Maternity care - no way to treat women

  • Niall Hunter, Editor


There's an old and bleak feminist joke which states that if men had babies, abortion would be a sacrament.

In assessing the Portlaoise infant death scandal report by Department of Health Chief Medical Officer Tony Holohan, it perhaps would not be too cynical to believe that if Irish men had babies, we'd have a safer maternity service.

Is it a mere statistical accident that the vast bulk of the treatment scandals of recent years have involved women's healthcare?

These scandals have included: infected blood products; missed miscarriage diagnosis; errors in breast cancer testing; preventable maternal deaths, unnecessary hystertectomies and, going back a bit further, symphysiotomies.

Do these scandals and how they were subsequently handled tell us that after years of alleged progress in gender equality and rapid advances in treatment and communication with patients, women are still second-class citizens when it comes to their health services, particularly maternity services?

Patient representative groups will tell us that while some women have good experiences of maternity care, others are sometimes treated like cattle. You can read examples of good and bad maternity care on Rate My Hospital. Some of the negative experiences related, particularly in terms of staff attitudes, are quite shocking.

So is the idea of an anti-woman bias in healthcare provision a conspiracy theory or is there something in it? Well, those who will rush to defend our health service will point out, for example, that we have an excellent breast cancer diagnosis and treatment service in public hospitals.

This is undoubtedly true. However, this women's health service was only organised into 'centres of excellence' after misdiagnosis scandals (including one at Portlaoise Hospital) forced the health authorities to take action. A leading consultant said at the time that if this service had been reorganised and revamped earlier, women's lives would have been saved.

Certainly, the pig ignorant treatment (there is really no other way to describe it ) of the women and their families when they sought explanations following the unexpected deaths of their babies at Portlaoise, as outlined in the Holohan report, might indicate that this anti-women bias exists.

Certainly, the Portlaoise revelations, if not necessarily showing an anti-women bias, show at least an almost contemptuous attitude to people when they are at their most vulnerable and seeking some comfort and the truth. All they got in Portlaoise was cold comfort and little truth.

In terms of so-called communication, the culture at Portlaoise maternity unit as outlined in the Holohan report is redolent of an old, grey, repressive Ireland when the the vulnerable and poor suffered all types of ill-treatment and those who queried this were told to mind their own business.

This authoritarianism led to huge societal and social problems which we are still trying to come to terms with.

The Portlaoise report, in addition to the findings of poor practice and inefficiency, also indicates that these old repressive attitudes obviously die hard.

These attitudes are obviously not held by everyone who works in Portlaoise's maternity unit or the hospital in general. However, whatever their prevalence in Portlaoise or elsewhere, they do not belong in a modern health service or an allegedly humanist and egalitarian society.

And just in case you might think the media and others might be hyping up the Portlaoise scandal, it's worth quoting the relevant section of the Holohan report outlining patient experiences:

"There were clear descriptions where patients felt backs were being turned (when they sought explanations about infant deaths); 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 (Portlaoise Hospital Maternity Service) but also to the paediatric unit."

"The specific descriptions provided of the care in the immediate aftermath of perinatal deaths added to the distress rather than support of the families. These accounts were powerful, clear and consistent. While we cannot say that they in fact typify the experience patients have in PHMS, they indicate a culture which is not consistent with good patient safety outcomes."

And there's more:

"Mothers (of deceased babies) were not necessarily accommodated away from other mothers who had delivered babies; practices with regard to handling, holding, dressing, bathing, and photographing their infants were at best variable; appropriately sized-coffins were not always made available. The transport of infants in the boot of taxis to Tullamore Hospital for post-mortem examination was one especially distressing finding. Some of the comments attributed to staff who dealt with the families in these circumstances also added to the distress."

The report goes on to state that information was available to the hospital to show that it knew that adverse events had occurred and that this was withheld from the families concerned. "In some cases this led to families believing that other factors, for which they might have had responsibility, explained the deaths of their children. Families blamed themselves for events in which they had no responsibility. They were allowed to go on not knowing even when the hospital had more information. These are failures in the duty of care of Portlaoise Hospital and the staff charged with the care of the patients. It is a most basic breach of the trust that is so essential to the delivery of good quality patient-centred care."

Even to seasoned observers of health scandals, the above paragraphs make for particularly distressing reading. These women and their families were treated in this way, it should be remembered, after the unexpected death of an infant.

Other findings of the report, relating to clinical standards, while worrying, are unfortunately not really surprising, They repeat the themes of many treatment scandals of recent years.

The Portlaoise unit's failure to act on warning signs about the deteriorating condition of patients is eerily redolent of the Savita Halappanavar scandal, and the failure of hospitals and the HSE to act on previous recommendations for safety improvements now runs like a Greek chorus of despair through practically every recent review of patient harm incidents in our health service.

Thankfully, the report pulls no punches in stating what went wrong and, and what needs to be done to make services safer, at least in the short term.

We are told that some health professionals will, as a result of the report, face disciplinary proceedings before their regulatory bodies. While this is to be welcomed, it remains unclear as to whether management will undergo the same level of accountability for what happened at the Portlaoise maternity unit.

You would be hard pressed to find evidence of disciplinary proceedings being taken against management staff in the wake of any of the Irish healthcare scandals of recent years.

Health Minister James Reilly should be commended for acting swiftly to bring in a transition team to run the maternity services at Portlaoise. This will in time be superseded by new links with the Coombe Hospital, to improve safety and quality of care.

The Minister also needs to act swiftly to fast-track promised safety reforms such as hospital licensing and the setting up of a patient safety agency. These changes are far more important even than universal health insurance, and should be given priority.

Dr Reilly was also at pains to point out that Portlaoise maternity unit will be made better, but it will not close down.

In some ways this is good news for the people who use the service, although a cynic might say that no Minister is going to close down a hospital service just before local elections.

However, a major national review of maternity services is set to report later this year.

It may have to consider whether we have too many smaller maternity units delivering babies to guarantee a safe service everywhere, no matter how well they might be reconfigured or more closely linked with bigger units.

We may have to ask ourselves whether it would in fact be better to close some small units with less than 2,000 births per annum that are not too geographically isolated, rather than take a leap of faith that such services can ever be guaranteed to be as safe as possible.

The Minister might not necessarily be correct in this instance in stating that broken things, such as the Portlaoise unit, can be fixed in the longer term.

What certainly needs to be fixed right away is the Dickensian communication attitudes and insensitive hospital policies of the type displayed at Portlaoise. No citing of resource shortages or work pressures can excuse the institutional and individual callousness outlined in the Holohan report.

Serious safety issues in Portlaoise




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