The Department of Health breached statutory obligations by not offering expecting mothers home births.
Angela Main-Thompson, the Tynwald Commissioner for Administration, examined the issue after a complaint from a couple who were refused a home birth.
The couple, identified as Mr and Mrs S, had lived in England but decided to return to the island to have and raise their children.
Having made plans for a home birth in England, the couple moved to the island when the borders were relaxed for residents in August 2020, by which time Mrs S was 30 weeks pregnant.
She had brought her medical notes and the birth plan agreed with her former midwife.
However, after meeting with the community midwife, she was told there was no provision for home births on the Isle of Man, and that she would have to have a hospital birth.
Ms Main Thompson said: ‘Mrs S was distressed by this, particularly when she received the news that the options available in hospital were limited. Already anxious, she was not re-assured when a midwife commented that she was not in N [the city in which they lived, which the report redacted] now and that Noble’s Hospital was not a centre of excellence.
‘Mr and Mrs S’s daughter was born at Noble’s in October 2020. After discharge, there were further difficulties with the community midwifery service which were investigated by the department and Mrs S decided not to refer that complaint to the IRB.’
She added that Mr S had written to her by this point, saying that ‘the denial of choice of birth on the Isle of Man is against current best practice as stated by the National Institute of Care Excellence’.
Despite initially seeming that the Department of Health and Social Care, then led by Kathryn Magson, was investigating the issue, it became apparent that it was only investigating the clinical decision, leaving the matter of legality to Ms Main Thompson.
There has also been a question of whether the pandemic and emergency measures would have superseded the right to a home birth, Ms Main Thompson said that she found that ‘no-one thought it necessary because those provisions had effectively been ignored for many years’.
Ms Main Thompson also looked at how many home births there were on the island in the last five years.
She found that between 2017 and 2021, 3,478 babies were born on the Isle of Man, with just four pre-planned home births.
It appears that part of the issue is that there are normally four midwives to cover a shift at the maternity unity but a home birth required two midwives to be available.
Ms Main Thompson said: ‘The problem is that the approach does not comply with the legislation. The adequate provision of midwives to attend women for home births was enshrined in the 1948 Act and was left unaltered by the 2001 Act.
‘The ingenious suggestion by the lawyer from the Attorney General’s Chambers that provided there is an adequate number of midwives to attend home births, they need not be deployed is a flawed argument.’
Towards the end of her report, Ms Main Thompson revealed that Mrs S is pregnant and had again requested a home birth, only to be told that ‘Manx Care was not offering choices on birth planning’.
Ms Main Thomspon said this didn’t tally with what she had been told by the former interim DHSC chief executive Ms Magson.
Manx Care later said: ‘The midwife who books the lady sends a request to the Head of Midwifery and contact is made to discuss the request. The likelihood of a home birth being available is low, however, if Manx Care did have a workforce that could accommodate the request on the day, they would attempt to provide this service (this would involve extensive preparation by all involved).
‘The staffing levels may improve (less staff on annual leave, positive recruitment drive) and Manx Care are working extremely hard with recruitment and retention. The Head of Midwifery has received two requests in the last eight weeks via e-mail for consideration of home-birth. On checking Mrs S’s records there is no mention by either the obstetrician or the midwife of a request.’
This appears to have been a miscommunication and Manx are said it was working to rectify this.
Ms Main Thompson said: ‘I trust that the conversation will now take place, but the message I take from this experience is that the expectant mother has to raise the possibility of a home birth in unequivocal terms in order to ensure escalation of the request to the head of midwifery.’
She added that the DHSC had ‘breached its statutory obligations over a number of years and acted ultra vires’ and that the ‘continuing failure by ManxCare to discuss the possibility of home births and decide on a case-by-case basis is unacceptable’.