Press Release HIQA Findings

PRESS RELEASE: Overview Report of HIQA’s Monitoring against the National Standards for Safer Better Maternity Services

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14th February 2020

Overview Report of HIQA’s Monitoring against the National Standards for Safer Better Maternity Services, with a focus on Obstetric Emergencies published on 12th February 2020

Patricia Hughes, Chairperson of the Midwives Association of Ireland (MAI) states that “The Supported Model of Care, with midwives leading and delivering care within a multidisciplinary framework, is not an optional luxury. If we are to improve quality, we must improve this. The MAI stresses that the primary and essential foundation for the implementation of the National Maternity Strategy is to immediately and rapidly establish the Supported Care Model as the basis upon which all other care is built, i.e. fund, enable and progress the Supported Care Pathway to take effect without further delay.

  • Acknowledgements:
    • The Midwives Association of Ireland welcome and endorse both the findings and the eight recommendations of the HIQA Report (Feb 2020).
    • The MAI acknowledge and commend the commitment of HIQA in seeking to ensure Safer Better Care in Maternity Services in Ireland through their work on developing and monitoring standards on an ongoing basis. The MAI note the many very positive aspects of the services identified by HIQA and in particular the commitment of the frontline staff.
    • The MAI acknowledges the staff including midwives who continue to prop up our maternity services  24/7 often at a personal cost to themselves in terms of physical and mental health.
    • The MAI endorses the contents of the INMO Press Release dated Wednesday 12th February 2020 re this Overview Report.
  • Safer care and more effective care for everyone – Supported Care Model
    • The MAI notes that for most women in Ireland, the ‘Supported Model of Care’ as defined in the Strategy will not only meet the needs (physical, psychological, social, maternal, neonatal and woman/ family centred) and wishes of the majority of women and their families in Ireland, it is also the most cost effective.
    • Midwives will return to Ireland to work in such a model of care, where the Midwife is enabled and supported to work to the her/his Scope of Practice as defined by our regulatory Body, the Nursing & Midwifery Board of Ireland and for whom they have been educated and trained but there is little appetite for midwives to work in our current configuration of maternity services and so the stasis and risks and expense (physical, social and monetary) continue.
    • The MAI do not accept that implementation of the Supported Care Model is “the cherry on top if and when everything else is fixed”. The Supported Model of Care is not an optional luxury. If we are to improve quality, we must improve this. The MAI note that the Assisted and Specialist Care models already exist for the most part in what were previously known as Shared Care (with the GP) and full Consultant care, respectively.
    • There has been little to no progress on the Supported Care Model to date. In fact there continues to be ongoing undermining of the limited availability of such a model where it existed prior to the National Maternity Strategy.
    • The evidence in support of the contribution of continuity of midwifery care to high quality maternity care, on which the Supported Model of Care is based, is clear. High quality evidence demonstrates that women who receive midwifery-led care have improved outcomes for them and their babies. They are less likely to experience episiotomies or instrumental births or a preterm birth. In addition, they are at lower risk of losing their babies.[1]
    • The MAI is concerned with the continuing and increasing portrayal (despite all of the best available and international evidence) of pregnancy and childbirth as being overtly risk laden for EVERYONE by some very vocal ‘medical’ personnel who have little or no experience of a Supported Care Model. The MAI challenges this dangerous and self-fulfilling prophecy as it has been clearly shown that early and accurate identification of certain risks is very effective in protecting low risk women and their babies from the vagaries of the “too much too soon” application of technology and medicalised intervention whilst early and accurate identification of risk also protects those of medium and/or high risk who can be protected from the “too little, too late” application of timely and  appropriate technology and care.  By ensuring effective care pathways where women can be easily and quickly referred into the appropriate pathway of care, everyone will benefit, immediately. Unfortunately, due to the current configuration of maternity services in Ireland, women, their babies and families and health care staff are victims of unintended life altering consequences. This must change. All care should be provided at the lowest level of complexity required but with clear pathways for timely transfer to appropriate levels as required. Safety for everyone.
    • The MAI strongly urges that the primary and essential foundation for the implementation of the National Maternity Strategy is to immediately and rapidly establish the Supported Care Model as the basis upon which all other care is built, i.e. fund, enable and progress the Supported Care Pathway to take effect. This will result in a reversal of the Recruitment crisis in Midwifery and will support inward migration of midwives, the decongestion of secondary and tertiary services allowing more time and space to be given to ALL women and to those that need obstetric intervention as and when they need it. Safer care and more effective care for everyone.
  • Evidence Based Care
    • The MAI is concerned with the accuracy of messaging, tone and direction of a publication last July of a National Guideline on Cardiotocograph Monitoring- the very aspect of technology that gives rise to most confusion and concern in modern maternity care. The Guideline has not been drafted to the standards set down by the National Clinical Effectiveness Committee (NCEC)- indeed it is not compliant with any reputable standard. It is not evidence based. It is confusing and erroneous in parts and although the concerns have been brought to the table of the responsible body- by numerous stakeholders including the MAI, the Guideline continues to exist almost 7 months later (over 30, 000 births later), potentially putting many mothers and babies and their clinicians at risk. This must be addressed without further delay. The MAI requested that the responsible body withdraw the Guideline until such time as it was reviewed and redrafted in line with NCEC standards. This has not happened to date. The MAI notes that two eminent post-doctoral research midwives resigned from the Committee in question and withdrew their names from the publication. 
  • Sláintecare and the National Maternity Strategy
    • The MAI drafted a Midwives Manifesto earlier this year, issued to the main political party leaders and their party spokespersons. Key to that Manifesto was to point out that Sláintecare which was on everyone’s lips during the election and which was published in 2017, a year after the much-lauded National Maternity Strategy (NMS), mentions the NMS but in a way that assumes that the NMS is driving the necessary improvements. There is a great risk that if the NMS is not fully implemented, there is no charge within Sláintecare to deal with maternity services as it primarily relates to health services for the acute and chronically sick only. There is not one mention of the word ‘Midwife’ in the Sláintecare report, the primary carer for every single pregnant and labouring woman in the State irrespective of level of risk or Model of Care.
  • Implementation:
    • The MAI now urges the Government, HSE and all stakeholders to urgently and completely address HIQA’s eight recommendations and to commit to and ensure the immediate and progressive implementation of all 77 recommendations contained within the National Maternity Strategy (DoH Jan 2016).
    • The MAI has repeatedly spoken out on these issues, underfunding, short staffing, unduly slow /absent implementation of the 77 recommendations contained within the National Maternity Strategy, now in its’ 5th year of the 10-year programme (2016-2026).
    • The MAI is cognisant of the origins of the National Maternity Strategy, the first in the history of the State, which was to finally and effectively address the terrible shortcomings of the state of maternity services in Ireland that has resulted in decades of so many tragic and avoidable injuries and deaths amongst the most vulnerable, women and babies, the future of our Nation.
    • The MAI notes that although a ring-fenced budget was assured by the then Government for the implementation of the Strategy, this did not happen. Moreover, there was no attempt to front load the budget so any hope of ensuring increased morale or harvesting of early wins and low hung fruit were soon dashed. In effect, this Strategy was bound to fail in its implementation. This is not only distressing for the countless families who have been the victims of totally outdated and inadequate /patchy services provided heretofore but for the many committed and dedicated staff who have tried to do their personal best in woefully inadequate circumstances. Indeed the recent resignation of Mark Molloy from the HSE Board, nominated in view of his personal experience associated with the tragic loss of his son within the Irish Maternity service, but who resigned out of utter frustration by the inability to positively affect change serves as a further blow and pushback to all who are stridently seeking to improve women’s health and maternity services in Ireland. To implement the current HIQA report, what is vital is that Ireland’s maternity services, two decades in to the 21st century, actually follow international evidence and the developments of maternity services in NI and Scotland, where extended scope to genuine midwifery-led care is a matter of core national policy as is home birth. 
    • The MAI now urges the incoming Government, the Dept of Health and the HSE to engage with all relevant stakeholders of which midwives are essential key stakeholders to ensure that the National Maternity Strategy is urgently prioritised and is properly and proactively organised and funded to ensure no more lost opportunities, no more primary or second victims insofar as is practically possible and let’s provide a service where women and babies are not only well cared for but feel safe and well cared for and a service where staff feel safe, fulfilled and proud of what they do. Is that too much to ask for? The MAI does not think so.
    • The MAI look forward to engaging further on these matters and to be part of the team who are willing and able to troubleshoot obstacles to improve care and services for all.



The Midwives Association of Ireland




[1] Sandall J, Soltani H, Gates S, Shennan A, Devane D. Midwife -led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews 2016, Issue 4. Art. No: CD004667. DOI: 10.1002/14651858. CD004667.pub5.

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