The High Court has begun hearing a challenge by an expectant mother against a decision of the Health Service Executive refusing to facilitate a home birth.
Aja Teehan, a university lecturer from Kilkenny, is 29 weeks pregnant and wants to be assisted during childbirth by a self-employed midwife.
She is challenging what she says is a "blanket policy" of refusing to cover home births for women who have previously had caesarean section births.
Ms Teehan says she has no medical condition or complications with her pregnancy to justify the refusal.
She believes the risks of vaginal birth after C section to be miniscule in her case.
She claims the ban by the HSE breaches her constitutional rights and her rights under the European Convention on Human Rights.
The HSE has told Ms Teehan she has the right to have her baby at home.
However, it cannot provide indemnity cover for any midwife attending the birth because of HSE guidelines.
Opening the case this morning, her counsel Mathias Kelly said Ms Teehan's independent midwife considered her a suitable candidate for home birth but could not facilitate her due to HSE rules on home births after C section.
The midwife's discretion in such matters had been granted but immediately fettered by the directive, he said.
Ms Teehan is expecting her second child in October.
The court was told she is extremely fit, having taken part in endurance training and many other physical activities.
She has carried out extensive research and believes the risks of uterine rupture are miniscule in her case because of her level of physical fitness and absence of complications.
She lives less than 30 minutes away from St Luke's Hospital in Kilkenny, or is willing to stay with relatives for the home birth who live minutes away from the hospital, should she need to be transferred.
A doctor's report submitted by Ms Teehan places her at the lowest end of the risk scale and that there was no medical evidence that a planned C section or a natural delivery in hospital was any safer in preventing uterine rupture.
The court was told this was a case about fettered discretion (of a midwife) and a refusal by the HSE to consider the evidence put before it by Ms Teehan.
Mr Kelly said there "simply was no engagement".
She was not trying to turn herself into some sort of martyr, she was trying to minimise the risk for herself.
She did not want to go into a hospital and increase her risk of a caesarean birth.
She was acting as a perfectly responsible mother, he said.
A number of sworn statements were submitted to the court from mothers and midwives detailing the safe delivery of babies at home to mothers who had previously delivered by C section.
Mr Kelly said the discretion of midwives to make decisions on home birth suitability had been taken away.
HSE defends precautionary approach
Counsel for the HSE Paul Anthony McDermott said the executive did not doubt the bona fides of Ms Teehan.
She clearly wanted a home birth and believed it was safe. But he said this was a court of law and the only issue to be decided was what legal right had she identified.
He said the Supreme Court had already ruled there was no legal right to a home birth. The policy on which the decision about Ms Teehan was made was based on medical evidence and best medical practice.
There were risks associated with a vaginal birth after a caesarean section, including uterine rupture which had catastrophic effects on mothers and the unborn child, both of whom had rights under the Constitution.
The HSE was entitled to form such policy, he said.
It did not have to be unanimous and the public did not have to agree with it. It was better to take a precautionary approach, he said.
The chance of uterine rupture might not be enormous but it was so serious and potentially fatal that it had to be included in criteria ruling out a home birth.
He said the HSE had not refused to engage with Ms Teehan. It had explained the guidelines and offered help.
He said: "This isn't an unthinking, uncaring machine which simply issues an answer which is no."
The HSE had not plucked the policy out of thin air, he added.
Mr McDermott said Ms Teehan, like everyone, had free will and could have her baby anywhere she wanted but she "could not demand that a public body breach its own policy to provide a service."
It was a rational policy based on medical evidence, he said.
The HSE respected Ms Teehan's right to disagree with it but she could not come to court to compel the HSE to provide, support or finance a practice it did not believe was safe.
The case was adjourned and judgment will be delivered on 13 August.