Since October of last year 19 pregnant women have gone to the High Court in Dublin to modify an injunction, in order to engage the services of a domiciliary midwife, Ann Kelly, and have their babies at home with her assistance. She had been prevented by the injunction from carrying out home births, pending the hearing of a complaint against her to An Bord Altranais. All 19 women were granted the modification of the injunction.
The rights and wrongs of Ann Kelly's case have yet to be resolved by the High Court and the Fitness-To-Practise Committee of An Bord Altranais. However, the action of these women highlights the strength of feeling of that small minority of women who want to have their babies delivered at home.
Why, when faced with a choice between a hospital, with all the latest technology, with several experts in childbirth at hand, with surgery available if necessary, do some women opt instead for having their babies in circumstances which many people associate with the bad old days of high maternal and infant mortality? Are they all ageing hippies, committed to an alternative lifestyle and hostile to modern science and medicine?
Not at all, according to the Home Births Association. Its spokeswoman, Monica O'Connor, pointed to a number of studies indicating that home births are no more dangerous, in a problem-free pregnancy, than hospital births. And there are positive advantages. She added those who choose this option may do so for a variety of reasons, but would all agree that a hospital is the place to be if a person is sick, or, in the case of pregnancy, if a problem arises.
For Jarlath and Georgina Hughes it was a matter of practicalities. He is a farmer and she works for the Eastern Health Board as a dental nurse, and they live in Summerhill, Co Meath, some 30 miles from Dublin. Meath is one of a number of counties in Ireland with no maternity hospital. "We could go to Dublin, Drogheda, or Mullingar," said Georgina, "and we chose Dublin. I was in the Coombe with Catherine (their first, now two). It was excellent. I had no complaints."
But they only just made it. Catherine was born 10 minutes after they arrived in the hospital, two hours after labour had begun. The mad dash to the hospital, which took place in the middle of the night, frightened Georgina more than anything to do with the birth. She never wanted to risk such a journey again and knew her second baby was likely to be born even more quickly than the first.
She was right. Her son, Iarla, now four months old, was born half an hour after labour began. Fortunately, they had arranged for him to be born at home. "We reckon we would have made it as far as the roundabout leading on to the motorway," Jarlath says.
"The main reason we started thinking about having Iarla at home was the very quick delivery of Catherine," Georgina says. "I was terrified of having the baby in the car. We contacted an independent midwife who lived not too far away. Our GP was extremely supportive and encouraging.
"We didn't start out thinking about it, but the pregnancy was normal and the baby was OK. Dolores Staunton, our midwife, is very definite on situations where you have to go to hospital and you just do it. We knew everything was normal."
Jarlath adds that, as a farmer, he has experience of birth. "You've learned over the years when to go to the vet and you don't deliver unless you can complete it." But he was less help than he had hoped, as he had broken his collarbone the day Iarla was due - the baby was more than a week late.
"I had everything ready, but I had forgotten to show Jarlath where I'd left it," Georgina says. "I had intended to lay everything out, but I had no time. Most of the things you'd need are in the house. Dolores arrived in about 10 minutes."
Anne Tobin and Tom Schnittger were both working as doctors in Seattle in the US when Anne became pregnant with their first child. Had they been living in Ireland, they would probably have had Patrick in hospital, as Anne had confidence in Irish obstetrics, but they were less happy with American obstetrics. "Our local hospital was a flagship hospital, and it had a caesarean section rate of 60 per cent for first-time mothers," Anne says. "We were very glad to have the option of a birth at home."
Anne had been very interested in obstetrics and gynaecology during her training: a joint winner of the Professor's Prize in the subject, she was well aware of the research on home births. "We had read a lot of literature and knew that for a normal pregnancy there was no evidence that a hospital birth was safer. There was even quite strong literature that it was better in some ways."
Their midwife had been the sister in charge of the local university labour ward for 18 years before turning to home deliveries, and therefore also had an academic background in the area. "Her clients were mainly the staff of the university hospital, including the obstetrician. "We had a high-tech person and an academic doing the delivery. We were far from home and our families but had very nice, motherly care. Patrick was an uncomplicated birth and it was a wonderful experience," Anne says.
When they returned to Ireland it seemed the natural thing to do to have their subsequent two children at home. "But we began to realise it was not a normal choice. In Seattle there had been a fair bit of interweaving between the hospital and domiciliary midwife and our midwife had admitting privileges to a number of hospitals. Here, if you have to go to hospital you leave the midwife's care."
Nonetheless, they went ahead. "Ann Kelly (their midwife) was very different from our American midwife, but she was very thorough and professional with record-keeping and all that," Anne says. "The level of after-care was excellent. Freya was born here at 3 a.m. Patrick was three. He woke up and he had a baby sister and he started to sing `Happy Birthday' to her." Because Anne did not go away and then arrive back with a baby, she says, Patrick adjusted much better to the arrival of a sister.
Laura and Gerry Brophy also appreciated the impact of a home birth on their baby's siblings. They live in West Tallaght in Co Dublin, and their first three children were all born in hospital, the latter two in the Coombe. "I couldn't fault the Coombe for their kindness and professionalism," Laura says. "But when I had Tom (the third, now aged seven) we felt if we had another we would do it at home. It meant not having to organise the other children.
"A home birth meant continuity. The boys went off to school and when they came home they had a sister. It was really, really special for our oldest, she's now 14, especially at her age.
"The aftercare is lovely. There's no regime, no visiting hours, no upset in the baby's routine coming home from hospital. There was no worry about the kids visiting. We had no car then and they would have had to be trekking in and out on buses."
"I was delighted," Gerry says. "In hindsight, I felt a bit excluded for the others. Any time Brigid Cummings (the midwife) came she could show me how things were developing. It kind of suited us." He is not working at the moment which meant he could cook, do the housework and look after the rest of the children. "People who opt for home births have to have their support system in place, and the partner able to be around. If not a partner, then a parent or a good friend," he says.
It also helps to have a supportive GP. Theirs was "very wary", especially as Laura had problems early in her pregnancy which meant she had to take time off work. She had to go to him for certificates as the midwife could not issue them. However, when she was assured the problems posed no threat to the pregnancy she decided to go ahead with the birth at home.
Being doctors themselves, Anne Tobin and Tom Schnittger do not really have a GP, as they can meet most of their own medical needs and have a family friend who looks after the children. Some of their friends assumed they were having their children at home because they were doctors, and that Tom was doing the delivery. But this was not so. "We weren't there in both capacities, we were there as mother and father," Anne says, adding that a qualified midwife is essential.
These three couples are among the tiny number having their babies at home. All are adamant that they would do the same again. Their enthusiasm explains the readiness of 19 women, in the middle of their pregnancies, to go to the trouble of going to court to vindicate their choice of a home birth.
The demand for this is growing, according to Monica O'Connor - so much so that the small number of domiciliary midwives cannot keep up with it. Although the policy of the Department of Health is to encourage women to have their babies in hospital, they have a statutory right to have them at home if they so wish. However, it can be difficult to make this right a reality, due to the shortage of domiciliary midwives and the lack of information and support from the public health authorities.
Following a lot of campaigning from the Home Births Association, health boards now give a grant of £400 towards the cost of a home birth, though this falls short of the £700 to £900 they cost, depending on the amount of travel necessary.
There are signs that the attitude of the health authorities may be changing. Following an initiative from a GP in Sligo who was also an obstetrician and did home births, three midwives were trained by the North Western Health Board and now attend women having babies at home, though this may be more out of emergency than choice.
According to Monica O'Connor the CEOs of all the health boards have now set up an expert group to examine the subject. This could lead to public health nurses being trained to do home births for those who wanted them.