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Officials work to head off ‘crisis’ over home births

Department of Health officials last night met with home birth advocates in a bid to head off a “crisis” over what proponents of home birth have branded Government interference.

Chief Medical Officer Cheryl Peek-Ball said she was “optimistic” that locally registered and qualified midwives could be found in time for the several imminent home births.

With liability and costs increasingly an issue in the option of giving birth at home, however, the two sides have been at loggerheads over the refusal of Immigration approval for two overseas midwives.

According to details provided by home birth advocates, one of the midwives has since been approved for registration by the Bermuda Medical Council, with the other offered six months' provisional registration.

Their entry to the Island remains subject to Immigration approval, and the second midwife will still need to have supervision by a local registered midwife or physician.

“In the last year or so there has been irregularity in following standard guidelines,” Dr Peek-Ball told The Royal Gazette. “But that isn't the current crisis. The crisis is really that we don't have locally trained midwives.”

On occasions in the past, she said, midwives have been unable to reach the Island in time due to delays in their commercial flights.

“It's a situation that we know has happened once or twice. That scenario is one that we don't want to see happening again.”

Dr Peek-Ball said the Bermuda Medical Council wasn't seeking to obstruct home births, and said Government is not tasked with “forcing” expectant families to attend King Edward VII Memorial Hospital.

“What we're trying to do is create a situation where we have local midwives. If they're competent and qualified, they wouldn't need to be supervised. They could liaise with obstetricians.

“The point I really want to get across is that we all want the same thing. I don't think you'll find a single home birth parent who wants to be without an attendant or with an attendant who isn't qualified.

“On the other hand, nor do we feel that we should be in a position of having to use people with standards that deviate from the best standards.”

She said that one “point of misunderstanding” was the need for easy access to emergency care during a couple's first birth.

“There seems to be a disconnect over what's acceptable to the healthcare community and what's acceptable to the general public. In every jurisdiction where home births are done in a safe way there are very strict emergency criteria. One of them is emergency accessibility. We have some issues with that in some parts of the Island, and that's a concern of ours.

“Another is the fact that it's crucial to have two healthcare professionals at a birth, because there are two potential patients — the mother and the baby.”

The issue turned problematic with the retirement of the former supervising practitioner, but Dr Peek-Ball said insurance and liability over home births had loomed larger in recent years.

“Liability is the scary part that nobody wants to talk about,” she said. “Nearly 100 percent of the time childbirth is not eventual, but sometimes there's a crisis and they don't always end well. It's that liability coverage that has become a big issue for the healthcare community.”

She said that home birth families have relied in the past on signing waivers, but that it was questionable whether a waiver would stand up in a court.

“The legal environment has changed, the number of births has declined in the last few years and the number of obstetricians has decreased. A lot has changed from the original business arrangement of six to eight years ago.”

She said she hoped that the Bermuda Medical Council would be able to find common ground with home birth advocates and come up with a locally registered midwife in time for next month's births.

As of last night the group planned to meet with five expecting couples to identify “specific options for the couples in light of the regulations on the practice of midwifery on the Island”.

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Published May 28, 2014 at 9:00 am (Updated May 27, 2014 at 11:42 pm)

Officials work to head off ‘crisis’ over home births

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