“There is a view in Ireland that the quality of maternity care does not matter, as long as you end up with a healthy baby. Well, of course that's the most important thing but there are many other crucial issues relating to maternity care which are simply not being addressed; basically, women are not being listened to by those providing services.”
So says Jene Kelly, Chair of AIMS Ireland, the Association for Improvements in the Maternity Services.
AIMS was originally established in the late 1970s, was quite active for around a decade and then dispersed. Earlier, this year, the organisation was revived as a campaigning and support group.
Jene Kelly feels it is an opportune time for AIMS to be back on the scene, as there is perhaps a greater need than ever for women to voice their concerns about our maternity services and to seek change.
“The feeling we get is that maternity care is not given the priority it should be in terms of infrastructure and services. The whole mindset of maternity care provision needs to change. I believe those providing and planning the services don’t know what women want.”
Jene believes the excessive emphasis on intervention in hospital birthing policy is beginning to make women actually doubt their ability to give birth, and to fear the process, and this might partly explain the continuing rise in caesarean sections.
“Women have, to state the obvious, been giving birth for thousands of years, but you would doubt that this was the case looking at many current hospital policies.”
Jene accepts that safety issues and possible medical complications have to be taken into account, but says the needs of mothers need to be looked after as well.
“Very few women are high-risk. However, the majority of women giving birth are effectively being led to believe that pregnancy and birth are not very normal. There is an over-emphasis on ‘what could go wrong.’
“Women are led to believe it is of benefit to them to have their labour speeded up when most women would be better off being left without intervention.” Jene says AIMS wants to highlight deficiencies that exist in maternity services and to promote births that are as natural and as ‘normal’ as possible.
“Most women should be allowed to go through birth without it having to be speeded up and without being persistently monitored and watched. Obviously there will be times when this is necessary, but not all the time.”
Jene Kelly points out that the active management of labour (AML) policy, which was first used in the National Maternity Hospital in Dublin in the 1960s, and is now used throughout Ireland and in many other countries, does not allow labour to go beyond 12 hours.
“So the clock starts from pretty early on in the labour. If you have not delivered within a certain period you are put on a drip, and we would have concerns about this.”
The current Master of Holles Street, Dr Michael Robson, stated in a recent article that the philosophy behind AML has always been the prevention of prolonged labour, in particular the prevention of the "physical and psychological morbidity that usually follows it.”
He said AML will continue to evolve as informed maternal choice becomes more influential in intrapartum care, but the prevention of prolonged labour and its associated complications will be as important to women in the future as it has been to women in the past.
“As far as advantages and disadvantages of AML are concerned, all women should have access to the relevant information on labour outcome. If they prefer a shorter (rather than longer) labour with a high chance of a normal delivery, then they will be opting for AML," Dr Robson stated.
Jene Kelly, however, claims a relevant factor in the intervention debate is the shortage of delivery beds in Dublin. “We have 24,000 births in Dublin each year and only around 30 delivery beds. What we are seeing is a conveyor belt baby factory. ”
Jene believes facilities and staffing in maternity units in Ireland leave a lot to be desired. She says are severely understaffed in many cases and some are in poor condition. “We need more units and we need more staff.”
She denies that the AIMS stance is essentially an anti-hospital one.
“We are not anti-hospital, we are pro a better choice for mothers. If the level of choice in the UK on the type of birth you can have was also available in Ireland, it would take a lot of pressure off the existing maternity units.
"There is a wide variety of options, such as midwife-led units (every hospital should have such a unit) and expanding home birth schemes utilising community midwives.
“When a woman has her pregnancy confirmed she should be given full information about the different options, and if she wants to go to a midwife-led unit that should be available to her in her region.”
She admits that there have been problems with indemnity insurance cover for midwives, but these, she says, could be resolved by extending the state insurance scheme to cover them
Another issue, Jene says, is choice and number of birthing partners. Recently, she says, birth assistants called Doulas were effectively banned, other than as a women’s sole birth assistant, from Dublin maternity hospitals.
Women can no longer alternate between two partners; for example their husband and a Doula.”
Jene feels that those running maternity care are not looking at the evidence-based research when it comes to implementing policies which limit women’s choices.
"For example, on the birth partner issue, it has been shown that women who are allowed have additional partners present have fewer caesarean sections, fewer interventions and less pain relief.”
She believes that despite the lip service paid to increased consumer involvement in maternity care care, very few hospitals actually listen to what women want.
“One of the few exceptions is Our Lady of Lourdes in Drogheda, which has an active consumer group. Every hospital should have such a group.” Jene adds that hospitals also need a complaints system that works.
Maternity services in the greater Dublin area are currently being reviewed by consultants for the HSE. Jene Kelly says, however, it is disappointing that the options which have emerged to date from the review appear to focus on providing units similar to the traditional model of maternity care in this country and do not focus enough on alternatives such as midwife-led units.
"Obviously we need new hospitals, but we need also to be thinking outside the hospital setting.
"Women want continuity of carer - the same person from pregnancy to delivery - at the moment women can only get this if they opt for private care. I believe there should be continuity of carer for a midwife-led option as well as hospital or consultant-led care," according to Jene.
"I don't believe private care is better than public care (in fact research shows you are more likely to have a c-section in you go with a consultant) but women are opting for it as you have the same carer throughout the pregnancy and the possibility of a private room at the end of it all."
AIMS is currently organising an initiative known as the Mother’s Heart Maternity Awards. Jene says the award scheme will highlight people and institutions that are striving to practise the mother-friendly care that women desire.
The scheme will gather data through surveying users of maternity services and through visits to maternity units. Hospitals will then be rated on the data collected.
Every hospital will receive a heart rating from 0-5 and the top three hospitals will receive an award - gold, silver or bronze. In addition, gold awards will also be given to staff who have been rated as making an outstanding contribution to hospital care and community care.
For more information about AIMS Ireland see…
If you have recently been a patient or were visiting a relative in a maternity unit, or in any hospital, and want to rate and comment on the standard of service, click on irishhealth.com’s http://www.ratemyhospital.ie
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