Pressure of baby boom takes its toll on maternity hospital

THAT Ireland is in the grip of a baby boom is indisputable – figures from the Central Statistics Office this week show births have reached a 110-year high.

But while new babies are something to celebrate, the upshot of an increase in the numbers being born is significant extra pressures on the country’s four maternity hospitals.

Last month, Dublin’s Rotunda Hospital was in the news when it emerged the first appointment a pregnant woman could get with a consultant was at seven months.

This month, it’s the turn of Cork University Maternity Hospital (CUMH) where the baby boom, combined with staff shortages, has affected staffing ratios in neo-natal care and has led to some patients being transferred to Dublin hospitals, and where a severely reduced administration staff is struggling to cope with the massive level of paperwork a hospital generates when dealing with up to 9,000 births per year and 66,000 outpatient appointments.

CUMH clinical director Professor Richard Greene says the hospital is providing an optimum service despite the pressure it’s under, but that “to maintain the current service with the current number of births we need more staff”. When the hospital opened in March 2007, 376 midwives were recommended to deliver 7,000 babies. More than two years later and projecting 9,000 deliveries by the end of the 2009, that staffing figure has still not been reached – it peaked at 365 last Christmas – and currently it’s at 341. However CUMH director of midwifery Geraldine Keohane says staffing is not the only issue when it comes to pressure on services.

“The birthrate has increased significantly – it is the highest in the EU. This has led to an increased demand on maternity services. To compound this problem, the care required by women who present has become increasingly complex.”

Ms Keohane said this included

* Greater numbers of first time older mothers.

* Higher levels of immigration, and, as a result, more women with infectious diseases and diabetes.

* Technological advancements which have led to increased survival rates among premature babies who require high levels of care.

* Improvements in assisted conception and higher numbers of multiple births.

* Higher expectations for good outcomes among patients and families.

* Expectations among parents that they have the skills and knowledge to cope with bringing their baby home.

In addition, because all but two of the hospital’s midwives are male, there are high levels of maternity leave among staff. Prof Greene said they have not been able to get additional staff because of the Health Service Executive moratorium on recruitment. However Ms Keohane said an area monitoring group set up two months ago by the HSE is now looking at which posts need to be prioritised. She also said staff could be deployed depending on need, although in the area of neonatology Prof Greene said: “Not all midwives are trained in that area, so it’s not as simple as taking staff from one area to another.” He described the staff shortfall as “significant” and Ms Keohane also said she would like to see an increase in staff.

Prof Greene said he was particularly concerned about the reduction in administration staff.

“Frontline administration is significantly down on when we came in here two years ago. People have retired or left and not been replaced.

“We are handwriting letters to GPs. We need to keep frontline administration staff free to talk to patients. They are all very hardworking, we’ve had close to a 40% staff reduction in two years, down to the high 30s compared to 54. This affects the front desk, the reception desks in our clinics, the ability to respond to GP requests for appointments or to do a lot of necessary paperwork that is very much part of the clinical service,” Prof Green said.

“I would like to see an increase in administration staff as a real priority, followed by getting our midwife numbers up and after that our medical consultant staff,” he said.

Asked if the hospital was providing an optimum service, Prof Greene said yes, but added “if we had additional numbers, could we continue to do that? Could we stretch up to 9,500 births, the answer is yes, but if we are just about maintaining that service at the moment, how much harder will it get?”

“The more deliveries we have, the harder it will be to keep on doing the same. If numbers get too high, there is a safety issue – that is why we have such close links with the neonatologists and why we look to have people transferred out.

“We are here two years and the hospital has been running very smoothly, partly because people have got used to the way it works. But the reality is every day is busy here,” Prof Greene said.

A number of initiatives have been introduced to relieve pressure on services including five outreach clinics around the county. The hospital also plans to offer more midwife-led antenatal clinics.

“It’s about working smarter rather than harder,” Ms Keohane said.


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