the mainstream health service is against home births, the midwife is paying the price of her outspokenness.
Ms Canning was a prominent advocate of non-hospital births, and a frequent critic of the HSE. She campaigned against baby formula companies and planned to set up a home-birth service completely independent of the HSE.
Whatever about this dispute, the home-birth sector is facing wider challenges. From December, a second midwife will have to be present for a birth, under the terms of the HSE-funded community midwife scheme.
