Call for better support of midwifery-led care services

Lynda Moore, executive member for midwifery with the Irish Nurses and Midwives Organisation and midwife at Cork University Maternity Hospital, said: '“The State of the World’s Midwifery (report) stated this very clearly, that (low c-section rates) is one of the outcomes of midwifery-led care.'

Better supports are needed for midwifery-led care services in recognition of low caesarean-section rates among their patients, the All-Island Maternity and Midwifery Festival heard.

Domiciliary care offers women a mix of hospital and community care during pregnancy, with midwives supporting women before and after a hospital birth including home-visits.

Lynda Moore, executive member for midwifery with the Irish Nurses and Midwives Organisation and midwife at Cork University Maternity Hospital, said such schemes should be supported.

She said “the bones” of a midwife-led system are present but more work is needed.

“At our Domino service, we have maybe 400 births a year out of not quite 7,000 that are birthed in the CUMH, so we are a tiny, tiny amount,” she said.

“Yet we are in our tenth year, and we have shown year after year that that’s a figure that is maintained. We have 10% or less caesarean-birth rates of our women, 75% of our women have spontaneous onset of labour and spontaneous birth. It’s just huge.” 

Speaking during a panel discussion on standards, she urged more support be provided to these services.

“I do think it is about women’s choice, but I also think it is about midwifery-led care,” she said.

“The State of the World’s Midwifery (report) stated this very clearly, that (low c-section rates) is one of the outcomes of midwifery-led care.” 

Our service hasn’t been expanded, it’s the exact same as it was 10 years ago and I think similarly around the country even though those figures are there, and statistically there.

CUMH offers a Domino (Domiciliary Care In and Out of hospital) service. This public service offers women the same team of midwives throughout the pregnancy, birth in hospital with early discharge, and home-visits including breastfeeding supports.

It is available for women living within a 15km radius of the hospital who are not experiencing a high-risk pregnancy.

Concern has been growing in Ireland about high caesarean-section rates, with more than one-in-three babies now delivered via c-section and higher rates than that in some hospitals.

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Ms Moore echoed calls at the conference, from the Chief Midwifery Officer for Northern Ireland Caroline Keown, for input from women as patients to be heard more often.

“I’m very interested in women’s voices and I don’t think in the Republic of Ireland we have enough of that, that’s informed in any way in the policy-making that has gone on,” she said. “And I think we need to do a lot more about that.” 

An in-depth review of maternity services in the North is expected to be published this summer, the conference heard. It will look at quality and safety of services and care for all women, babies and families as well as a comprehensive review of freestanding midwifery-led units. 

Ms Moore said she hopes services in Ireland can “piggy-back” on the learning from this.