National maternity strategy provides clear framework


Sir, – The statement from the Institute of Obstetricians and Gynaecologists (IOG) to the Oireachtas Health Committee on the National Maternity Strategy 2016-2026 (News, February 21st) suggests that the development of the three pathways of maternity care identified in the strategy has potential to cause divisions between midwives and doctors.

Maternity care in Ireland is, as the strategy notes, largely consultant-led and hospital-based and we are concerned that the statements such as that by the IOG, and others, might be seen by some as a less than enthusiastic endorsement of the strategy, which was developed by consensus within a large and diverse group of women, midwives, obstetricians and other key stakeholders.

The strategy recommends an overhaul of how maternity services are provided and provides a clear framework for each of the three pathways (supported care, assisted care and specialised care) to ensure effective integration of care as required by the multidisciplinary team, as and when indicated.

Women should, as the strategy recommends, be offered a choice of pathway based on their preferences, clinical need and best evidence. In each pathway, care is provided within a multidisciplinary team, with care provided by midwives in all three pathways; led by midwives in the supported care pathway and by obstetricians in the assisted and specialised care pathways, while ensuring clear pathways of referral and reciprocal transfer as appropriate.

There is substantial high-quality evidence from international randomised trials demonstrating the effectiveness, safety and cost savings when midwives are the care lead for women accessing supported care-type pathways. Further, a large randomised trial conducted alongside birth centres in Ireland reinforces the safety and cost-effectiveness of this model of care for women in an Irish context.

Ensuring the strategy’s recommendations on the three pathways of maternity care are fulfilled as intended will, on the contrary, help improve the recruitment and retention of midwives and build and strengthen respectful and collegiate working relationships. Maintaining the status quo is problematic and will progressively undermine confidence in the overall strategy. – Yours, etc,


Chair of Midwifery,

NUI Galway;


Chair of Nursing

and Midwifery,

Trinity College Dublin;


Director, Midwifery

& Nursing Expertise;



Association for

Improvements in

Maternity Services Ireland;


Director of Midwifery,

University of Limerick



Group Director

of Midwifery,

Saolta Health Care Group;


Research Midwife,

Coombe Women & Infants

University Hospital, Dublin.