A Master in waiting

Dr Rhona Mahony has just been elected the first female Master of a Dublin maternity hospital, and will take up her new post in 2012

IMAGINE BEING responsible for the births of 10,000 babies every year. And their mothers’ safety. And being de facto chief executive of a hospital, with overall responsibility for the staff and infrastructure. Welcome to the world of Dr Rhona Mahony, who has just been elected the first ever female Master of a Dublin maternity hospital.

Dr Mahony will replace the current Master of the National Maternity Hospital (NMH), Dr Michael Robson, whose seven-year term expires on December 31st, 2011. She will become the 17th Master since the foundation of Holles Street hospital in 1894.

Far from being fazed by creating history, Mahony says, “I am incredibly privileged to be given the opportunity to perform this role.”

Currently a consultant obstetrician and gynaecologist at Holles Street, she has no illusions about the task ahead. “It won’t be easy. We live in a difficult economic climate that is affecting every single public service [in the State].”

There is some speculation as to what her title will be. “Of course, I will be known as Mistress,” she says jokingly.

Confirming she will use the title Master, she says it has long been in use, is well understood and is, she says, an “affectionate” term. So Master Rhona it will be – in a positive, asexual, way.

The Mastership system is unique to the three Dublin maternity hospitals – the Rotunda, Coombe and Holles Street. Established in the 18th century by a royal charter given to the Rotunda, the system was well ahead of its time. It means the buck stops with one individual, both clinically and administratively.

With such clear lines of responsibility, it has streamlined decision-making. Historically, it has applied a rigour to the standards of care offered by consultant obstetricians, in that, uniquely in Irish medicine, they were answerable for their actions to a clinical peer, the Master.

Every month, the Master conducts a formal audit of the hospital’s clinical activity, with extensive discussion of issues such as perinatal mortality and morbidity. Where a need for improvement is identified, it is acted upon; the system also acts as an early warning system, allowing issues to be identified before they become a problem for patients.

Does Mahony have a past Holles Street master she particularly admires? John F Cunningham, appointed in 1931, she says without hesitation. He took over the hospital at a time when the building was in some disrepair and the number of hospital births was rising significantly as home births began to decrease.

“He was a dynamic individual, a very quick surgeon, who succeeded in halving the maternal mortality rate and completed a rebuilding programme.” He was also an academic, who established links with St Vincent’s Hospital and University College Dublin.

Which brings us to a topical subject: Holles Street has been in talks to move to the St Vincent’s campus for some time. How does she view the prospect? She firmly but politely declines to comment on any aspect of the proposed link with St Vincent’s University hospital (SVUH).

But the move is likely to take place during Mahony’s tenure. Published in 2009 and undertaken by KPMG, the Review of Maternity and Gynaecology Services in the Greater Dublin Area made recommendations as to how best to reconfigure maternity services in the region. The report unequivocally recommends that the Coombe, NMH and Rotunda, move to Tallaght, St Vincent’s and the Mater sites respectively.

Almost 50 per cent more babies were born in Holles Street in 2009 compared with 1994. Last year saw a further 7 per cent rise, bringing the total annual birth numbers to just under 10,000 babies.

The current Master has spoken of the need to urgently move to SVUH “before serious consequences occur”. It is clear the increasing number and complexity of births at the hospital, combined with a staff recruitment embargo, have brought the hospital to a knife-edge.

KPMG also recommended that NMH develop midwifery community services for both expectant mothers and those who have recently given birth. The review also asked that each of the Dublin maternity hospitals set up midwifery-led units on-site.

Holles Street has a number of community-led schemes already in place, Mahony notes. But she declines to reveal any plans she may have to expand community midwifery until she takes up her post next January.

On the issue of climbing Caesarean section rates, the Master designate says they have started to plateau. She believes the key to reducing the number of sections is in how a woman’s first labour is managed – “we must make sure we don’t make her first delivery complicated” – as this leads to a much higher probability of an operative delivery. And she doesn’t consider the “too posh to push” phenomenon as something that exists in Ireland where, she says, obstetricians promote good, safe medicine.

At several points during the interview, Mahony emphasises the extent to which every single staff member contributes to the success of NMH. “They go the extra distance every time and have a great esprit de corps,” the Master-designate says with obvious pride.

Who Is Rhona Mahony?

Rhona Mahony is a Dublin native who was educated at the Holy Faith Convent, Clontarf. She graduated in medicine from UCD in 1994, with first class honours in obstetrics. Following internship she went straight into obstetrics training at the Coombe hospital. Further training included time as assistant master of the Rotunda and sub-specialty training in foetal and maternal medicine in Birmingham. She was appointed to the staff of Holles Street in 2009 as consultant obstetrician specialising in foetomaternal medicine. Aged 40, Dr Mahony is married with four children.