Maternity services - Resource misuse adds to inadequacy

WITH the country’s health service creaking, it is not surprising that women should take issue with broad aspects of maternity care.

What is surprising is the range of dissatisfaction that emerges from today’s Irish Examiner/Lansdowne Market Research opinion poll showing that pregnant women are being fast-tracked through maternity services.

While the majority of mothers expressed overall satisfaction with their most recent experience, the poll findings show that two out of every three are deeply unhappy with aspects of the State’s maternity and gynaecology service.

Coming two weeks before the publication of a Health Service Executive survey of attitudes among professionals, the picture that emerges from the nationwide poll underlines the widely held view of the state system as sub standard.

Among key areas of dissatisfaction, two out of every three mothers are unhappy with the maternity services they received during pregnancy, labour and following birth.

With only 37% saying they were satisfied with the level of care provided, there were strong complaints about the length of time women have to spend waiting in queues at antenatal clinics.

In stark contrast with the scenario in France, where childcare facilities are so good that expectant mothers seldom bring their other children to a clinic, the lack of adequate créche facilities here leaves women with little choice but to bring children with them.

On average, pregnant women here have to wait just under an hour before they are seen by a doctor. Highlighting the two-tier nature of the health service, one in three public patients was dissatisfied with the waiting time, whereas just one in 10 private patients voiced similar complaints.

Another source of dissatisfaction concerns the extent of ‘intervention’ during both labour and birth of a child. As a result of this trend, one in three mothers now have their labour induced or started artificially in Irish hospitals.

By international standards, the rate of pregnancy induction here is extremely high. The 31% level of pregnancy induction is more than three times the guideline rate set down by the World Health Organisation which says that “no geographic region should have rates of induced labour over 10%”.

Further expressions of dissatisfaction with the system concern the lack of nursing staff in hospitals, while those on duty are generally seen as over-worked.

Concern also focuses on the inadequacy of communication between mothers and professional staff. Many stressed the need for closer contact with mid-wives, especially in terms of follow-up checks and basic information following the birth of a child.

One in ten mothers are sent home less than a day after giving birth, another sign of a system under intense pressure. Across the country, short stays are relatively common, with 27% of mothers spending only a day or two days in hospital.

It is hardly surprising that some women felt they were sent home from hospital far too early. By and large, however, the vast majority of mothers (86%) are generally happy with their length of stay in hospital.

Overall, according to Professor Cecily M Begley of Trinity College Dublin, Ireland is adopting what she succinctly describes as an ‘economic model’ of childbirth.

In other words, scarce resources are used in the least cost-effective manner, with expensive consultant obstetricians employed to provide care for normal, healthy women, while the skills of highly-educated midwives are under-utilised.

With women now being channelled through hospitals on a conveyer-belt system, there is urgent need for improvement in the country’s maternity services and support systems.