AIMSireland issues Proclamation to the Birthing Women of Ireland

AIMSIreland Proclamation

This proclamation from AIMSIreland to the Birthing Women of Ireland is to mark the centenary of the original Irish Proclamation which was read from the GPO 100 years ago today. The original proclamation strove to ensure equal rights for all the future citizens of Ireland, a worthy aspiration that has yet to be fully realised.

There are many areas of maternity care which are not equitable, not evidenced based and in which women and the babies they are birthing could be better served. Under the 8th amendment to the Irish Constitution women are not treated as equal citizens once they become pregnant. They surrender bodily autonomy to the State and as such are not free. AIMSIreland strives to fight these inequities and to ensure that all women who birth in Ireland have the right to safe, compassionate, evidenced based care and bodily autonomy.

Watch our Proclamation video here

AIMSIreland to the Birthing Women of Ireland

WOMEN of Ireland: In the name of all those women who have gone before you and of the dead generations from which you draw your strength to birth, AIMSIreland summons you to our Charter for Safe Maternity care and strikes for the freedom of all women to choose, to be fully informed and to be treated with compassion and dignity in our maternity services.

Having organised and trained her advocates through her outspoken organisation; and through other Irish voluntary birth advocacy organisations, having resolutely waited for the right moment to reveal itself, AIMSIreland now seizes that moment, and supported by her sister global advocates, but relying in the first on her own strength, she strikes in full confidence of victory.

We declare the right of the women of Ireland to the ownership of their bodies and to the unfettered control of their destinies, to be sovereign and indefensible. The long usurpation of that right by the state and health care professionals has not extinguished the right, nor can it ever be extinguished except by the destruction of all women in Ireland. In every generation women of Ireland have asserted their right to bodily autonomy and sovereignty; countless times during the past hundred years they have asserted it collectively and individually. Standing on that fundamental right and again asserting it on social media in the face of the world, we hereby proclaim the bodies of the birthing women of Ireland as independent and autonomous and we pledge our lives and the lives of our fellow advocates to the cause of its freedom, of its welfare, and of its equality among citizens.

AIMSIreland hereby claims the allegiance of all women of Ireland to call for improved maternity care. We demand equal rights and equal opportunities for all women in birth, and declare our resolve to pursue the happiness and prosperity of all birthing women, cherishing all of the birthing women of the nation equally, and oblivious of the differences carefully fostered by the State, which have divided a minority from the majority in the past.

Until our advocacy has brought the opportune moment for the establishment of a safe compassionate dignified maternity service we will carry the mantle of ceaseless questioning.

We place the cause of Improving the Irish Maternity Services under the protection of the moral high ground Whose blessing we invoke upon our campaign and we hope that no one who serves that cause will dishonour it by cowardice.

In this supreme hour AIMSIreland must, by its valour and determination, and by the readiness of its committee and membership to work voluntarily for the common good, prove itself worthy of the august destiny to which it is called.

Signed on behalf of AIMSIreland

Krysia Lynch

Breda Kearns

Jene Hinds Kelly

Sinead Redmond

Helen Guinane

Lucy Peprah

Barbara Western

Rebecca Hegarty

Nuala Hoey

Lisa Finnegan

Edel Quirke

Aisling McCarthy

Launch of the Maternity Strategy for Ireland 2016-2026

The Association for the Maternity Services Ireland (AIMSI) welcomes the Maternity Strategy for Ireland 2016 - 2026

www.aimsireland.ie

For more information call Krysia Lynch 0877543751

AIMSI welcomes the Maternity Strategy for Ireland launched today 27th January 2016.  by Minister Leo Varadkar.  AIMSI was delighted to be able to participate in the steering group for the last nine months via its Chair Dr.Krysia Lynch.

The Maternity Strategy when implemented will offer women and their families increased choices in maternity care. Women who are experiencing a normal straightforward pregnancy will have the option of birthing at home, in an alongside birth centre or in a specialist birth centre. The first two options will offer women with a normal pregnancy a much increased chance of a normal birth, with interventions not being routine but only carried out on request or necessity, and where the lead carer will be a midwife.

Women who are of medium risk or of high risk will not have any increased choices, and will birth in an obstetric led specialist birth centre. AIMSI are disappointed that for women who have only transient risks or marginal increased risks there will be no choice in care setting as there is for example in the recently launched GAIN guidelines in Northern Ireland. AIMSI are further disappointed that free standing birth units are not recommended in this strategy, even though the evidence for their safety is stronger than for home birth, which the Strategy does recommend, and even though there was a clear overwhelming demand for in the public consultation.

AIMSI welcomes the Minister's comments on perinatal mental health at the launch of this strategy and the need for increased service provision in this area that the strategy recommends. AIMSI also welcomes the increase in a community midwifery service that this Strategy recommends for antenatal, postnatal and intrapartum care as being cost effective, designed to meet the growing demand for women to have more care within the community and cognisant of the views of the many service users who took part in the consultation.

AIMSI welcomes the increased provision that the Strategy recommends for information and audit. The strategy recommends that evidenced based information be made available in a one stop shop for for women and that women be advised of their options at the start of their pregnancy using evidence rather than clinician preference. The Strategy also recommends that HIQA will annually audit the maternity services, which AIMSI welcomes.

The Strategy recognises the effect of birth trauma on women and the Minister made reference to this in his speech at the launch. AIMSI are delighted to hear that there will be recommendations to assist women who experience birth trauma, as so many of our calls come from women who have had traumatic experiences in our maternity services.

AIMSI are delighted to see that the Strategy recommends the provision of alongside birth centres even in smaller units. AIMSI also welcomes the provision made for smaller units to comply with dedicated home from home rooms to act as alongside birth settings with midwives as lead carers until an alongside birth centre can be built as this will ensure continued provision of maternity services in rural areas.

AIMSI welcomes the importance that this Strategy places on breastfeeding and its role in life long health. We welcome the recommendations that all hospitals achieve Baby Friendly Status and that women should have free access 24/7 to lactation consultants within hospital settings and also free access in the community.

Finally, AIMSI welcomes the provision made for service user representation in the implementation of the Strategy and in continuing review of the maternity services

Strategic review of the maternity services: the importance of service user representation

On Saturday 23rd May 2015, the Irish Times printed an article which highlighted a letter sent from the Institute of Obstetricians and Gynaecologists of Ireland to the Minister for Health Leo Varadkar about the Membership of the Strategy Review Steering Group.

AIMSI Ireland through their Chair Krysia Lynch has a place on the committee representing the views of service users. Also on the committee are two service users whose babies died in Portlaoise Hospital.

In the letter, Prof Robert Harrison, said his members were "dismayed about the make-up of the group". He stated that the presence of three obstetricians and no anaesthetists or critical care specialists, compared to nine people from a midwifery background and three lay people, “does not reflect a fair balance of those who work in maternity services today”.

The letter implies that those who work in the maternity services should dominate how future maternity services are delivered and planned. It  discusses ratios of those that work in the maternity services today and assumes wrongly, as it turns out, that obstetricians should have the majority of seats. There are many more midwives working in the maternity services than obstetricians; it is logical that the majority view around the table should be from midwives. Perhaps what the statement really means to imply is that obstetricians have grown accustomed to dominating discussions surrounding maternity services, and suddenly finding themselves not in a majority is unfamiliar and unwelcome territory.

The reporting of the letter in the Irish Times implies that the querying of the service users by Prof Harrison was insensitive and inappropriate given the way these women had been treated by the members of his own profession.

Whilst the comments re service users made in the letter received a lot of publicity, little commentary was made on the demands from the Institute of Obstetricians and Gynaecologists of Ireland for the inclusion of a critical care representative and  the inclusion of an anaesthetist representative; both of which were duly appointed following the request from the Institute. 

An interesting question that the letter does not address is whether the inclusion of two service users and one advocacy organisation is sufficient. AIMSI would argue (along with the other service users representatives) that 70,000 maternity care service users might deserve even more than two service users representing them. To this end AIMSI also wrote to the Strategic Review Committee suggesting the inclusion of a further consumer representative who had perhaps experienced a different model of care and a different outcome to those already included. AIMSI were told no further representatives could be added.

On Tuesday 25th May 2015 AIMSI issued the following statement:
 

"The recent comments in the Irish Times questioning the inclusion of two service users was unhelpful. This group might not be sitting if it were not for the experience of the service users on the committee. Their bravery in coming forward  and the support they received from advocacy groups is an important aspect of improving maternity services for women in Ireland, and AIMSI would if anything be advocating for more service user inclusion on the group"

The full article can be read here
http://www.irishtimes.com/news/health/obstetricians-query-inclusion-of-mothers-in-group-1.2222952

The second article following Prof Harrison s resignation can be read here
http://www.irishtimes.com/news/health/institute-of-obstetricians-withdraws-portlaoise-letter-1.2224543

SHOUT BACK - YOUR SAY: A Note on the Issue of Balance

AIMSI have received quite a few messages on our SHOUT BACK - YOUR SAY submissions; passionate pleas to include positive stories in the interest of balance.

AIMS Ireland spent 42 weeks highlighting positive, healthy birth in Ireland. (www.42weeks.ie)
42 weeks was well received, particularly by health care providers. However, during this campaign, many women contacted us who felt isolated; that their voice and experience was not represented.

SHOUT BACK - YOUR SAY represents a safe place for women to share their experiences which were not positive. These submissions are vitally important as they represent a voice which rarely has the opportunity to be heard; those who survive. AIMS Ireland passionately believe that experiences of abuse, disrespect, assault, unsafe care practice should not matter less simply because the woman and baby survive.  Yet these experiences are too often dismissed consistently by our politicians, policy makers, care providers, and media.

Baby alive. Mother alive. Non story. Regardless of the profound impact on the physical and psychological wellbeing of women, babies, families - the health and lives of all involved.

Assistance with complaints and birth trauma is the #1 reason why women make contact with AIMS Ireland. The SHOUT BACKs representing a small percentage of what comes into our inbox.

We need to be very careful that in a desire to create balance, we do not dismiss the experiences of women who have not had positive experiences. The SHOUT BACKs are difficult to read. They represent everything we hope to change in the Irish maternity system. These experiences are real and need to be heard in their own light, not buried. Its so important we do not dismiss these women's experiences by asking for the focus to change - to make us all feel more comfortable, by including positive stories.

It is in everyone's interests that these experiences are acknowledged and the courage that these women and families have shown in coming forward is respected. They are heartbreaking and very difficult reading but their place in the maternity care system is of huge importance; it is as a result of this opportunity to share, just at this particular time, that REAL change may come about.

Balance is about hearing and facing up to the difficult things. People are living with the repercussions of such treatment - often alone, isolated, while taking care of their young families - and up to now they have remained unheard and unacknowledged.

It is vital that we do not look back at this opportunity in 20 years time and say "if only we'd listened".

More of this please! Positive stories set the bar

MORE OF THIS PLEASE!

AIMSI are delighted to hear that women are reporting positive experiences and hopefully this trend will continue.

We acknowledge the many individual care-givers, unit leaders, and other individuals in the Irish maternity system whom are attempting, in so far as hospital protocols allow them, to introduce more woman-centred care which realises evidence based findings and the significance optimum care has on women's physical, mental and emotional well-being; which has far-reaching impact on not only her health, but that of her family and baby.

The long term benefits of providing evidenced, supportive, women-centred care would also be seen down the line in terms of demands on the health services and other resources.

It is becoming clearer, as more research is done internationally in this area, that disrespectful and uncaring, and thoughtless treatment of a woman at such a significant time leaves lasting, very often hidden scars, unresolved physical injury, and often serious trauma which can go unrecognised and untreated. AIMS Ireland's support and advocacy services witness this on a daily basis.

It is wonderful to read this positive story in the Times, however, AIMS Ireland recognise that this level of care is not offered to all women accessing maternity services in Ireland. This should not be.

AIMSI will continue unceasingly in its efforts to ensure that every woman in the Irish maternity system has access to evidence based, kind, supportive care with a strong emphasis on informed decision making in order to support each woman to make the best decisions for her and her baby in her unique circumstances.

Very much remains to be done to realise this reality, including:

recognition of woman's rights in pregnancy
Informed decision making; consent, refusal
providing clear, unbiased information
a range of evidence based, safe care options
effective use of resources
listening to women and their experiences
humanising care for women with "high risk" status and caesarean births - such as skin to skin, baby in recovery, individual assessment, etc

Women should not have to be dependant on the attitude of individual care-givers or unit leaders for respectful and optimum care. Nor should women's care vary depending on the opinion/ routine practice of the care provider they see.

Women should be able to put trust in their maternity care and care providers.

There are very many extremely overworked and exhausted midwives and HCPs - stressed because they are unable to provide the care they know is evidence based and safe. There is much attention placed on the faults of our maternity system, to which there are many. However, AIMS Ireland fully recognises the very many wonderful care providers, who strive to bring the best practice and evidence based care to those they care for. There are pockets of amazing, supportive care in Ireland and these individuals are the backbone of these stories!

AIMS Ireland hope that maybe, someday, positive stories, such as the one here and others from 42 weeks campaign will be the norm for ALL.

Until then, all the negative experiences and feedback received from women must be carefully scrutinised and recognised as powerful tools of change. Lessons to learn from. A mirror to show us where we are - and where we must go. It is not an 'either/or' situation and we need the support of the media and Government to recognise this. ALL experiences are part of the system. ALL are worthy and should be heard. Only when we are able to be accepting and acknowledging of this - by highlighting what needs to be changed and what can be achieved - will women, babies and families get the optimum care and treatment they deserve and need.

This woman's story shows it can be done.
Here is the bar.
RISE to it!

#moreofthisplease

Irish Times: Maternity services: ‘I felt safe in the hands of the professionals’ http://www.irishtimes.com/life-and-style/health-family/parenting/maternity-services-i-felt-safe-in-the-hands-of-the-professionals-1.2168618
‪‬

Compensation costs, accountability, and listening to women.

On Monday, March 30th 2015, the Irish Times ran an article "Childbirth malpractice cost HSE €67m over five years" by Ciarán D'Arcy in which new figures were revealed from the HSE that nearly €67 million has been paid out to families in compensation for medical malpractice for birth procedures in the past 5 years.

The article states: "The increase in birth-specific payouts in 2013 reflects an overall spike that year, in which HSE hospitals spent over €50 million compensating patients and members of the public. This compares to €26 million in 2012, and €32 million last year, according to figures obtained through Freedom of Information legislation. As an organisation, the HSE has spent about €367 million in compensation payments for more than 2,000 cases over the last decade."

What is omitted from this discussion is the human voice of those touched by these cases. The experiences and lives of families affected.The people behind the HSE's compensation figures.

 
One woman provided a powerful comment following the posting of this article:

 "If these so called 'medical professionals' did their jobs properly in the first place then there wouldn't be babies born with severe brain damage which is life changing for them and their families! If these so called midwives and doctors were held accountable for their actions and were not let free to do it again there would be less children born with brain damage. We as parents have not come in for some kind of 'windfall' as is quoted in the article and also said at a medical conference by the head of the States Claims Agency! It is NOT about money. Our children's lives have been ruined. Do these people have children? Do they know what they are going to say at their childs funeral? I do."

This woman and others, should be at the very heart of this conversation. Her experience. Her child. They are not a number on a list of pay-outs nor the words in a court brief.

Another notable absence in this discussion is recognition of a culture within our maternity services which fails to deliver accountability and best practice standards to women and babies.

Have individual clinician's practices been reviewed following these cases?
Have any clinicians been suspended or required to re-train as a result of adverse outcomes?
Are these cases open and transparent so that women can make informed decisions?
Have there been investigations into routine clinical practices which do not meet best practice standards?

The reader quoted above also posted on the AIMS Ireland page, that she,

 "would love to see a change but unless a legal duty of candour is brought in nothing will."

The reluctance of medical professionals and the State Claims Agency (in spite of their media spin) to bring in 'open disclosure' in the case of adverse events means no apologies and no clear and helpful information for those who have suffered, and continue to be profoundly affected, by these significant events.

Accountability

What is a grave concern to AIMS Ireland is the number of failures at national level identified in numerous reports which include timely access to maternity services, inadequate staffing levels for safe care, a maternity care model that hasn’t been revised in 59 years despite numerous national and international reports and recommendations, a lack of accountability and governance, and a strategic review of maternity services in which women's voices have not been included in the consultation process.

Ireland is a nation of numerous reports and recommendations. Report , after report, after report come to the same conclusions with absolutely no preventative action from the HSE or Department of Health to implement best practice standards and individualised care in Irish maternity care options. There is a fundamental failing to identify and act on local and individual clinical practice;  all necessary to ensure full accountability.


Silencing Experiences

As a nation, we have a comprehensive failure to listen to women and those at the centre of the issue. The HSE have claimed 'unverified accounts' within the most recent HIQA report. How can our Irish health services be accountable when a woman's/family's first person account is considered 'unverified' in the eyes of the HSE?

 This is a reoccurring complaint to AIMS Ireland – women do not feel their experiences, concerns, and the implications of their birth are acknowledged or listened to.

Women are told what their experiences were, rather than being asked.
Women are spoken for by politicians, health care providers, and other 'experts'.
Women are told what they are feeling.
Women's stories, choices, and concerns are silenced.

Women also referenced  'not being listened to' in the AIMS Ireland 2014 survey, "What Matters to You" in which nearly 3,ooo women took part who had birthed in Ireland over the past 5 years. This trend is highlighted in the following graph including women's comments.

#WMTY2014


Change of Culture

A change of culture is desperately needed from the top to the bottom in Irish maternity services with a focus on high quality, evidenced clinical practice and accountability for failures in clinical safety. The experiences and voices of those using the services, those living with the consequences of their birth, those at the very centre of the issue, must be consulted as equal and worthy partners in the process.  #listentowomen


Full article on compensation costs here: http://www.irishtimes.com/news/health/childbirth-malpractice-cost-hse-67m-over-five-years-1.2157876

What Matters to YOU 2014 - AIMS Ireland survey available to read here - next batch of results due out in April: http://aimsireland.ie/what-matters-to-you-survey-2015/

The Coombe, Portlaoise, The Report and Managing the Media

Portlaoise Hospital www. Midlandsradio.fm

AIMSI was doing a media interview yesterday and we were asked by the radio presenter what our opinion was of the Minister of Health's response to the issues with Portlaoise, in particular with reference to the overtaking of services in Portlaoise by The Coombe Women's and Infants University Hospital.

Three days ago (25th March 2015) the Minister for Health, Mr Leo Varadkar  appeared on the Pat Kenny show on Newstalk national radio and made the following statements re the as yet unpublished draft HIQA report on Portlaoise hospital.

"It is a draft report. It's not a draft report that I've seen yet"
"The draft report hasn't yet been put to the board of HIQA. Like any draft report, on any matter, it needs to be fact checked and that's the process that's now underway. I do expect to see it in a couple of weeks and it will be published."
"The draft report casts the net very wide, not just making findings against senior management in HSE at national level but also front line staff at local level."
"The HSE would take the view that it has to defend the reputation and good name of its staff on the frontline."
"I don't want to see government agencies suing each other. I think it's not appropriate, it's a waste of money."
"I haven't seen the report yet so I'm not going to come down on any side until I have."

Minister Varadkar on Newstalk Radio with Pat Kenny 

The next day, Thursday March 26th we hear that a memorandum of understanding has been signed between the Coombe Women's and Infants University Hospital and Portlaoise Hospital to transfer governance as part of a  "managed maternity network", The implied message is that this a direct response from the Department of Health to the HIQA  (as yet draft and unpublished) report. How could this possibly have happened in direct response to the HIQA report when the day before the Minister of Health admitted on national radio that he had not even read the report?

The logistics required to make it such a response could not possibly have been implemented in 24 hours. Rather than a direct response to the HIQA report this was a cynically  managed media response to divert attention away from the spat between HIQA and the HSE, and the abhorrent failures within Portloaise itself. In fact this response coming in the first quarter of 2015, highlights another HSE failure, as these measures were recommended to have been in place by the second quarter of 2014.

The transfer of governance to the Coombe Women's and Infants University Hospital was recommended on the 24th February by the Chief Medial Officer based on the fact that it was ALREADY agreed government policy that this would happen based on the hospital trust policy. http://health.gov.ie/wp-content/uploads/2014/03/IndHospTrusts.pdf

The process was initiated on the 28th February 2014, when staff from the Coombe were initially transferred to Portlaoise Regional Maternity Hospital

"In a statement, the HSE said a new management team has been appointed on an interim basis in order to run the service from today.
The new team consists of Michael Knowles who is currently General Manager in Naas Hospital and Angela Dunne, currently the Assistant Director of the Coombe Women and Infant University Hospital.
The National Director for Acute Hospitals, Ian Carter, said “the new governance arrangements will bring the appropriate vigour to maternity services in Portlaoise Hospital.”"
http://www.thejournal.ie/portlaoise-management-hse-1338134-Feb2014/

This new management team wa  a result of the preliminary report to the Minister for Health relating to he issues that arose following a Primetime Investigates programme relating to Portlaoise Hospital Maternity Services on 30th January 2014.

The Interim Report to the Minister for Health Dr James Reilly TD From Dr Tony Holohan Chief Medical Officer on the 24 February 2014 on "HSE Midland Regional Hospital, Portlaoise Perinatal Deaths (2006-date)"stated that

"The overall conclusions in the Report are as follows: 1. Families and patients were treated in a poor and, at times, appalling manner with limited respect, kindness, courtesy and consideration. 2. Information that should have been given to families was withheld for no justifiable reason. 3. Poor outcomes that could likely have been prevented were identified and known by the hospital but not adequately and satisfactorily acted upon. 4. The PHMS service cannot be regarded as safe and sustainable within its current governance arrangements as it lacks many of the important criteria required to deliver, on a stand-alone basis, a safe and sustainable maternity service. (See Overall Recommendation 3). 5. Many organisations, including PHMS, had partial information regarding the safety of PHMS that could have led to earlier intervention had it been brought together. 6. The external support and oversight from HSE should have been stronger and more proactive, given the issues identified in 2007. " p. 10
http://cdn.thejournal.ie/media/2014/02/portlaoise_perinatal_deaths.pdf

The recommendations of this report included the following

"Recommendation O.R.3: A team should be appointed to run the PHMS pending implementation of Recommendation O.R.4 below. Recommendation O.R.4: PHMS should become part of a Managed Clinical Network under a singular governance model with the Coombe Women & Infant University Hospital. Recommendation O.R.5: Other small maternity services should be incorporated into managed clinical networks within the relevant hospital group." p. 10 http://cdn.thejournal.ie/media/2014/02/portlaoise_perinatal_deaths.pdf

Overall recommendation 3 was expanded on:

"In this regard the HSE should immediately put in place a transition team to take control of the service at PHMS and to oversee the planning and execution of the orderly implementation of the managed clinical network recommended below. The transition team should consist of appropriate clinical and managerial expertise".  p. 69 http://cdn.thejournal.ie/media/2014/02/portlaoise_perinatal_deaths.pdf

Overall recommendation 4 was expanded on, and the report recommends implementation of this in the second quarter of 2014

 "The number of births at PHMS shows that there is and will continue to be a need to have a maternity service at Portlaoise Hospital which meets the requirement of good safety, patientcentred and sustainable care. A decision to close the service would not be appropriate given the scale of activity. Neither is it an option to maintain and develop the service under its current governance arrangements given the findings and conclusions in this report. Portlaoise Hospital is a constituent hospital of the Dublin Midlands Hospital Group. This Group also includes the Coombe Women & Infant University Hospital. The development of a managed clinical network within the Dublin Midlands Hospital Group, initially comprising the PHMS and the Coombe Women & Infant University Hospital provides a sustainable solution to the leadership, staffing, training, quality assurance, clinical standard and risk management issues identified in this report. The implementation of the Establishment of Hospital Groups34 will ensure that the future service needs of the whole population of each hospital group will be quantified and planned in a more integrated fashion. The overarching system of clinical governance and enhanced communication and cooperation between hospitals within the hospital group setting, will underpin the provision of quality and safe healthcare. The managed clinical network should consist of the following features:  A single clinical service under the governance, direction and authority of the Master of the Coombe. Capacity for medical, midwifery and other staff to be appointed to the network and to rotate as required by service and training needs between sites. Training for junior doctors and midwives to happen on both sites. Common system of clinical governance i.e. policies, audit meetings, quality assurance, incident reporting, incident management etc. with pooling of all data to ensure that all quality assurance is on the basis of one single service- albeit operating on two sites. Risk stratification of patients attending PHMS to ensure that higher risk pregnancies are dealt with at the Coombe site". p.69 http://cdn.thejournal.ie/media/2014/02/portlaoise_perinatal_deaths.pdf

Overall recommendation 5 was also expanded on and the report recommended implementation of this at the end of the second quarter of 2014

"This Report recommends the urgent transition of Portlaoise Hospital as the first smaller hospital to become part of a managed clinical network under the clinical governance of a larger hospital, in this case, the Coombe Women & Infant University Hospital. A managed clinical network with the features described above would provide a number of advantages for smaller units. It can provide clinical governance, leadership, shared clinical guidance, shared training and processes for rapid referral. In these circumstances, other small maternity services in the country should be incorporated into a managed clinical network within the relevant hospital group. Given the findings of this Report which are in part the result of small size and the challenge of sustaining services by attracting and retaining staff, it is considered reasonable that work commence on integrating smaller maternity units into systems of common governance in line with the planned hospital networks. It should not await the outcome of further analysis by HIQA which is recommended below." p. 70
http://cdn.thejournal.ie/media/2014/02/portlaoise_perinatal_deaths.pdf 

The report also made these observations

"In the preparation of this Report a number of issues of concern emerged through meetings with families and others. There were clear descriptions where patients felt backs were being turned; honest accounts were not given; and unprofessional behaviours and language were frequent. Insensitivity and a lack of empathy were common themes. Younger patients were not so much spoken to directly as through their mothers and had the feeling of being “judged” by staff. There were even accounts of senior clinical staff (more than one) inviting families to “sue”. There was also a lack of cultural sensitivity. These accounts were not just applicable to the PHMS but also to the paediatric unit." http://cdn.thejournal.ie/media/2014/02/portlaoise_perinatal_deaths.pdf 

AIMSI are used to hearing these types of descriptions from service users of the Irish Maternity Services. Most health professionals prefer to keep their ears closed and believe that such reports are grossly over exaggerated. In fact many health care professionals feel that patients airing grievances with the maternity services should not happen in the media at all. Without the media, the alarming events at Portlaoise would never have come to light. We know that internal inquiries were carried out in Portlaoise with appallingly long time lags; averaging three years from incident to report. In one case the incident took six years to reach report stage. AIMSI will continue to liaise with the HSE whenever our input is welcome and appreciated. When it is not, we will continue to highlight lapses in care and safety in the media.

Our press release in response to the HIQA report is here http://aimsireland.ie/hse-response-to-hiqa-report-on-portlaoise-hospital/

To answer the question; what is AIMSI s response to the managed maternity network between the Coombe and Portlaoise (as recommended in 2014). Our response is that this can only be a good thing. Our hope is that this will ensure adherence to the National obstetric guidelines, primarily with respect to CTG, and to the new guideline for the use of syntocinin in labour. We also hope that the ethos of The Coombe as a forward thinking hospital, looking to encourage midwifery led options for low risk women will also transfer to Portlaoise. Recent developments in the Coombe have included water births, DOMINO, early transfer home and midwife led antenatal clinics. They are also the first hospital to have initiated a doula policy in Ireland. On May 7th they will be hosting the 8th Essence of Midwifery Care Conference looking at Changes, Choices, Childbirth in which many of these changes will be highlighted. AIMSI will be speaking at the conference.Or more information on the conference see .http://www.nursingboard.ie/en/events-article.aspx?article=c19af0c9-a4f4-4361-9675-0d9552b5e5c6