The Dublin city coroner has recommended the development of national guidelines to allow independent midwives access to services at maternity hospitals.
Dr Brian Farrell announced the move at the conclusion of an inquest into the death of a still-born baby during which an independent midwife said she "felt inhibited" from raising issues with the Rotunda hospital in Dublin.
Currently, independent midwives, of which there are approximately 18 countrywide, are unable to access such services and instead advise their clients to seek the scans and blood tests independently at hospital, without their support.
Dr Farrell said he would be writing to the Department of Health, the Health Service Executive and An Bord Altranais with a view to establishing recommendations and guidelines that would allow independent midwives to access facilities, such as scans and blood tests, for their patients at maternity hospitals.
The coroner was speaking at the conclusion of an inquest into the death of Chuck Long, a stillborn baby who was delivered at the Rotunda on December 5th, 2005. The inquest heard that the baby died from a lack of oxygen (hypoxia) in the womb caused by post-maturity syndrome - a disorder that causes the placenta to malfunction thus disrupting the oxygen supply to the baby.
When the baby's mother, Tanya Long, presented at the hospital on December 1st, after feeling no movement from the baby for over a day, an ultrasound confirmed that he had died.
According to the hospital the expected date of delivery, based on scans and calculations, was from November 13th to November 19th, which meant that by the time Ms Long arrived at the Rotunda, she was 12-13 days overdue.
Rotunda Master Dr Michael Geary told the inquest that the hospital's policy was to refer women for scans once they were 10 to 12 days overdue in order to assess the baby's condition, with a view to assessing whether other interventions were needed.
But the midwife, Kate Spillane, had calculated Ms Long's expected date of delivery as November 21st, which she later revised to November 23rd.
When Ms Long made a call to Ms Spillane on November 26th to say that her partner, Shane Terry, was worried because the baby had not been born, Ms Spillane told the court she advised her to go to the Rotunda to have the baby checked.
However, Ms Long was not concerned as the baby was moving as much as usual, and she decided not to attend the hospital because she did not want to "run the risk of being induced".
During questioning Kate Spillane told the coroner she felt inhibited from ringing the hospital with regard to the due date issue, among other issues. "If she [Ms Long] disclosed the fact that she was seeing me, they would not have wanted to see her. The hospital's policy was that it is one or the other - the hospital or the domiciliary midwife," she said.
Dr Geary told the court he regretted the current situation, which has existed since 2003, whereby independent midwives are unable to access bloods or scans at hospitals, but where they usually encourage women to attend hospital independently for those services.
"We took that decision in 2003 and I'm not happy about it. I hope this situation can be resolved. The issue of vicarious liability still exists . . . but I still believe women should have the choice to deliver at home," he said.
"If anything comes out of today and of this process in terms of regulation that would be good. I do see a place where independent midwives can work in conjunction with their nearest hospital, but under good guidelines . . . that is the way to go."
He stressed the hospital's doors had always been open to all women who were pregnant and that any woman with concerns about her pregnancy should not hesitate to access services at the hospital.