Victoria White

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The HSE’s entrenched attitude to criticism and change is unhealthy

We can only have confidence again in our maternity services by way of a wholly independent, root-and-branch evaluation followed by swift action to effect radical change, writes Victoria White

The HSE’s entrenched attitude to criticism and change is unhealthy

THE irony is stunning

The HSE has threatened legal action to stall the publication of the HIQUA report into the deaths of five babies at the Midland Regional Hospital, in Portlaoise, because it says staff should have had a chance to defend their good names.

This is the self-same HSE that last year destroyed the practice of independent midwife, Philomena Canning, by removing her indemnity cover overnight, although she did not know what she was supposed to have done that was wrong and was given no opportunity to defend herself.

The HSE, which complains in its letter to HIQUA that the adverse findings in the report are “broad” and “sweeping” and lack “clear reasoning as to the evidential base on which those findings are made”, whipped Canning’s practice from her in the absence of any evidence.

On the eve of Canning’s case against the HSE, earlier this month, her indemnity cover was renewed. But she has had no explanation and no apology.

She had done nothing wrong. The two complaints against her came from hospital staff and related to transfers to two hospitals. One of the hospitals was, irony of ironies, the Midland General Hospital, in Portlaoise. The mothers in question had no complaints.

So, where were the “specific and serious” concerns about Philomena Canning to which the Minister for Health, Leo Varadkar, referred in the Dáil?

It is deeply ironic that Varadkar should have hinted that “when the HSE suspends an individual as a precautionary measure, pending a review/investigation, it does not do so lightly,” because no-one was suspended pending the publication of the HIQUA review into Portlaoise, although five babies died.

Five shocking, cataclysmic tragedies from which five families will, no doubt, never fully recover. Yet no one lost their living, no one’s name was splattered all over the papers.

Tragedies happen in hospitals, no matter how high their standards of care, and I have compassion and respect for the people who work in them, in high-stakes jobs. But the HIQUA report apparently finds 250 significant lapses of care at the Portlaoise hospital, between 2006 and 2012.

These impact on more than 80 women. And now, when HIQUA has made findings of malpractice in the hospital, the HSE wants to stop their publication, because they would “shatter” the public’s confidence in our maternity services.

We are into “appalling vista” territory here — remember Judge Alfred Denning’s ominous comment regarding the possibility of the Birmingham Six being vindicated?

There is an instinct to protect the institution in HSE director general Tony O’Brien’s letters to HIQUA, which I find chilling. HIQUA is pictured, not as an independent watchdog, but as the HSE’s partner in running the health service. O’Brien writes that the two agencies “could actively work together to enable a publishable report.”

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Yes, but not a report that anyone else would want to read. Five babies have died. We can only have confidence again in our maternity services by way of a wholly independent, root-and-branch evaluation followed by swift action to effect radical change. Although the HSE may try to claim that Portlaoise was unique in the years in question, I doubt many women who have had babies in Ireland believe that.

An independent enquiry into two deaths of babies and seven cases of anoxia (a lack of oxygen to the brain), at Portiuncula Hospital, in Ballinasloe, is also pending.

The inappropriate use of an artificial form of the birth hormone, oxytocin, is one of the possible contributing factors that will be investigated. The use of oxytocin was also a possible contributing factor in two of the Portlaoise deaths, those of little Mark Molloy and little Joshua Keyes-Cornally.

The use of artificial oxytocin is routine in Irish maternity hospitals, because it means they can call the shots. They can decide when a woman goes into labour, and if it goes on too long they have a range of instruments at their disposal to bring it all to a swift conclusion: breaking of the mothers’ waters, episiotomies, forceps, vacuum caps, Caesarian sections.

The woman would hardly have to be there at all, except for the stubborn fact that the baby is in her womb.

AIMS Ireland, the lobby group for evidence-based maternity practices, has just released the findings of a survey of 3,000 women who gave birth in the five years up to 2014. It found that 52% did not receive information on the potential implications of procedures they were advised to have, and only half felt they were able to make an informed refusal during labour and birth.

The failure to listen to the women who are in labour is itself a risk. Jo Murphy-Lawless has documented how Catherine Dunne’s voice of alarm went unheard, and how that contributed to her son being born with cerebral palsy in Holles Street, in 1982.

Remember Valerie Neary, herself a professional midwife, begging of Dr Michael Neary, “don’t do a hysterectomy on me”, in 1996, as he unnecessarily cut out her womb in Our Lady of Lourdes Hospital, Drogheda? And remember Savita Halapanavaar’s pleas for the termination of a septic pregnancy in Galway University Hospital, in 2012?

Philomena Canning was poised to do her bit to change our birth culture, when the HSE stopped her in her tracks last year. She had just secured premises and funding to set up a birthing centre, under the HSE’s provision that women can have home births in someone else’s home. This would be a place where women’s voices would be heard.

A place where interventions happened when they were medically indicated, not when it suited the staff. A place not governed by the fear of women.

Such localised, down-shifted centres are the way to go for Irish maternity services.

There are 100 such centres in the UK, where ‘Changing Childbirth’, a major report into the maternity services in the 1990s, gave women some say in their own labours. Midwife-led care is also cheaper than hospital care, which is important when you consider the HSE’s demand that the failures at Portlaoise be put in the context of cut-backs and under-staffing.

There is ample evidence, as documented by research in Trinity College in 2009, that midwife-led care is as safe for low-risk women as hospital care.

The Irish Examiner recently highlighted the UK’s National Centre for Health Care Excellence’s findings that midwife-led care outside a hospital is now safer than hospital birth.

There is nothing to fear from a report that shatters confidence in the system we have, if it means we can build a better system. That’s the lesson HIQUA must teach the HSE, by publishing their report immediately and in full.

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