A report for the HSE reveals deep concern at a sub-standard maternity service. Martin Wall reports
A report drawn up by a sub-group of the Institute of Obstetricians and Gynaecologists for the HSE has revealed deep concerns among doctors, midwives and patients at the standard of maternity and gynaecology services around the State.
The final report of an institute sub-group says that in many of the 22 maternity units, the labour wards and other facilities are significantly sub-standard.
It says the sub-group identified "significant infrastructural deficits" during its visits to different units.
It states there is a dissatisfaction among many health professionals with the arrangements for maternity services nationally, relating to both resource allocation and the prioritisation of the care of women and babies within the current health reform programme.
"Many consultant obstetricians in smaller units expressed their sense of professional isolation. Obstetricians in smaller units felt that their views on the development of services were not being given due consideration," it says.
The report also states that despite improvements in perinatal mortality rates over the past 20 years, these could be improved further.
It says that there was a view that neonatal outcomes could be improved.
It also maintains that there are significant deficits in consultant numbers and delays in the approval and appointment of additional and replacement positions.
The report maintains that midwifery/nursing staffing levels are also perceived to be inadequate in most units and that no standardised staffing model has been agreed nationally.
It says that midwives told the report's authors that career advancement and continuing education were highly variable.
It says midwives in most locations would like to offer a choice of models of care to expectant mothers and their families.
"There are examples of team midwifery, midwifery-led care, domino schemes, etc in several maternity units.
"However, there are clear variations in the schemes available nationwide and obvious disparity in access according to region," it states.
The report maintains that among the areas of dissatisfaction highlighted by patients were the lack of choice in the types of care available, the problems of having to travel long distances to maternity units, inconsistency in the frequency of post-natal visits and limited availability of post-natal depression service.
The report also says that there is a general view among gynaecologists that "Irish practice is lagging behind other European countries, particularly in areas of minimal access surgery and outpatient surgical treatment".
It says there are concerns at a lack of protected gynaecology beds, particularly in large general hospitals, a shortage of nurses/midwives with experience in gynaecology, especially in large general hospitals, and poor facilities and equipment in gynaecology theatres in maternity hospitals when compared with general hospitals.
The report says the Republic should be divided into five clinical networks, each headed by a referral centre to which women at risk of severe obstetrical or medical complications would be sent.
The report says the basic infrastructure in each maternity/gynaecology unit should include: a labour ward with a dedicated obstetrics theatre; dedicated adequate theatre sessions for gynaecology (separate from emergency obstetrics); dedicated obstetrics wards; and dedicated separate gynaecology wards staffed by nurses/midwives who are trained in gynaecology.
It says there should be a dedicated 24-hour assessment area for obstetrics and gynaecology emergency cases and a dedicated outpatient area for obstetrics and gynaecology.
The report also proposes that an agreed national staffing model for midwifery and nursing should be developed and applied across all maternity and gynaecology units.
The report says that in the referral centres there should be 24-hour, on-site, on-call consultant obstetric cover in labour wards dealing with 6,000 deliveries or more each year.
It says it is envisaged that such units will require a complement of at least 20 consultants on the roster to be able to provide 24-hour labour ward cover.
It also maintains that the referral centres should have a skills set, expertise and resources to look after complex maternal and foetal problems and very small sick babies.
It says they should have an obstetric high dependency unit, with immediate access to intensive care beds as necessary, and ready access to maternal/foetal medicine services.
The report also proposes that each network should have sub-speciality gynaecology services in urogynaecology, minimal access surgery, reproductive medicine and gynaecological oncology.
It also says that assisted reproduction services should be publicly funded. "All assisted reproduction services are currently provided only in the private sector. A total of eight units provide these services. Three units are linked to public hospitals [ Rotunda, UCHG and the National Maternity Hospital] but are nevertheless privately funded," it states.
The report says that at least 175-200 consultant obstetrician/
gynaecologists will be required in Ireland in 10 years' time to provide the staffing levels necessary in maternity units and referral centres.
It proposes that there should be at least one consultant per 350 births in maternity units.