Sir, – I am delighted that recent press coverage has sparked debate in relation to the delivery of maternity services. Jacky Jones (HEALTHplus, November 22nd) indicated that I was requesting additional funding for extra theatre space to do caesarean sections. She is totally incorrect in her conclusion.
The reason I have asked for additional funding for resources to invest in maternity services is so we can efficiently and effectively deal with the 37 per cent increase in maternity hospital activity over the past five years. This massive increase in activity has meant that we have had to reduce our gynaecological operating capacity by about 50 per cent. The additional theatre space is so we can continue providing a gynaecology service to our patients.
In fact the caesarean section rate in the hospital over the past year dropped by 0.5 per cent, as per my annual report.
All of the maternity hospitals are working above an acceptable capacity.
All have a ratio of midwives to patients well below the accepted international norms and all are working with a significant deficit in terms of consultant numbers. The massive increase in activity over the past five years has put a huge strain on the existing system to the extent that the existing infrastructure cannot deal effectively and safely with the dramatic increase in numbers. There has been no significant investment in community services which would enable us to conduct a considerable amount of our activity outside the hospital setting. There has been no significant movement to locate each of the maternity hospitals to a general hospital setting as was recommended in the KPMG Report in 2007.
All of the factors that have come together to create the present women’s ability to access fertility services, contraceptive advice and probably most importantly gynae-oncology services have been severely affected. The diagnosis of gynaecological cancers will ultimately become delayed if this situation is allowed to persist.
Jones’s use of statistics is interesting. She quotes the WHO suggesting a caesarean section rate of 10-15 per cent. A rate of 15 per cent was suggested from the point of view of reducing maternal mortality to a more acceptable level. She also quotes the percentage of babies being born naturally as 100 per cent in a midwifery-led unit. This is, of course, absolutely correct because all the patients who require more intervention are transferred out of the midwifery- led unit and moved to the medical- led unit. In fact between 50 and 60 per cent of women are transferred out of midwifery-led units, depending on what unit you look at.
There are, however, aspects of Jones’s article that I agree with. I absolutely concur that a model which increases women’s confidence in their own abilities is what we should be after. However, I think the ideal model of care is one where all women start off with the advantage of one-to-one midwifery care and this should continue as long as the situation remains normal. However, once more medical input is required or indicated then there should be a seamless transition to this model of care with exactly the same midwives being involved, maintaining the skills of the midwife and maintaining the continuity and quality of care for the patient. There is no reason why when the model of care is changed from midwifery to medical that there should have to be a geographical change of location and staff for the patient.
All women in 21st-century Ireland should be entitled to one-to-one midwifery care for the duration of their labour and delivery. It is vital that our politicians and decision-makers understand that the journey from the womb to the outside world may be the shortest journey that any of us will every make but it is without doubt potentially the most hazardous. We need to get away from the fact that any one group of professionals has ownership over a pregnant woman, but rather that this is a team of professionals working together to achieve a common aim of the safest most uncomplicated mode of delivery for all of our patients.
I think if Jones were to ask what most women want, a safe uncomplicated delivery would be the answer. – Yours, etc,