Review into baby and maternal deaths will begin this year, HSE confirms

Move to investigate perinatal deaths follows recommendations from the National Perinatal Epidemiological Centre

The review will seek to learn from the deaths to improve maternity services, the HSE has said. Photograph: iStock

An annual review into baby and maternal deaths will begin this year, the Health Service Executive (HSE) has confirmed.

The move to investigate perinatal deaths follows recommendations from the National Perinatal Epidemiological Centre (NPEC) and a proposal by the National Women and Infants Health Programme (NWHIP).

It will seek to learn from the deaths to improve maternity services, the HSE said.

The review will look at three years’ worth of data at a time, beginning with 2021-2023. A report will be produced annually with another year’s data being added each time.

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The HSE said it is a confidential review “only in the sense that it will be anonymised” with reviewers conducting the inquiry not knowing any identifying details.

Reviewers will not be assigned a case from their own hospital and will be drawn from obstetrics, midwifery, neonatology, neonatal nursing and other specialities if required.

A separate governance group is being established to oversee the inquiry and will involve public and patient involvement, though the terms of reference have not yet been agreed.

“Ireland’s perinatal mortality rate compares very well with that in other countries. However, the death of any infant is a tragedy and the HSE reviews all such events in line with the HSE’s Incident Management Framework,” a HSE spokeswoman said, adding that quality and safety are of “paramount importance”.

It comes as an alliance of organisations representing parents and babies who have died called on Taoiseach Simon Harris to establish a commission of investigation earlier this year into perinatal deaths and catastrophic birth injuries.

The alliance, which includes Safer Births Ireland, Féileacáin, Aims Ireland and The Birth Rights Alliance, said there had been at least 42 avoidable baby deaths since 2013 and called for actions to “try to stop these repeated deaths and injuries in Irish hospitals”.

Safer Births Ireland co-founder Claire Cullen, whose firstborn son Aaron Ben Cullen died five days after his birth at the Midland Regional Hospital in Portlaoise in 2016, said the three-year historic time frame outlined by the HSE is insufficient.

“We believe looking back on the 10-year period is necessary for it to be constructive and transparent enough,” she said.

She said the number of baby deaths due to medical misadventure over the last 10 years has since risen to 52, though this figure is based on news reports of inquests.

Ms Cullen, who settled a case against the HSE concerning her son’s death, questioned why a confidential review has been deemed necessary rather than an independent one, saying there is a “lack of transparency”.

She said campaigners have been “sidelined” and have not received a response from the Taoiseach, nor were they directly informed of the HSE’s plans.

Johan Verbruggen, head of medical negligence claims at Fieldfisher, said there has been a feeling among those who have been affected by birth trauma that they have been excluded from conversations around improving maternal healthcare.

“They don’t want their experience being seen as a problem on a piece of paper. They don’t want others to experience the same trauma they have faced. Often lessons that can be learned offer the only silver lining,” he said.

“The best way to do that is through an inquiry.”

Mr Verbruggen, who suffered a birth injury, said he and advocates have had difficulty in ascertaining the exact number of maternal deaths, and he hopes this inquiry will be able to assist in this regard.

“Until we do that, we won’t know what problems we have or what great a service it is because if there isn’t a centralised database for all of that information then I don’t know what the State is working off in assessing it,” he said.

Jack White

Jack White

Jack White is a reporter for The Irish Times

Shauna Bowers

Shauna Bowers

Shauna Bowers is Health Correspondent of The Irish Times