Unacceptable inequalities in maternity services persist

Even with a national maternity strategy it seems we cannot guarantee equitable care for pregnant women here

 

The inquest into the death in May 2014 of one-day-old Conor Whelan in Cavan General Hospital is another a reminder of unequal standards in maternity services in the Republic.

Returning a verdict of medical misadventure, the inquest jury recommended the immediate appointment of a radiologist with obstetric expertise at Cavan General and that an ultrasound examination be carried out on all pregnant women when they reach 20 weeks gestation.

Baby Conor died after blood vessels tore in his head, causing brain injury. It subsequently emerged that his mother had a rare condition, vasa previa, in which the placenta lies near the neck of the womb.

Foetal blood vessels within the placenta or the umbilical cord are trapped between the foetus and the opening to the birth canal; as a result there is a high risk the baby may die from haemorrhage due to a blood vessel tearing during labour. If detected during pregnancy, the mother is closely monitored and delivery by Caesarean section planned.

Speaking after the verdict, Siobhán Whelan said: “Every pregnant mother is entitled to a decent scan ... this should be afforded to every mother in Ireland, not by a postcode lottery.” She also noted it had taken the family two and a half years to get answers as to why her son died. Unlike larger maternity units, Cavan General does not routinely perform 20-week scans to look for foetal anomaly. Nor does it have the medical expertise to fully interpret such scans.

At the time of the launch earlier this year of the “National Standards for Bereavement Care following Pregnancy Loss and Perinatal Death”, it was noted that neither specialist ultrasound nor foetal medicine services are uniformly available across the State. Dr Keelin O’Donoghue and her consultant colleague Dr Nóirín Russell drew attention to a deficit in the ability of specialists to make an accurate and early diagnosis of foetal abnormality. In the Cavan case this had fatal consequences; it also meant the Whelan family did not receive the best possible bereavement care.

There are 19 maternity units in the State. Even with a national maternity strategy it seems we cannot guarantee equitable care for pregnant women here. Public confidence in maternity services was severely dented by the Savita Halappanavar case in 2012 followed by more recent concerns about safety at both Portiuncula and Portlaoise hospitals. It is time to stop this erosion.

Unfortunately it is not possible to say for certain that Conor Whelan would have survived vasa previa even if proper diagnostic facilities had been available in Cavan General.

What is absolutely certain is that he and his mother were not afforded the “gold standard” care available to babies and women living elsewhere in the State. Such geographic inequality is unacceptable in a modern health service.

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