Last week, on the 26th February 2019, a large group of people gathered in front of Dáil Eireann in Dublin to hand in a petition with some five and a half thousand names to the Minister for Health on behalf of the independent homebirth midwife Philomena Canning.
Philomena was diagnosed some time ago with ovarian cancer and though the initial treatment was strenuous and daunting, by last spring, Philomena was optimistic that all would be well. She came to the one day Human Rights in Childbirth conference in the Mansion House on the 27th April 2018 and delivered a detailed and incisive talk, Limits to freedom? Why consent in Irish labour wards is problematic.
Sustaining space and freedom for a woman to birth as that woman wants, and to support her to the full with phenomenally skilled midwifery care has been the hallmark of Philomena’s life and work. Philomena was always meticulous in all aspects of care and women fortunate enough to have her as a homebirth midwife rightly prized their experiences of pregnancy and birth as a time to be remembered all the rest of their family lives.
The birth community in Ireland, mothers, birth support groups, our few independent midwives, our aspiring midwives to be, all were utterly shocked when the National Office of Nursing and Midwifery of the Health Services Executive (HSE) suspended Philomena from her independent midwifery practice on the 12th September 2014, revoking her indemnity insurance, and ordering her to hand over all her records.
This was no mistake as we first thought, but turned out to be a sophisticated and ruthless hunting down of a midwife with an impeccable record of care by a group of midwife administrators in the state’s HSE, the operational arm of the public health services. It was initiated, we have always believed, in fear and panic on their part that Philomena’s long-hoped for plans for an independent birthing centre with fully independent insurance were nearing fruition.
That dream of Philomena’s was vital in a country where the obstetric profession, senior nurses and midwives within the administrative apparatuses of the HSE, the HSE itself, and the Department of Health have continued to set all their power against not only continuity of midwife care, but against midwifery-led units, a properly resourced community midwifery service, and of course against home birth. The number of independent home birth midwives rarely hovers far above the high teens. The State does pay their indemnity insurance but in return they must sign a set of protocols which severely restricts the women they can accept and eliminates their own clinical judgement. The criteria for acceptance reflect the grim reality that maternity services in the Republic are many decades behind the development of services in Northern Ireland, Wales and Scotland. For example this same self-interested national office in the cavernous depths of the HSE has decreed that no newly qualified midwife can begin to practice in the community as an independent midwife until she has worked for three years in the mainstream obstetric consultant-driven hospital maternity services – with, of course, not a single shred of evidence to justify this ‘rule’.
Midwives around the country fight to build up tiny initiatives against this vicious institutional machinery which has such political dominance. It is a gruelling fight: only a minority of our 19 maternity units offer DOMINO births, and fifteen years after the first two pilot midwifery-led units (MLUs) were established, they remain the only two in the country. Little wonder that we are haemorrhaging midwives abroad. Little wonder that Philomena has been seen as a mainstay for women seeking home birth and little wonder that she is the outstanding inspiration to our newer midwives. When she was suspended in 2014, she had 29 women on her books, some only weeks from giving birth. We turned out in droves on a sodden wet day in front of the Dáil three weeks later to show our solidarity with Philomena. She had already gone to court to appeal, her legal team demanding to know how two normal births with minor complications, one requiring the transfer of a woman to hospital soon after the birth, both births in strict adherence to the very HSE protocols under which she was now suspended, could possibly lead to her suspension. She lost the appeal that evening and her supporters outside the Four Courts were devastated.
By February 2015, it was evident even to these pusillanimous beings inhabiting the HSE offices, that there was no case to answer, that there had never been a case to answer. Even the expert hired by the HSE readily stated that Philomena’s practice, entirely focused on women’s and babies’ safety and wellbeing, was impeccable. So on the 27th February, 2015, we all gathered at the Four Courts to hear the expensive lawyer hired by the HSE read into the court record that all charges were dropped and that her appeal costs would be paid in full by the HSE.
However, these same ignoble HSE cowards had a second debased line of attack. They began a so-called ‘systems analysis’ of the two cases and until this was settled and Philomena’s name fully cleared, she was not able to return to practice. No amount of press attention, lobbying, PQs, queries to successive Ministers for Health, statements from TDs on the floor of the Dáil, dislodged this position. Philomena had to sell her house to pay continuing legal costs; the process of legal discovery of the documents being used in this so-called systems analysis was tortuous, held up at every turn.
Four and a half years.
It is distressing to realise that there are unnamed, unaccountable HSE officials who had their hands in this case, whose income was never disrupted, not for a single day, while they pursued their false claims about Philomena being a threat to ‘public health’, some of whom may already have moved on to the fruits of their retirement. While time ran out on this midwife who always sought to give of her best to women.
It is only in this last fortnight, after a diligent investigative journalist put the story out there, did the Irish public begin to understand that Philomena is dying and that her dying wishes are: to have the settlement made - which has been owing to her since 2015, her lawyers paid, this ‘systems analysis’ dropped, and her good name and her flawless reputation restored, so that she can die in peace. Even then, it has taken the petition and innumerable emails and letters to the Minister for Health and pleas on the floor of the Dáil, before finally this weekend, a settlement was announced.
Philomena released a statement on Saturday, expressing in all her dignity, ethical strength and power, to say she has accepted this settlement. It can be viewed here in full.
In 1760, the great eighteenth century authority on midwifery, the distinguished midwife, Elizabeth Nihell, urged women to discard the ‘cloud of hard words and scientific jargon’ even then gaining strength to discredit midwives and midwifery, and to ‘Deign then for your own sakes, to examine by that light of Reason, the spring of which is forever in yourselves’ and by ‘your own fair examination’ make a decision about birth, a decision ‘that will no longer be dangerously and precariously that of others for you, but become truly and meritoriously the genuine result of your own judgment’.
Following in Elizabeth Nihell’s steps, Philomena has this eloquent message for women and for midwives:
‘I want to say to every pregnant woman out there, and every woman who wishes to be: you have within you the great gift of creation. Therein lies enormous power and potential. Aeons of time and tides have pushed against your centre of power - sometimes gently, sometimes not. Only woman can have dominion over birth, yet she is made battle continuously to guard her territory, or to gain access to it.
Every woman has the right to be supported by her healthcare providers in the birth of her choosing - just as she has the best interests of her baby at heart. Your inner compass will show you the way. Look to it. Listen to your intuition. Sit in the centre of your courage: fear may be part of the journey but courage will overcome it every time. And please listen to my words. You were born to do this. You were born to do this.’
Your hearts will break reading Philomena’s full statement. Ours are already broken.
And still the burning questions remain – how does a state which wants to designate itself as ‘modern’, aid and abet this kind of treachery, with all its secrecy and dirty tricks, which must surely border on the criminal, towards a midwife who has always been there for women? And when will the hunting down of midwives end?