Will the new standards for maternity services make a difference to women’s health?
Given the flat-earth mind-set of many obstetricians, resistance to their implementation seems certain
There is convincing evidence that midwife-led care produces better outcomes for women and babies
At last there is good news for Ireland’s pregnant women. The National Standards for Safer Better Maternity Services were recently launched by the Health Information and Quality Authority (HIQA). They were developed because “it has been highlighted that women have faced serious failings in their maternity care and a series of significant service deficits have been identified. These failings have undermined confidence in Irish maternity services and have impacted significantly on staff morale.”
A total of 409 standards are grouped into eight themes: Person-centred Care and Support; Effective Care and Support; Safe Care and Support; Better Health and Wellbeing; Leadership, Governance and Management; Workforce; Use of Resources and Use of Information. The standards cover the care of women and their babies from before pregnancy until six weeks after the birth.
The standards mean that women will be involved in the planning and design of maternity services in their area. The maternity workforce will be managed in a way that provides continuity of carer, and informed consent will be sought for all examinations and procedures. Women must be given evidence-based information to ensure they can make informed choices. Irrespective of their care pathway, all women will have a midwife and GP involved in their care.
The standards mean women can refuse to be induced and refuse drugs to speed up labour. Women can refuse to participate in “the active management of labour”, which is practised in the vast majority of Irish maternity hospitals and units, and means that doctors decide how long labour lasts.
Will the standards be implemented? Given the flat-earth mind-set of many obstetricians, resistance to their implementation seems certain. Dr Peter Boylan was interviewed by Sean O’Rourke a fortnight ago. A former Master of the National Maternity Hospital, he wants the Master model, which has an obstetrician in overall charge, “a captain of the ship” as he put it, to apply to all maternity units. He claimed outcomes for women and babies are better with the Master model and maternity services should be organised “like the cancer strategy”. Cancer is a disease and needs effective medical treatment. Pregnancy is not a disease, it is a normal life event.
There is convincing evidence that midwife-led care produces better outcomes for women and babies. In a 22-minute interview, he did not mention midwives. Do other obstetricians working in Irish maternity hospitals and units think like Dr Boylan? If so there is little hope that the standards will be implemented.
Best practice care pathways are described under Theme 2 Effective Care and Support. All pathways support the normalisation of pregnancy and birth. According to the standards, the vast majority of women do not need an obstetrician and will receive a “supported care pathway” with midwives leading and delivering care. “Responsibility for a woman’s care will be assigned to a clinical midwife manager and care will be delivered by the community midwifery team, with most antenatal and postnatal care being provided in the community and home settings.” Only women with medium- and high-risk pregnancies will receive care from an obstetrician who will be part of a multi-disciplinary team.
Will women will be happy with a midwife? Since the Maternity and Infant Care Scheme was introduced more than 50 years ago, Irish women have become convinced that they need an obstetrician. They may feel a midwife-led service is not good enough, or worse, a cost-cutting exercise. It will probably take another 50 years to change mind-sets and develop a culture that respects and understands what midwives do. For too long they have been seen as a doctor’s assistant instead of highly skilled professionals in their own right. It will probably take several generations of women giving birth according to the new standards before a woman is able to say “I can manage my own pregnancy”.
Exhibition commemorating maternal deaths
A multimedia exhibition commemorating maternal deaths in Irish hospitals will be launched in the Institute for Lifecourse and Society, NUI, Galway, at 6pm on Friday, February 3rd. The exhibition will run daily from 9am until 5pm from February 4th to the 10th and includes a documentary, a quilt knitted by 150 women, and portraits of women who received inquest verdicts of medical misadventure. A panel discussion will be held following the launch on the 3rd – Why are women dying and what we can do about the failures in our maternity services” – chaired by Prof Declan Devane, School of Nursing and Midwifery, NUI, Galway.