“On the one hand, demands for services are increasing, as are expectations, but at the same time, the resources we are investing are far too low,” said Professor Michael Turner, director of the UCD Centre for Human Reproduction.
Prof Turner’s concerns about funding and staffing levels in maternity services, which have not kept pace with either the number of births or the risk profile of mothers, are against a backdrop of a fourfold increase in Caesarean section rates over a 30-year period (1984-2014).
C-sections carry almost three times the risk of maternal morbidity and mortality than with vaginal delivery.
The Irish Nurses and Midwives Organisation (INMO) said there was a need for a significant annual increase in midwifery numbers in order to reduce the ratio of the number of births per midwife from the current 1:36 to 1:29.5 as envisaged in the National Maternity Strategy.
“This will require an additional 100-110 midwives per year for the next four years, so the question is, will the HSE service plan provide not just for the filling of vacant midwife posts but also for those additional posts envisaged in the strategy, which is government policy,” said Liam Doran, INMO general secretary.
Prof Turner said the country also needed more obstetricians. A 2013 OECD report showed that out of 34 countries, Ireland ranked third from the bottom when it came to obstetrician and gynaecologist staffing numbers. While Ireland had 15.3 obstetricians per 100,000 women, the UK had 23.8. Both were below the OECD average of 27.3.
If pushed to choose between a modern, new hospital or additional staff, Prof Turner said his own view was that “human resources are more important”.
“If you were to give me €1m I’d prefer to have adequately trained staff in a poorer unit than two few in a state-of-the-art facility,” he said.
The state of the country’s maternity services, the rising use of C-section and the associated risks to mothers and babies will be discussed at a conference ‘National Trends and Hospital-level Variation Caesarean Section: Evidence from Ireland’ which gets under way in the ESRI this morning.
Prof Turner said social and demographic changes “over which maternity hospitals have no control” were among the factors driving the rise of C-section rates and contributing to a worsening risk profile for mothers.
These included women putting off having their first child until in their 30s; growing obesity levels leading to more and more cases of gestational diabetes — the proportion of mothers with gestational diabetes increased from 1.3% in 2005 to 5.5% in 2014 — and multiple births.
“The fact that infertility can now be successfully treated in a way that couldn’t be done 20 years ago is one such change. It can lead to multiple births which tend to deliver prematurely, putting an additional load on maternity units,” Prof Turner said.
He said there was a need to respond to the effects of these social changes, including increasing the number of neonatal intensive care beds to deal with the growing numbers of multiple births.
Prof Turner said it was a matter of public record that four new maternity hospitals were needed, three in Dublin and one in Limerick.
As part of the government plan to reorganise maternity services in Dublin, the Rotunda Hospital is to move to the Connolly Hospital campus in Blanchardstown, while the Coombe is to relocate to a site next to the planned new children’s hospital at St James’s. Holles St is to move to a site on the campus of St Vincent’s Hospital. However the moves are unlikely to happen for a number of years.