Midwives leaving - Our most vulnerable now at risk

Ireland’s neonatal and maternal death rates have been a source of pride to the medical community in recent years.

More than 996 out of every 1,000 babies born here survive birth and the immediate aftermath and it is rare to have a year where more than one or two mothers lose their lives in childbirth.

Given the record number of births and the increase in older mothers, overweight mothers, multiple births and pregnancies in women with medical conditions that in the past might have ruled out conception, it is a credit to all involved from the primary care professionals to the emergency intervention medics that there are so few delivery room tragedies.

But this is not a situation that can be taken for granted. Rather, it is a challenge that is reborn with every new pregnancy. That makes the comments of consultant obstetrician Dr Gerry Burke about the impending loss of almost a quarter of the midwives at the Mid-Western Regional Maternity Hospital in Limerick all the more critical.

Midwives are the engine of hospital maternity services and they run smoothly, efficiently and quietly over often bumpy ground in less than ideal conditions. But reduce its horsepower dramatically or drive it too hard for too long and that engine will splutter and seize. That’s when services suffer and that’s when mothers and babies are put at risk. Dr Burke pulled no punches in predicting the outcome — lost lives.

He isn’t the first to deliver such a warning. Sam Coulter-Smith, master of the Rotunda in Dublin made similar remarks about his own hospital late last year.

The National Maternity Hospital in Dublin, the country’s busiest, is meanwhile labouring to deliver almost 10,000 babies a year in a building considered overcrowded when the number was 6,400. Cork University Maternity Hospital, the country’s newest, was playing catch-up as soon as its doors opened with staff numbers and space falling short of demand.

And it isn’t that long ago that a board member of Our Lady of Lourdes Hospital, Drogheda offered to give up €36,000 of his salary to fund the recruitment of just one more precious midwife, so concerned was he by the pressure on services.

This was all before the worsening of the country’s finances and before the loss of 47 midwives out of a staff of 200 was considered a good thing because it reduces payroll costs.

The vulnerability of the newborn was brought into stark focus by the deaths of three infants from a pseudomonas outbreak at the Royal Jubilee Maternity Hospital in Belfast.

Their deaths show that even in optimal conditions, dangers lurk. In the far from optimal conditions in which the republic’s maternity services are operating, the hazards can only increase.

An often repeated reflection since our economic collapse is what kind of future we have created for our children. But what kind of future have we at all if we can’t get them safely over the first hurdle of childbirth?