By now we were meant to have revolutionised maternity services.
We were meant to have a community midwife-led service in all our maternity hospitals.
We were meant to be on track to having a midwife-led “alongside birthing unit” in all our major maternity hospitals by the last quarter of this year.
Imagine my dismay when I heard towards the end of last month that the midwife-led unit in Cavan General Hospital - one of only two in the whole country - was due to close by June 1st.
We already knew that the National Maternity Strategy 2016-2026 had mostly gone up in smoke due to lack of funding and lack of political commitment.
The Irish Times’s Paul Cullen found out last year that no new money had been allocated to implementing it in 2019, a shortfall of at least E3.8 million. While R/ois/in Molloy, whose baby died due to failings at the Midland Regional Hospital, Portlaoise in 2012, resigned as a Patient Advocate on the National Maternity Strategy, saying the money was going instead to the provision of abortion services, Krysia Lynch of the AIMS maternity services lobby group said the money was spent “firefighting” the aftermath of the Cervical Check debacle.
But even I didn’t expect was to wake up in the morning and find half the mid-wife led units in the country axed.
The RCSI maternity hospitals group is led by the Rotunda, Dublin, which comments only that it “ has always articulated and campaigned for a strong role for Midwives in the delivery of maternity care and continues to engage with and to be available to support other hospitals in the delivery of best practice in maternity services.” The lobby group AIMS Ireland understands the issue was that no consultant could be found to sign off on the care of women at the midwife-led unit.
Wholly against the spirit of the National Maternity Strategy, the decision was taken to close the unit without further ado.
Many of the women who were booked into the unit to have their babies were very distressed while many others didn’t even know it was happening.
A petition was got up which was signed by 11,500 people and as of this week the Minister for Health says the unit will not close and he will review how the decision to close it was taken.
I suppose that’s welcome but we are staring the possibility in the face that a maternity hospital felt empowered to wholly contradict the National Maternity Strategy and total its midwife-led unit because none of its consultants would sign off on the care.
Our maternity services are a product of our patriarchal history.
Maternity services should have been revolutionised by women for women decades ago.
Most similarly developed countries pivoted towards so-called “woman-centred care” in the early 1990s.
The National and International Review of the Literature on Models of Maternity Care which was commissioned by Government to inform the National Maternity Strategy 2016-2026 and compared Ireland with the UK, the Netherlands, New Zealand, Australia and Canada, clearly summarised the two different philosophies underlying maternity services worldwide: the “medical/technocractic model” and the “midwifery/holistic/social model”.
In the first, pregnancy is a “medical condition, inherently pathological” while in the second, pregnancy is “a normal human state, inherently healthy.” It’s easy to see that the first derives from a male view of the woman’s body, the second from a female view of the woman’s body.
It’s not as simple as that, however, because we women are often acculturated by the male view and see our own bodies as alien. It is often women themselves who opt for time-tabled inductions and elective Caesarian sections.
That’s fine, you’d say, but it really isn’t. Midwife-led care has been comprehensively shown in international literature and here in Ireland (Begley, 2011) to be as safe for women with normal pregnancies as doctor-led care and to involve fewer interventions.
No intelligent person doubts the need for serious medical intervention in the small percentage of maternity cases which call for it.
About 80 percent of women are however reckoned to require no medical intervention to deliver safely and each unnecessary intervention carries risks, including the risk of further intervention.
One thing leads to another: epidurals lead to more instrumental deliveries and more Caesarian sections which themselves carry risks such as infection in the mother, difficulty establishing breast-feeding and breathing problems in the baby.
Ireland topped the table for rates of Caesarian section in the Irish and International Literature Review, with the Netherlands, the UK and New Zealand taking the bottom three places.
In the Netherlands, 30 percent of women give birth at home while 41 percent only ever receive primary care. In the UK, 99 percent of women have access to either doctor-led or midwife-led care within an hour’s drive. In New Zealand, 78 percent of “lead maternity carers” were midwives.
Among the main drivers behind the National Maternity Strategy were the seemingly avoidable deaths of eight babies in the Midland Regional Hospital, Portlaoise. As bereaved mother, Roisin Molloy, said at the time, “The greatest apology that all of us who have lost babies and partners in Irish maternity services could have would be to implement this Strategy.” However Irish perinatal mortality statistics seem to compare fairly well internationally.
Our statistics for that much rarer tragedy, maternal mortality, are not as good. Interestingly, the Irish and International Literature Review found the countries with the most access to the midwife-led model to have declining maternal mortality statistics, while Canada and Ireland, predominantly doctor-led, had increasing rates; Ireland’s increased by 31 percent between 1990 and 2013.
This must remind us that a second factor in the establishment of the National Maternity Strategy was the avoidable death in Galway University Hospital of the pregnant young Savita Halappanavaar in 2012.
Being a pregnant woman doesn’t make you a seer but it does give you some insight into the workings of your own body. Again and again, when we remember tragedies that happened in our maternity hospitals, we remember the woman’s voice which was not heard: Savita Halappanavaar, who knew she needed an emergency abortion; Valerie Neary who begged Dr. Michael Neary “Don’t do a hysterectomy on me!” in 1996; Catherine Dunne who knew her baby William, born in 1982 with Cerebral Palsy, was distressed in the womb, but was ignored for too long.
Empowered midwives, working more closely and intensively with mothers than consultants, hear the woman’s voice more clearly.
That’s no use if they are disempowered by the medical establishment. Reporting on the scandal at Our Lady of Lourdes Hospital, Drogheda, in 2008, which saw 129 healthy women having their wombs removed for no reason by Dr. Michael Neary, Judge Harding Clarke commented the work of her review was trying to understand why alarmed midwives, “principled women of training and intelligence, did not take their concerns further.” Women have come an awfully long way in this country but when it comes to maternity services they have barely got off their starting-blocks.
The proposed Programme for Government vows to implement the National Maternity Strategy 2016-2026 but instead let’s admit that it has been a total failure and start once again, with feeling.