‘Geographic lottery’ to access maternity care

Pregnant women are being subjected to a “geographic lottery” as a direct result of “outdated, patently unsafe” standards in Ireland’s maternity service.

A leading patient group made the claim after a wide-reaching investigation into Savita Halappanavar’s death.

Among the issues raised in the Health Information Quality Authority (Hiqa) report is that the health watchdog cannot stand over claims that the country’s 19 maternity units are safe for patients.

Hitting out at Ms Halappanavar’s sub-standard treatment, the Association for Improvements in the Maternity Services Ireland spokeswoman Krysia Lynch said the case is indicative of system-wide problems.

“The findings of the Hiqa report indicate a failure at all strata of responsibility to provide basic levels of adequate and appropriate care to Savita which would have saved her life,” said Ms Lynch.

“What is also of grave concern is the number of failures at national level identified in the report, including timely access to maternity services, inadequate staffing levels for safe care, a maternity care model that hasn’t been revised in 59 years and a lack of accountability and governance.

“The 2007 ‘safer childbirth’ document recommends midwife-to-woman staffing levels are never to exceed 1:28 for low risk women and 1:25 for high- risk women, in order to ensure women are safely looked after and not left alone in labour.

“Irish ratios drastically exceed these recommendations and were seen to be contributing factors into the deaths of Tania McCabe, Bimbo Onanuga, and now Savita Halappanavar.

“Regional variations in obstetric interventions across Ireland essentially present women with a geographic lottery in terms of their maternity care. There is no standardised care. Ireland purports to be one of the safest countries to have a baby, yet these incidents of gross neglect continue.

“[We are] a nation of numerous reports and recommendations. Report after report after report come to the same conclusion, with absolutely no preventative action.”

The comment came as Hiqa confirmed to the Irish Examiner two vital guidelines University Hospital Galway failed to meet during Savita Halappanavar’s care were specifically put in place at the facility to prevent this exact tragedy from recurring.

On Wednesday, Hiqa said just six out of 19 maternity services implemented vital HSE reforms linked to the 2007 death of Tania McCabe, who, like Ms Halappanavar, died from sepsis after her membranes ruptured.

University Hospital Galway was one of eight facilities which put in place some of the guidelines — including the two above — to prevent a repeat of the 2007 tragedy. However, the life-saving rules were not followed when they mattered most — contributing to Ms Halappanavar’s death.

In addition to the failed reforms, HIQA said 13 of the country’s 19 maternity services have no high-dependency beds, while none has a critical care bed.

Health Minister James Reilly is setting up a maternity services review, as requested by Hiqa.