Key points of New NICE Recommendations: Guidelines for Intrapartum Care

The new NICE Guidelines for Intrapartum Care were released today in the UK.


The NICE Guidelines are evidence based recommendations on care practices for healthy women in healthy pregnancy; the majority of pregnancies.


You can read the full NICE Guidelines here: http://guidance.nice.org.uk/CG/WaveR/109/Consultation/DraftGuidance/pdf/English


AIMS Ireland committee are just going through the full guidelines the past hour or two...and to be frank.... the HSE should be MORTIFIED with the services they offer to women in Ireland. Irish maternity services fail every recommendation. Women and babies in Ireland deserve better. Women and babies in Ireland deserve the NICE level of care.


A taste of some of the key recommendations.


Care, Respect, Support of women & their Choices


Lets start with the opening line: "Giving birth is a life-changing event, and the care that a woman receives during labour has the potential to affect her both physically and emotionally in the short and longer term. Good communication, support and compassion from staff, whilst having her wishes respected, can contribute to making birth a positive experience for the woman and those accompanying her."


"Providers, senior staff and all healthcare professionals should ensure that in all birth settings there is a culture of respect for each woman as an individual undergoing a significant and emotionally intense life experience, so that the woman is in control, is listened to and is cared for with compassion. [new 2014] [16]"




Place of Birth


"Advise low-risk multiparous women to plan to give birth at home or in a midwifery-led unit (freestanding or alongside). Explain that this is because the rate of interventions is lower and the outcome for the baby is no different compared with an obstetric unit. [new 2014] [3]"


"Advise low-risk nulliparous women to plan to give birth in a midwifery-led unit (freestanding or alongside). Explain that this is because the rate of interventions is lower and the outcome for the baby is no different compared with an obstetric unit, but if they plan birth at home there is a small increase in the risk of an adverse outcome for the baby. [new 2014] [4] "

"Commissioners and providersa should ensure that all 4 birth settings are available to all women (in the local area or in a neighbouring area). [new 2014] [8] "


"Explain to the woman that she may choose any birth setting (home, freestanding midwifery unit, alongside midwifery unit or obstetric unit), and support her in her choice of setting wherever she chooses to give birth. [new 2014] "


"planning birth in an obstetric unit is associated with a higher rate of interventions, such as instrumental vaginal birth, caesarean section and episiotomy, compared with planning birth in other settings "


"there are no differences in outcomes for the baby associated with planning birth in any setting. [new 2014]"

In Ireland: The HSE determines the criteria for women's eligibility to midwife-led units and homebirth. There is no individual assessment based on current pregnancy/health or history. Women who do not meet HSE eligibility, cannot access this care option, regardless of her personal decision or informed choice.


Ireland has very limited midwife-led care options - the large majority of women have no midwife led unit or homebirth options in their region. There are NO freestanding birth centres in Ireland.

Recommendations for staff - treatment of women/personal perceptions & beliefs

"When performing an initial assessment of a woman in labour, listen to her story and take into account her emotional and psychological needs."

"Providers, senior staff and all healthcare professionals should ensure that in all birth settings there is a culture of respect for each woman as an individual undergoing a significant and emotionally intense life experience, so that the woman is in control, is listened to and is cared for with compassion. [new 2014]"

"When discussing the woman’s choice of place of birth, do not disclose personal views or judgements about her choices. [new 2014]"


"Treat all women in labour with respect. Ensure that the woman is in control of and involved in what is happening to her, and recognise that the way in which care is given is key to this. To facilitate this, establish a rapport with the woman, ask her about her wants and expectations for labour, and be aware of the importance of tone and demeanour, and of the actual words used. Use this information to support and guide her through her labour. [2007]"


"Encourage the woman to adapt the environment to meet her individual needs."


 "Encourage the woman to have support from birth partner(s) of her choice. [2007]"


"Healthcare professionals should think about how their own values and beliefs inform their attitude to coping with pain in labour and ensure their care supports the woman’s choice."


Clinical Governance

"maternity services should provide a model of care that supports one-to-one care in labour"

"Ensure that there are clear local pathways for the continued care of women who are transferred from one setting to another, including where this involves crossing provider boundaries. These pathways should include arrangements for occasions when the nearest obstetric or neonatal unit is closed to admissions or when the local midwifery-led unit is full. [new 2014] "


"Base any decisions about transfer of care on clinical findings, not on the birth setting."

Latent Labour


"If a woman seeks advice or attends a midwifery-led or obstetric-led unit with painful contractions, but is not in established labour: recognise that some women experience pain without cervical change, and although these women are described as not being in labour, they may well think of themselves being ‘in labour’ by their own definition"


"When performing an initial assessment of a woman in labour, listen to her story and take into account her emotional and psychological needs."
"If there is uncertainty about whether the woman is in established labour, a vaginal examination may be helpful after a period of assessment, but is not always necessary. Take the woman’s wishes into account. "


Vaginal Examinations

"be sure that the examination is necessary and will add important information to the decision-making process "

"recognise that a vaginal examination can be very distressing for a woman, especially if she is already in pain, highly anxious and in an unfamiliar environment "

CTG


"Do not perform cardiotocography on admission for low-risk women in suspected or established labour in any birth setting unless the initial assessment indicates there is a risk factor for, or actual, fetal acidosis (see recommendations 45 and 46). [new 2014] [54] "


"Do not make any decision about a woman’s care in labour on the basis of cardiotocography findings alone. [new 2014] [109] "

If continous CTG is needed - " remain with the woman in order to continue providing one-to-one support"

"Offer continuous cardiotocography if intermittent auscultation indicates possible fetal heart rate abnormalities, and explain to the woman why this is necessary. Remove the cardiotocograph if the trace is normal after 20 minutes. (See also section 1.10 on fetal monitoring)."

 "ensure that the focus of care remains on the woman rather than the cardiotocograph trace."

Labour

"Encourage women with regional analgesia (epidural) to move and adopt whatever upright positions they find comfortable throughout labour. [2007]"

"Upon confirmation of full cervical dilatation in a woman with regional analgesia, unless the woman has an urge to push or the baby’s head is visible, pushing should be delayed for at least 1 hour and longer if the woman wishes, after which actively encourage her to push during contractions. "


"After diagnosis of full dilatation in a woman with regional analgesia, agree a plan with the woman in order to ensure that birth will have occurred within 4 hours regardless of parity".


"Do not routinely use oxytocin in the second stage of labour for women with regional analgesia."


"Offer intermittent auscultation of the fetal heart rate to low-risk women in established first stage of labour in all birth settings"


"If continuous cardiotocography has been used because of concerns arising from intermittent auscultation but there are no concerning features on the cardiotocograph trace after 20 minutes, remove the cardiotocograph and return to intermittent auscultation."


"In all stages of labour, women who have left the normal care pathway because of the development of complications can return to it if/when the complication is resolved. "


"Do not routinely offer the package known as active management of labour (one-to-one continuous support; strict definition of established labour; early routine amniotomy; routine 2-hourly vaginal examination; oxytocin if labour becomes slow)."

"In normally progressing labour, do not perform amniotomy routinely."

"An obstetrician should assess a woman with confirmed delay in the second stage (after transfer to obstetric care if she is at home or in a midwifery unit, following the general principles for transfer of care described in section 1.6), but do not start oxytocin."

Birth

"Discourage the woman from lying supine or semi-supine in the second stage of labour and encourage her to adopt any other position that she finds most comfortable. "


"Inform the woman that in the second stage she should be guided by her own urge to push".


"Do not carry out a routine episiotomy during spontaneous vaginal birth. "


"Inform any woman with a history of severe perineal trauma that her risk of repeat severe perineal trauma is not increased in a subsequent birth, compared with women having their first baby. "


"Do not offer episiotomy routinely at vaginal birth after previous third- or fourth-degree trauma. "


"Diagnose a prolonged third stage of labour if it is not completed within 30 minutes of the birth with modified active management or within 60 minutes of the birth with physiological management. Follow recommendations 1.14.17 to 1.14.24 on managing a retained placenta. "


"For modified active management, administer 10 IU of oxytocin by intramuscular injection with the birth of the anterior shoulder or immediately after the birth of the baby and before the cord is
clamped and cut. Use oxytocin as it is associated with fewer side
effects than oxytocin plus ergometrine"


Cord Clamping


"Do not clamp the cord earlier than 1 minute from the birth of the baby unless there is concern about the integrity of the cord or the baby has a heartbeat below 60 beats/minute that is not getting faster."

"If the woman requests that the cord is clamped and cut later than 5 minutes, support her in her choice. [new 2014] [234] "


Other
"If there are no signs of infection in the woman, do not give antibiotics to either the woman or the baby, even if the membranes have been ruptured for over 24 hours. "


"Encourage women to have skin-to-skin contact with their babies as soon as possible after the birth."

ANALYSIS - NEW STUDY: Private Health Coverage is an Independent Risk factor for Caesarean Section

Last week, an important new study was released: "Private health care coverage and increased risk of obstetric intervention"


AIMS Ireland examines the new study and key points.


What was the study looking for?


When complications arise during pregnancy, labour, or birth interventions are often necessary to improve the health of women and/or babies. This medical need is often called clinical or medical indications. Appropriate use of intervention is necessary and important to ensure that women and their babies are safe.


In Ireland there are wide variations in rates of interventions. Rates can vary significantly across the 19 public maternity units. This suggests that practice in maternity units is not standardised and that interventions may not be used appropriately - based on medical need.


Previous studies have shown that women who choose obstetric led care and private obstetric led care have higher intervention rates than women who attend midwife led care or public obstetric led care. Discussion following these studies often focused on risk factors between the two groups - that women who opted for private obstetric led care were of higher risk groups (have more risk factors) than women who did not.


This study wanted to see if there is a difference in interventions used in Irish maternity hospitals between women who book into public maternity care (without using private health insurance) vs women who book into private maternity care (with private health insurance).


This study is significant as researchers controlled for relevant risk factors between public and private patients.

* Obstetric Led Care is hospital based care where a consultant obstetrician is the lead clinician. The policies, practice, and guidelines in the maternity unit are based on a medical care model.

What are "obstetric interventions"?


This study looked at the outcomes of 403, 642 births across Ireland - a third of which were private consultant led care - and examined the births WITH and WITHOUT the following:


* Caesarean Section

* Operative Vaginal Delivery (some times called   'assisted  delivery' - use of forceps or vacuum)



* Induction of Labour


* Episiotomy





Why is controlling for risk factors significant?


When we talk about "risk factors" this is a way of estimating the odds of a woman requiring intervention during her pregnancy, labour, or birth. Some risk factors suggest that a woman is more likely to require an induction of labour, episiotomy, emergency caesarean, or planned caesarean.


Sometimes risk factors can be conditions occurring in a pregnancy, like gestational diabetes or placenta previa. Others can be age (we hear a lot of older mothers), previous births, epidural, or if you are having multiples.


 This study isolated known risk factors for each obstetric intervention, in order to compare like with like.


The following risk factors were adjusted for each intervention group:


Induction of Labour

* Age

* heart disease

* diabetes

* placental disorders

* previous caesarean section

Planned and Emergency Caesarean Section

* age

* heart disease

* diabetes

* placental disorders

* previous caesarean section

* multiple births

(Due to recent evidence, use of epidural and induction of labour were not considered risk factors for Caesarean Section)

Assisted/operative Vaginal Births (Forceps and Vacuum)


* age
* heart disease
* diabetes
* previous caesarean section
* multiple birth
* induction of labour
* epidural




Episiotomy


* age
* multiple birth
* assisted/operative vaginal birth (forceps or vacuum)

What did the study find?


After controlling the public and private groups for relevant risk factors, the study looked at the birth outcomes between women who chose public vs private health coverage. The study found:


* women with private health coverage were more likely to have a planned caesarean section


* women with private health coverage were more likely to have an emergency caesarean section


* in vaginal births, women with private health coverage were 40% more likely to have an episiotomy




Key Points: Quotes from the full study which AIMSI feel are of significance.

"Irrespective of obstetric risk factors, we found that women who opted for private maternity care in Ireland were significantly more likely to have an obstetric intervention than women who opted for public care."

"assessing the influence of health care coverage status in a variety of health care settings is critical given that rates of obstetric intervention are likely impacted by a country’s prevailing model of obstetric care (i.e. midwifeled, obstetrician-led or shared care models) and health care system (i.e. socialised medicine or fee-for-service).

"health care coverage status is part of a broad spectrum of non-clinical reasons, including obstetrician preference [27,28], litigation fears [29-31], maternal preference [32,33], and fewer women attempting a trial of labour after previous caesarean [34,35]. For this reason, to better understand both clinical and non-clinical dynamics, in future studies of health care coverage status and caesarean delivery, mixed-method research would be a clear advantage."

"We are unable to confirm why differences in episiotomy rates were observed in this population. Speculatively, however, uncomplicated deliveries in the public scheme are largely attended by midwives, who may be less likely to carry out an episiotomy [44]."

"residual confounding is of concern as we were not able to adjust for all maternal (e.g. parity, obesity, assisted conception, ethnicity and socio-economic status) and fetal (e.g. position, intrauterine growth restriction, macrosomia, heart rate) risks factors which may have increased risk of obstetric intervention."

"Data extracted from hospital records may underreport the true extent of covariates and outcomes of interest in this population."

AND FINALLY AND MOST SIGNIFICANTLY,

In relation to increased C-section rates:

"While undoubtedly such trends are impacted by differences in obstetric profiles, our study suggests that health care coverage status is likely an independent risk factor for caesarean delivery."

The National Committee for the Elimination of Home Birth (NCEHB)

This National Committee has been in existence for several decades. It came into being some time in the 1960s when Ireland first bought into the medicalisation of childbirth and the only acceptable birthplace became a centralised obstetric-led maternity unit. Control over birth started to move into the domain of the obstetrician; a specialist in abnormal labours and birth. Traditionally, normal births had been attended in the community by midwives; the specialists in normal birth. Their place of work was either in local maternity homes or in the women’s home. The BBC TV series “Call the Midwife” captures the spirit of these times well

Membership of the Committee.

The Committee has had many members over time, and membership changes as and when demand arises. So for example, sometimes it would appear that the committee is only made up of HSE personnel, whereas other times it would appear that the judiciary, social services, regulatory bodies and the media are also opted into the committee as ad-hoc members.

Some members have of course been given honorary life membership for their great and tireless devotion to Committee business. They have been outspoken on home birth within their hospital units, within the media and even sometimes as expert witnesses in the country’s Coroner’s Courts or High Courts.

Accessing the Minutes of the Committee.

In true HSE style the Minutes of NCEHB meetings are difficult to access or find and may require an FOI. Sometimes when Minutes are found they bear no real reflection of what actually happened at the meeting, with meeting events spuriously added in by key individuals to suits the Committee’s central agenda. As with all committees the real work is done is secret working groups and subcommittees that do not maintain minutes, so the best stuff is probably recorded on someone’s mobile phone!

Furthermore, since the Committee’s membership is so fluid and not officially noted anywhere it is hard to know how often they meet and who attends never mind what decisions have been reached. It is assumed that these meetings take place in the dark corners of the HSE, in Department of Health corridors and in the by-ways of the nation’s Maternity Units, not to mention golf clubs and dinner tables of the medico-media-legal triumvirate. Some Committee members do not even realise that they are members of the Committee believing themselves to actually be part of the home birth supporters club.

Key achievements of the Committee

1. Eliminating the term independent midwife.
2. Removing autonomy from the midwife to make clinical assessments and judgements for their client
3. Insisting on indemnity insurance for midwives in the cynical knowledge that this was not available on the open market yet legislate that other medical professionals can attend childbirth without such indemnity
4. Creating a set of exclusion criteria that eliminates the choice of home birth for women without even allowing them individual assessment
5. Requiring that obstetricians who are not experts in the field of home birth decide on whether women can avail of a home birth service or not
6. Insisting that women whose babies are not in clinical distress transfer to a hospital setting in labour where they will probably be subject to a rigorous set of interventions
7. Ensuring that women transferring from a home birth to a hospital setting do not get to transfer with their primary care giver.
8. Insisting on two midwives present at every birth, in the cynical knowledge that there are not enough second midwives available in certain areas to perform this role.
9. Refusing to engage in the recruitment of more midwives in order to provide midwives for the second midwife service. This is a particularly notable achievement of the NCEHB as there is no evidence anywhere to show that having a second midwife present at the birth improves outcomes for mother or baby.
10. Tell women who are booking into hospitals for their bloods and scans that there is no national home birth service
11. Ensure that the wage paid directly to self employed community midwives is very low and ensuring that any unaccompanied transfer to hospital, even in the woman’s best interests incurs a reduction of up to €1000
12. Ensuring that newly qualified midwives cannot act as second midwives in a community setting until they have had three years experience in a maternity hospital. This is a great committee achievement especially considering that there is absolutely no evidence anywhere to suggest that second midwives improve outcomes for mothers and babies at all, neither is there any evidence to suggest that experience in an obstetric dominated maternity setting prepares newly qualified midwives for work in the community. Leaked Subcommittee Minutes tell us that this particular decision was based on a number pretty much plucked out of thin air and agreed upon based on the personal experience of individuals present in the room at the time.
13. Striking independent midwives off the register following in-camera hearings in which it would appear evidence from midwifery professors currently practising in home birth is ignored in favour of evidence from those not currently involved in home birth.
14. Subjecting SECMs to a different set of professional practice evaluation criteria than those reserved for other maternity care professionals. The country has been shocked in the last year by so many revelations of failure in our hospital maternity services, but so far none of the individuals involved have been subjected to any disciplinary action blame or reproach. In fact do we even have a guarantee that they are not still doing the same thing? Thankfully, due to the Committee’s ever vigilant and tireless pursuit of self employed midwives they get a public lambasting at best should they merely be within a whiff of an event the Committee doesn’t like, and if they were present at such an event the FTP card pops up like a jack in the box..
15. Ensuring that mothers who disobey the Committee’s rules are punished. What is the best way of punishing a new mother? The best possible way of torturing a new mother is to take her baby way from her. The NCEHB have been carrying out some interesting experiments in this area by suggesting to social services that mothers who insist on birthing at home are unfit or unsafe parents, who therefore need to have their newborns removed from them.
16. Forbidding midwives to attend women who do not wish to transfer to hospital care, thereby putting the woman her baby and her family at greater risk and putting midwives in the invidious position of having to relinquish their commitment to duty of care.
17. Refusing to acknowledge the woman’s right to choose the circumstances by which she becomes a parent. This is carried out despite a European Court of Human Rights ruling to the contrary.
18. Creating research that is deliberately statistically biased to try and prove that home birth is dangerous. The committee is aided and abetted in this regards by journals, which the committee control, that are willing to print such poor research.
19. Citing the 8^th amendment as a justification as to why a mother should not be permitted to proceed with a home birth.
20. Eliminating home birth as an option for women who have had previous cesarean birth. This, despite the fact that she may have had previous babies at home in Ireland. Given the country’s extremely poor VBAC rates (despite the existence of national guidelines too promote it) this means that such women are basically being forced into repeat sections even though this is not in their baby’s or their best interest and is not best practice.

Congratulation to the NCEHB, you are doing a great job. The only fly in the ointment are the women’s advocacy groups that seem to be opposing Committee business; harping on about such irrelevant issues as human rights in childbirth, the right to choose, evidenced based care and the right to bodily self autonomy. Some of these groups have even exposed the high quality research that shows home birth to be safer than hospital birth in an obstetric unit, with both mothers and babies having better outcomes and fewer interventions. Whilst the Committee are aware of such evidence, the general modus operandi (as with any other evidence that does not align itself with any accepted clinical practice in our maternity system) is to simply ignore it.

AIMS Ireland shocked to learn that obstetrics has been reclassified as Arts subject

AIMS Ireland shocked to learn that obstetrics has been reclassified as Arts subject

Wednesday, March 26, 2014 The Association for Improvements in the Maternity Services Ireland (AIMS Ireland) today expressed bemusement over comments from the HSE that the obstetric led Irish maternity system is not based on Science as previously thought, but is an Art form.


AIMSI Statement: AIMS Ireland campaigns for evidence based, safe, and appropriate practice and care options for women accessing Irish maternity services. The obstetric care model is the only care option available for the majority of women in Ireland.


A spokesperson from AIMSI states, "AIMS Ireland has long had concerns on the appropriateness of the obstetric care model given findings from high quality, robust science. To be informed by the HSE today that obstetrics is indeed an Art form, and not a science, raises new and serious concerns. Women and their babies deserve the best care possible for themselves and their babies. Science provides us with the answers we need to make best practice recommendations. To learn that maternity care in Ireland is not based on a scientific basis is surprising to say the least. Many women pay significant sums to be provided with private obstetric led care under the pretence that their care is being provided by a highly qualified medical professional, not an Artist. We wonder also are obstetricians eligible to apply for an Arts Council Grant and perhaps they could pass on the savings to their clients? We advise women to consult the most current scientific data, which concludes that for the majority of women, midwife led care is the recommended professional medical, science-based care option.”


ENDS


Reference:








The HSE spokesperson, based in Kilkenny, is quoted as saying "The art of obstetrics is getting the balance right." http://www.independent.ie/irish-news/health/new-mums-more-likely-to-have-a-csection-in-some-units-30125330.html

Legendary Beverley Beech to close AIMSI's 42 Weeks Campaign

“The way a woman gives birth can affect the whole of the rest of her life. How can that not matter? Unless the woman herself does not matter”” ~ Beverley Beech

Beverley Laurence Beech "is a freelance writer, researcher, campaigner and mother of two who has campaigned to improve maternity care since the birth of her second child in 1976. For six years she was a lay adviser to the National Perinatal Epidemiology Unit at Oxford and was for seven years a lay member of the Professional Conduct Committee of the Nursing and Midwifery Council (NMC) and a member of the Midwifery Committee of the NMC. She was also a lay member of the Royal College of Obstetricians and Gynaecologists Maternity Forum, and a founder member of CERES (Consumers for Ethics in Research).


She lectures, both nationally and internationally, on consumer issues in maternity care and the medicalisation of birth. She is the honorary chairman of the Association for Improvements in the Maternity Services (UK)."

                           42 Weeks Campaign Closing Ceremony

What is the 42 weeks Campaign?


AIMS Ireland invites you to attend the closing ceremony of our 42 weeks campaign on March 29, 2014.


42 weeks is a public information campaign for women giving birth in Ireland. 42 weeks began on Sunday 9 June 2013 and ran for 42 week closing Mother’s Day 2014, Sunday 30 March, focusing on healthy positive birth for healthy mothers and babies through positive Irish birth stories, a gallery of beautiful birth photography, and articles to help women make the best choices for themselves and their babies.


Why 42 weeks? Most pregnancies go to full term, which means that a woman will go into spontaneous labour some time between the 37 and 42 week mark. Our campaign is called 42 weeks to reflect that the vast majority of babies will arrive when they are ready – not on an Estimated Due Date (EDD) but some time during this 5 week window – up to and including 42 weeks gestation.


Closing Ceremony: March 29th at 1pm - Cassidy's Hotel in Dublin


Keynote Speaker: Beverley Beech, 'Informed Choice - an Irish illusion?'


Special Guests Presentations:


AIMSI member Nuala Hoey, shares her personal experiences of self advocacy: "Birthing Decisions - A Positive Choice"

Krysia Lynch: " 42 weeks in the Irish maternity system; the rights, the wrongs, and the going forwards"


Angela Martin, 42 weeks photographer, on birth photography

 A 42 weeks slideshow over-view of the campaign


And MORE!




Admission is €5 per person


Doors open at 12:30, with presentations beginning at 1pm.


Cassidy's Hotel: http://www.cassidyshotel.com/?gclid=CKHQoOTSmb0CFYRf2wodOI4AVg




















Reference:


Beverley Beech Biography: http://www.zoominfo.com/p/Beverley-Beech/34783645

Portlaoise: "ground zero" of a failing maternity system?

AIMSI are horrified to hear of the recent death of a baby in Portlaoise over the weekend. Our thoughts are with the family and also the women who are booked into Portlaoise hospital and may be feeling scared, concerned, or anxious following the events of the past few weeks.

It is unclear as to if the baby died from natural causes or if the care/practice was a contributing factor. The results of the post mortem will tell us more.

The hospital is under new management, lead by the Coombe. AIMSI have been informed (unverified) that the former lead consultant from OLOL Drogheda - Maire Milner - has also been transferred to Portlaoise. So there has been a changing of the guards so to speak.

However, questions still remain on some of the findings from the Holohan Report and contributing factors:

Is Portlaoise a case of a few bad apples practicing individually unsafe care? A single maternity unit with an underlying culture of inhumane and detached care?

OR Is Portlaoise the "ground zero" for a maternity system with systematic failures and a culture of indifference to those working in and accessing services from management, policy makers, and the Department of Health? An under-prioritised branch of the health system which lacked provision for care options and was overlooked for investment by the current and former health ministers. A maternity system which is the result of years of over-stretched services, lack of choice, poor moral, and reports of bullying and fear hidden by a complete lack of transparency.

A maternity system which is:

* centred around a care model which is inappropriate for the majority of women - obstetric led vs midwife led

* routinely practices interventions without medical indication which are shown to do more harm than good for the majority of women - CTG, Syntocinon, ARM, episiotomy, caesarean section

* women and midwives report bullying and coercion

* local policy does not reflect evidence or best practice

* evidenced based care options, midwife led care (where available) is not self selecting and does not allow for individual assessment or informed choice

* informed consent/refusual is not recognised in the National Consent Policy

* local policy is not obligated to implement National Clinical Guidelines

* the system lacks transparency and accountability - no watchdog which enforces evidence based practice, guidelines

* the complaints system is grossly inadequate - women regularly report that complaints are not dealt with within the time frame of the HSE's own guidelines, replies are inadequate and do not address concerns, women are fobbed off with consistent replies stating that the unit needs more time to look into her complaint, leading to long time periods with no resolution, responses often provide little or no resolution or validation into the nature of the complaint "we are sorry you feel that way, our unit boasts a high maternal satisfaction percentage"

* large numbers of women contacting AIMSI report that notes have been changed retrospectively or are inaccurate

* maternity system is over-seen by a Department and Health Service Body who puts maternity services and choice low on the list of priorities and does not consult the concerns/opinions/interests/needs/desires of service users, midwives (obstetricians consulted but not midwives), and maternity advocacy groups representing service users which do not hold a conflict of interest. Instead, consultancy and reviews should be open - not by invitation - to all service users as well as advocacy/support organisations, health care providers, and policy makers. Anyone who wants to lend their voice to the discussion should be welcomed, not shut out.

 

* a system in which a HSE risk manager argues that he does not see how refusing women individual assessment or informed choice/consent on their care options is a human rights violation

 

The Irish Maternity system has been neglected for decades and as a result is imploding.

We need an urgent investment in healthy care options for women & babies with immediate implementation of self-selecting, evidence based care, midwife led birth options - MLU, Birth Centres, Homebirth. There must be an immediate over-haul of the current obstetric led care options, so that women who need or choose this type of care receive the highest quality of services possible. Individualised healthy and positive birth - not birth high in morbidity, intervention, and over-crowded conditions. Women deserve time with their chosen care provider. Women and babies DESERVE to be invested in. Women must be supported to make the best decisions for her and her baby - treated with dignity and respect. Midwives must be respected to practice with autonomy - recognising their skills and qualifications. Not bullied into complying with routine intervention or demoralised by having to few colleagues to provide safe and evidence based supportive care to each woman.

 

There must be repercussions for individuals and maternity units who fail to provide evidence based care and healthy working environments for HCPs. There must be repercussions for units using inappropriate rates of intervention, units with large regional variations, who actively manage women in labour with sytocinon, who use episiotomy or refusal of choice inappropriately, who devalue midwives, - a demand for accountability and investment NOW.

 

There must be a change of culture. A change of priority. The Department of Health, Minister, and HSE must stop lying to women - to the public. Hold your hands up. Tell the truth. Stop firefighting.

 

The only way to prevent next week's tragedy is to be open, listen, and invest.

Revealed: Midwifery Staffing Levels for 19 public units (Feb 2014)

Revealed: Midwifery Staffing Levels for 19 public units (Feb 2014)

February 2014 the INMO (Irish Nurses and Midwives Organisation) took a survey of clinical staffing levels of the 19 public maternity units in Ireland. The results highlight grossly inadequate & unsafe staffing levels in Irish units.

These are the findings of the survey:

Irish Nurses and Midwives Organisation

Ireland - Midwifery Staffing (Public Hospital/Unit)

Survey of Current Clinical Staffing Levels - February 2014

Hospital/Mat Unit          No of Midwives     No. of Births       Ratio Midwives/Births      Shortage

Holles Street                         303                          9142                              1:30                          7
_______________________________________________________________________________________

Mayo                                     55                            1785                              1:32                          5
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South Tipp                            34                             1167                              1:32                          6
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Limerick                               144                           4950                              1:34                           24
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Sligo                                      46                             1660                              1:36                          10
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Waterford Regional               63                             2250                             1:36                           13
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Cork                                       243                           8900                             1:37                           59
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Kerry                                     45                             1676                              1:37                           12
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OLOL Drogheda                   99                             3654                              1:37                           24
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Kilkenny                               50                             1907                               1:38                           15
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Portiuncula                           54                              2055                               1:38                            16
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Coombe                                215                            8586                               1:40                            76
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Galway                                 82                              3377                               1:41                            32
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Letterkenny                          46                              1881                                1:41                            18
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Cavan                                   45                              1897                                1:42                             19
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Wexford                               46                               2180                                1:47                             28
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Rotunda                               188                              9041                                1:48                            118
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Mullingar                             54                                2712                               1:50                            38
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Portlaoise                            37                                  2059                               1:55                           33
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Total:                                 1804                                70879                            1:39 (average)    

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Internationally Recommended Midwife: Birth Ratio:                                   1:29.5
(Birthrate Plus UK)
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Total Number of Midwives (Clinical Areas) in Ireland:                               1821
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Total Number required to reach ratio and safe standards:                             2403
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Shortfall:                                                                                                         582

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* Safer Childbirth Recommendations (2007) from RCOG and RCM recommend that the midwife to woman ratio should not exceed 1:28 for the majority of women, and for women with complicated case loads, the ratio is recommended at 1:25