The culture of our maternity services has not changed, three years into the national strategy, writes
A heavy silence of sadness hangs over the deaths of lovely young mother Marie Downey and her precious four-day-old baby Darragh in Cork University Maternity Hospital last week.
In the rare moments we allow ourselves to think about it, many of us probably travel back to the first days of our own babies’ lives.
We remember the flowers, the cuddles, the phone calls, all indications of the love a new baby brings into the world and which surrounds new parents. We remember the miracle of a tiny human being, so dependent on us for everything and yet so much an individual.
To lose a mother and her baby like that… Stop. It quite literally doesn’t bear thinking about. Yet we must. We do not yet know how this tragedy happened.
Two investigations are under way and eventually Marie’s husband Kieran Downey and his two sons, James and Sean, will, we hope, know the full facts.
All we know so far is that Marie fell out of bed and died with baby Darragh under her. We wonder if it was best practice to give a new mother with epilepsy a room on her own.
We don’t know if the staffing allocation at Cork University Hospital the morning Marie died contributed to either of these tragic deaths but it is likely it wasn’t optimal: The optimal midwifery staffing rate in such a hospital is 29.5 to one birth.
Irish maternity hospitals have been found in recent surveys to have a 40:1 ratio, on average. The same survey found Northern Irish maternity hospitals to have a 24:1 ratio.
Krysia Lynch, of the Association for Improvements in Maternity Services, makes the point that when there is a staffing shortage, high-risk and first-time mothers tend to be prioritised, leaving lower risk women having subsequent babies still more deprived of care.
The hearts of all decent human beings should go out to the staff who discovered and dealt with the aftermath of Marie Downey’s death and her son’s fatal injuries.
However, that shouldn’t stop us demanding proof that optimal staffing levels and allocation were in place for them. Didn’t she and Darragh deserve that? Don’t all birthing mothers?
Yet in the same week as these tragedies happened, we learned from Paul Cullen in The Irish Times that no new money has been allocated this year to implement the National Maternity Strategy 2016-26 which I heralded in this newspaper as the plan which would revolutionise maternity care in Ireland.
The €4.1m allocated to implementing the strategy this year will only fund posts approved in previous years. There is no new development funding for the many elements of the plan which were meant to be put in place this year.
Krysia Lynch, who sat on the strategy’s steering committee, says she has long since stopped ticking the elements which have not been implemented on time because there are so many.
Examples of developments which were meant to be in place by the end of last year include:
By now, half of Irish mothers should have access to non-medicalised, midwife-led care if that is what they choose and what is appropriate to their cases.
It’s not happening. There have been some small changes for the better. There are more midwife-led antenatal classes and more early discharges with home visits by midwives. The University Maternity Hospital in Limerick has a pool in its Danu birthing suite. A revolution? Hardly.
This year, there is at least €3.8m missing from the required funding for the strategy, despite the commitment made by then-health minister Leo Varadkar in 2016 that funding for the plan would be ring-fenced. There sure are some big gaps in that fence.
There are differing views as to where the money has gone. Roisín Molloy, a patient representative and National Maternity Strategy steering group member, has said the money which should be going to the strategy has been used to fund abortion services since January. Krysia Lynch says the money has gone to fire-fighting in the wake of the CervicalCheck scandal.
She says this reactive response is symptomatic of how we cope with women’s health care; instead of putting proper systems in place and resourcing them we wait for tragedies to happen and then attempt to react.
The new strategy was an opportunity, she said, to put in place a plan which would ensure safety for mothers and their babies and offer them choice as to how they gave birth no matter where they lived.
“Instead of grasping it with both hands,” she said, “it’s back to same old, same old.”
That’s the issue, really. It’s not a question of which area of women’s health is funded as opposed to any other. Why should the provision of abortion services or the attempt to rectify the mistakes made by CervicalCheck be blamed for this shameful failure to fund the National Maternity Strategy?
The question is why issues which are in the political spotlight are funded as opposed to those which represent the kind of long-term, strategic vision which would not only avoid many future scandals but would also make women and their babies happier and healthier.
The truth is that the culture of our maternity services has not changed, three years into the term of the national strategy. Energy still goes towards blocking anyone who asks questions.
Independent midwife Philomena Canning, who died just days before the Downey tragedy, had her indemnity summarily taken away in 2014 after she applied to set up two home-birth centres in Dublin.
By the time she was cleared of the false allegations against her, her practice was effectively gone. The HSE is understood to have finally made her a settlement shortly before she died so hopefully she got her last wish, which was to go to her grave in peace.
Late last year, the National Maternity Hospital won its case against the State conducting an inquiry into the death during surgery for an ectopic pregnancy of beautiful young Malak Thawley in 2016. The judge ruled that issues identified at the hospital were also issues in hospitals all over the country. That’s how badly we need systems change.
It should be a considered a major scandal that the National Maternity Strategy is unfunded and unimplemented — but there shouldn’t have to be a scandal before there is political action.