IMA Statement on Current Discourse in Maternity Services

Press Release, Irish Midwives Association, 20th December 2016

Care in our national maternity services

At the time of Savita Halappanavar’s death in 2012, then Minister for Health James Reilly declared that despite the tragedy, our maternity services were amongst ‘the best and safest’ in the world. When the HIQA report on the issues surrounding Savita’s death was issued in 2013, the Minister said the report was ‘very disturbing’ and that our maternity services needed a new national plan which would be pursued ‘with urgency’.

The ‘urgency’ was never urgent enough.

In September, 2016, the Master of the Coombe Hospital, Dr Sharon Sheehan made the following comments at a patient safety conference, stating that there was a ‘severe lack of confidence in our maternity services and a chronic under-investment in the service’:

‘Staffing in the Irish maternity services is in crisis and staff shortages are having a serious impact on staff morale.’

‘In terms of consultants, Ireland has the lowest number of consultant obstetricians per 100,000 women of every OECD country. We are Paddy last on that graph.’

In respect of midwifery numbers, Dr Sheehan said:

‘I guess most staggering are the deficits we are seeing in the three Dublin maternity hospitals, whereby we are operating at a 17% deficit in the number of midwifery staff that we need to run our services.’

Furthermore Dr Sheehan stated:

‘There are a number of factors that have to be addressed if we are to make any meaningful impact on improving quality and patient safety, staffing, training, the woman herself, our resources, leadership and governance’

Reported in Irish Examiner, 13 September 2016

On 2 December 2016, the current Minister for Health Simon Harris stated in the Dáil that ‘in years past our maternity services did not receive the degree of priority they required’ and that he was ‘concerned about the increasing claims to the State Claims Agency arising from maternity cases’.

Since Savita’s tragic death, a series of investigations across a number of our 19 maternity units, have been carried out by the HSE and HIQA in response to the deaths of babies. These have consistently pointed to lapses in safe care which result from the factors that are outlined above by Dr Sheehan.

The controversy stirred up by Dr Jacky Jones’ article in this week’s Irish Times on the dreadful impact and legacy of symphysiotomy for women is testament to the pressure being confronted daily in our maternity services by midwives and by obstetricians.

In the recent past, there have been many scandals of care which have left women without a voice. This includes the terrible Neary case of the late 1990s and the scans crisis of 2010. AIMS Ireland, the national consumer organisation seeking to document women’s experiences, have carried out national surveys where women have detailed sub-optimal care and resulting trauma.

Equally, lack of voice, stress and lack of confidence are widespread amongst caregivers who are suffering burnout and work-related trauma.

Yet it took two years, from 2014 to 2016, for the Department of Health and the HSE to complete a review of staffing numbers using the Birthrate Plus UK formulas. Earlier this year, 100 new midwifery posts were finally sanctioned as part of Phase I in addressing staffing issues. As of the end of October, only 78 posts had been filled. According to the HSE, a further 100 midwifery posts are needed nationally. The national maternity strategy launched in January 2016 remains dormant.

Midwives and obstetricians cannot give optimal care, the care they have trained very hard to give, when their numbers are so overstretched. The current situation helps no one and is doing harm to women and to caregivers.

It should not take two to three years to begin to address this critical situation.

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