The new National Standards for Bereavement Care following Pregnancy Loss and Perinatal Death have just been published. Why are they needed? How hard can it be to show empathy to parents who have experienced pregnancy loss and perinatal death? There are about 500 perinatal deaths a year in Ireland and about 15,000 miscarriages.
Maternity staff must be well used to dealing with loss by now. Unfortunately, they have not always treated bereaved parents with empathy so standards are needed. They include “All hospital staff will receive mandatory training on how to communicate sensitively and how to break bad news”; “If parents have chosen a name, the baby is referred to by name at all times”; and “The hospital facilitates parents with overnight rest and refreshment facilities.”
Although the standards have been welcomed by many parents who have experienced pregnancy loss, will they be enough to change the culture that persists in Irish maternity hospitals and units? Will staff remember the 212 standards?
Harsh treatment
Women have always been treated harshly and with little empathy in Ireland’s maternity hospitals and units. The culture in these hospitals and units persists and is related to what the European Ombudsman, Emily O’Reilly, recently referred to as the Irish State treating women like children, too immature to know what’s best for them.
Speaking at the official opening of the Parnell Summer School, in Rathdrum, Co Wicklow, she said "vast swathes of women were essentially infantilised through the laws of this newly independent State, their rights little greater than those of their children, their bodies, minds and actions controlled through the cultural, legal and religious apparatus of the Republic".
Nowhere were women’s bodies controlled more than in Irish maternity hospitals where they were expected to do what they were told and still are today.
In 1946 my mother gave birth to her second child, a daughter Josephine, in what is now University Hospital, Galway. The child died in the hospital two weeks later. My parents received no explanation, no information, and were told to go home and forget about it.
My mother hardly ever spoke about what happened but the experience resulted in a lifelong fear of hospitals and a dread about the outcome of seven subsequent pregnancies in case the same thing happened. My mother did not need counselling; she needed information and open disclosure. No one knows if there was a post mortem or an inquest.
Recently, I asked for copies of the birth and death certificates. The same nun had registered both events so was aware that my sister had been named by my parents.
The nun did not bother to register my sister’s Christian name in the death certificate, giving only the surname. Mothers and babies did not matter then and 70 years later parents are sometimes treated in the same way.
Despite the New National Maternity Strategy, Creating a Better Future Together 2016-2026, things have not improved much for women and their newborn babies.
My August 2nd column on breastfeeding (iti.ms/2bN7jGU) provoked hundreds of emails from women who have given birth this year in Irish maternity hospitals and units.
Most of them said they received little or no support from maternity staff and breastfeeding was even discouraged by some midwives. Several mothers found their babies were bottle-fed even though the women had asked for this not to happen. Free bottles are still distributed like “smarties”.
The national maternity strategy wants to improve breastfeeding rates. According to the strategy, “The HSE Infant Feeding Policy for Maternity and Neonatal Services now applies to all maternity care settings. All settings are encouraged to review their maternity and neonatal procedures and practices to ensure that they are fully aligned with national breastfeeding guidance.
“While all 19 maternity units/hospitals participate in the WHO Baby Friendly Health Initiative (BFHI), only nine units/hospitals are currently designated baby friendly. Full compliance with the BFHI is now recommended.”
This obviously is not happening. Do we need national standards for everything including breastfeeding? What about standards for induction, labour, episiotomies, birth, and Caesarean sections? Maybe it is about time everything that happens in maternity hospitals and units is completely controlled and not left up to maternity staff to pick and choose their own standards.
Clarification: The statistics given in the August 2nd piece on breastfeeding were confusing. The rate for exclusively breastfeeding on discharge from hospital in 2014 was 46.6 per cent, the same as in 2013. The 56 per cent rate referred to "ever breastfed". Ever breastfed rates for 2014 were the same as 2013.
Jacky Jones is a former HSE regional manager of health promotion and a member of the Healthy Ireland Council. drjackyjones@gmail.com