The pounds 1m trials of this midwife could decide how your baby will be born

SOME PEOPLE are calling her a "danger to patients". Others are calling her the victim of an establishment witch-hunt. But the fate of Ann Kelly is likely to shape the future of home childbirth.

Ms Kelly, an independent midwife who has been the subject of a pounds 1m legal campaign by the medical establishment to stop her from working, has won the right to continue practising natural childbirth. She now faces two further inquiries, which could still see her struck off.

Her case has become a cause celebre in Ireland, highlighting the growing tension between hospital obstetricians driven by the demand for technological excellence, and midwives who believe women should be able to choose the kind of birth they want and where they have their baby.

Ms Kelly, 49, who works in Dublin, has faced 17 court orders over the past two years in her battle with the Nursing Board, Ireland's disciplinary organisation. She had been suspended from practising since August 1997. The board had argued that the midwife, who offers mothers the chance of a home birth and the opportunity to take charge of their own labour, was a "danger to patients".

The case against her began in November 1996 when a consultant at the National Maternity Hospital in Dublin made a complaint against her over the late admission of a woman who had allegedly been in labour for three days, although the length of time is disputed. Neither mother nor baby was harmed and the mother later wrote to the board, complaining about the use of her case in what she described as a "witch-hunt" against Ms Kelly.

Last month an application by the board to have Ms Kelly's suspension made permanent was rejected by the judge, who criticised the board for failing to re-examine her case. The decision means that she is free to practise for the first time in 22 months.

In that time, despite her suspension, 60 women applied to the courts and were granted permission for her to act as their midwife. So far, at least 47 have given birth in her care.

Ms Kelly, who has practised as a midwife for more than 25 years, the last 12 of them in Ireland, said she felt "very sad" at the board's action. "I practise natural childbirth and I offer a very personalised service," she said.

"I only take on four mothers a month because it is a 24-hour a day job. I have always had to be very professional with all my cases but I have had to be ten times stronger to stand up to what has been said about me."

She added: "My service is about giving women choice and respecting their rights but it is also extremely safe. I wouldn't do it if it wasn't."

But the medical establishment is not yet prepared to back down. She now faces two inquiries into her fitness to practise and could yet be struck off. They involve four cases in which mothers who encountered complications in labour were allegedly brought too late to hospital.

All of the babies were born safely and none suffered injury but Ms Kelly has been charged with misconduct because of the alleged delay.

The first inquiry began in March 1998 but was delayed when the board refused to allow Ms Kelly to bring in expert witnesses. Her lawyers appealed to the Supreme Court and won. The inquiry resumed on 10 May this year, and was adjourned until 21 June.

The second, which has yet to start, involves three other complaints, one from the same hospital and two from the Rotunda hospital in Dublin. But the three mothers involved are also supporters of Ms Kelly and one has since had a second baby, employing Ms Kelly as her midwife.

Ms Kelly has no funds to defend herself because the insurance carried by her nursing union only covers cases in which a patient has been harmed. Her legal team are acting unpaid and supporters have raised pounds 33,000 to cover air fares and expenses for witnesses. Legal experts estimate the total cost of the actions involving her at around pounds 1m.

Supporters claim that the extraordinary amount of resources devoted to proving a case against her shows there is a medical backlash against home births, which have become increasingly popular. Independent midwives in the UK and France have also been prosecuted in similar high- profile cases in recent weeks.

Lesley Page, professor of midwifery at Queen Charlotte's Hospital in Hammersmith, west London, said the case had elements in common with that of Caroline Flint, the independent London midwife who was found guilty last month of serious professional misconduct over errors involving a breech birth. "They have both been prosecuted and maybe even persecuted because they tried to provide safe care for women in labour without unnecessary interference," Professor Page said. "The system is not set up to support normal birth and to give women choice. It should be the system that is on trial rather than the individuals."

The Nursing Board declined to comment before the conclusion of the inquiries.

A Danger To

Patients?

September 1996: The first complaint about Ann Kelly is made by a consultant obstetrician at Dublin's National Maternity Hospital. He alleges a mother with a prolonged labour had been brought to hospital too late. The baby was delivered unharmed and mother and baby are well.

November 1996: Nursing Board informs Ms Kelly of allegations. She rejects them.

February 97: Three more complaints relating to delays in admission of women in labour are made to Nursing Board. Ms Kelly is not told.

April 97: Nursing Board announces inquiry into first complaint.

August 97: Nursing Board successfully applies to court for Ms Kelly's suspension on the basis that she is a danger to patients. Ann Kelly Support Group set up

March 1998: Inquiry begins and adjourns after Board refuses to allow Ms Kelly to call independent experts in her defence.

May 98: Ms Kelly appeals unsuccessfully to High Court over experts.

December 98: Appeal goes to Supreme Court. Ms Kelly wins.

10 May 99: Inquiry resumes with experts giving evidence. Adjourned to 21 June.

18 May 99: Injunction suspending Ms Kelly is lifted. She is free to practise again pending the outcome of the inquiry.