Call for full reconfiguration of maternity services

Tue, Dec 6, 2011, 00:00

THE STATE’S new dedicated professor of midwifery has called for an entire reconfiguration of maternity services to ensure women have better options.

“There is no evidence to support that the centralisation of maternity services in large hospitals improves outcomes for women and their infants,” Prof Declan Devane, recently appointed to the post at NUI Galway (NUIG), has said.

“On the contrary, there is substantial high-quality evidence demonstrating benefits for midwifery units in which the skills and expertise of midwives are used to their full potential,” he said.

“Common sense suggests, and scientific evidence demonstrates, that it doesn’t make clinical, social or economic sense for most women to give birth in large, centralised hospitals that are heaving at the seams. Yet, this is precisely what is happening,” he said.

NUIG’s last professor of midwifery held the position 135 years ago, when Prof Richard Doherty lectured at what was then Queen’s College, Galway. Prof Devane has been appointed to the only current dedicated post in the State in this speciality, according to NUIG.

Prof Devane, a trained midwife himself, emphasised no single model of care should be advocated for all women, as “midwives, obstetricians and general practitioners each have their place. However, every woman should experience the best possible care from the most appropriate professional, chosen by her” to ensure the best outcomes, he said.

In Ireland, an over-reliance on one model of care has led to a situation where the State has one of the lowest midwife-to-women ratios in Europe, at a time when the birth rate is climbing.

In Britain, the Royal College of Obstetricians and Gynaecology has recommended the need for more midwifery units, and a similar recommendation was made in a 2009 KPMG consultancy study on Dublin’s three major maternity hospitals.

It recommended the three maternity hospitals should move to nearby acute hospital locations.

“By using midwives to their full potential in cases where mothers are at low risk, this frees up obstetricians to focus on high-risk cases,” Prof Devane said. “Midwifery care is no more expensive, and certainly less expensive in many cases.”

A study published a year ago comparing two methods of maternity, commissioned by the Health Service Executive and conducted at Trinity College Dublin’s (TCD’s) school of nursing and midwifery, found midwifery-led care was as safe as consultant-led care, but used less intervention in pregnancy and childbirth.

A reconfiguration of maternity services would also address a climbing Caesarean section rate, up from 10 per cent to 26 per cent of all births in the past two decades, with “dramatic variations” in Caesarean rates between hospitals, according to Prof Devane.

The fact there is no national community midwifery service and one of the lowest breastfeeding rates in Europe are also related issues.

Prof Devane said he agreed with issues raised recently by the master of the Rotunda, Dr Sam Coulter-Smith, over lack of resources. “The Dublin maternity hospitals are pushing a figure of 10,000 births a year, with no increase in infrastructure, and with some units handling 25-30 births a day, with women being discharged too early after Caesareans,” he said.

Prof Devane qualified as a nurse in Galway and as a midwife in Bristol and Gloucestershire, where he worked before returning to Ireland to work in the Rotunda, the Coombe Women Infants University Hospital and TCD.

He is a member of the expert network of research advisers at the International Confederation of Midwives (ICM), a member of the midwifery committee of An Bord Altranais, and an honorary visiting fellow of both the British Cochrane Centre and the Coombe Women Infants University Hospital.

He is a director of the children’s cancer charity Hand in Hand, and raised over €35,000 for it in 2009 when he set a Guinness World Record for the longest open saltwater scuba dive.