Marie O'Connor
Letter to Medicine Weekly
Dear Editor
Dr Simon Mills is to be congratulated for bringing a historical
perspective (10 March 2004) to bear on the long-running dispute
between the Masters of the three main Dublin maternity hospitals
and the Region's independent midwives, now entering its fifteenth
month. But your correspondent is quite wrong to suggest that independent
midwives are unlicensed.
The facts are as follows: all midwives in this country, including
independent midwives, are registered with the Nursing Board, their
regulatory body. Registration is, in effect, a license to practice:
unlike doctors, midwives cannot practice without being registrants.
Midwifery as a profession is more highly regulated than medicine:
midwives are subject to national guidelines issued by their regulatory
body, and these guidelines are both comprehensive and up-to-date.
Independent midwives, moreover, are subject to additional statutory
controls: midwives are required to notify the health board annually
in whose functional area they intend to practice; health boards
have a statutory duty, under the 1970 Health Act, to supervise
their clinical practice.
Secondly, Dr Mills' view of midwifery as a branch of nursing is
incorrect: midwifery is recognised in European law as an autonomous
profession, separate from nursing, an adjacent profession. In
many Member States of the European Union, midwifery has never
been restricted to nursing. Copenhagen's renowned 200-year old
School of Midwifery, for example, has always been open to all
students meeting the School's entry requirements. In Ireland,
graduates of the first "direct entry", or open access, course
in midwifery at Trinity College have just entered the profession.
Neither is the continuing refusal of maternity hospitals to provide
routine blood tests and ultrasound scans to the clients of independent
midwives limited to Dublin: Cork obstetricians, like their Dublin
colleagues, have also decided not to accept referrals from independent
midwives. This is in spite of of, perhaps because of, the excellent
outcomes demonstrated by community midwives in Dr Harold Brenner's
recently-published evaluation of their work for the Southern Health
Board.
Could professional jealousy be a factor in this gladiatorial contest?
Dr Mills mentions litigation, but this is not a difficulty for
midwives: no awards have ever been made against independent midwives
in Ireland. Can any other profession make a similar claim?
Or is the battle of obstetrics against midwifery simply a turf
war? The stakes are extraordinarily high: the market for private
maternity care in this country has been estimated at EUR52m annually:
a public salary averaging EUR152,000 (as reported recently in
The Sunday Tribune), means annual earnings in obstetrics alone
top EUR650,000.
As one midwife observed, it’s like winning the Lotto every year.
But then, midwives get paid 8 per cent of what consultants earn
for more than equal work in normal birth.
Marie O’Connor
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