Tuesday 16 January 2018

Fear of roadside births if small maternity units are closed

The National Maternity Hospital, Holles Street. Photo: Damien Eagers
The National Maternity Hospital, Holles Street. Photo: Damien Eagers
Eilish O'Regan

Eilish O'Regan

The prospect of a roadside birth is one that terrifies all mothers-to-be who are living in rural areas or small towns and face a long journey to get to their nearest maternity unit.

For all the heroic "taxi-driver turns midwife" stories we read about, where a healthy baby is safely delivered, there is a huge risk for mother and infant in not making it to the hospital on time.

And even if a mother makes it to her local unit, will she get the safe care she needs? It's a concern at the forefront of many pregnant women's minds in recent years in light of controversies over baby deaths.

The latest figures suggest some women are choosing not to take the chance, opting for a larger maternity hospital or unit instead.

The challenge now is to keep these smaller units open across the country - and also make sure they are safe.

And for the most part, mothers have untroubled births in these units. They are a happy and secure place where they hear the welcome first cry of their newborn before returning home.

However, as doctors see even more complicated pregnancies, there is an urgent need to ensure they are also made as safe as they can be - although accidents can never be eliminated.

That is proving difficult as these units, along with other key areas of the health service, are finding it difficult to attract the right specialist staff. It means they are often too reliant on agency workers or locum doctors who are standing in on a temporary basis.

The Rotunda in Dublin last year tried to recruit a specialist to jointly work in the Dublin maternity hospital and Cavan maternity unit.

This would ensure pregnant women in Cavan would have a routine 20-week anomaly scan. But there were no takers.

There were also no applicants for another joint appointment of a doctor with expertise in foetal medicine to work in both the Rotunda and Our Lady of Lourdes in Drogheda.

There has been an inability up to now by the Department of Health to think creatively on how to package these jobs to make them attractive.

It is one of the difficulties facing the new Minister Simon Harris, who must also work within the confines of doctors' contracts and pay limits.

Pregnant women who are known to be at risk of potential birth complications are already being referred on from these units to more specialised care in the big hospitals. But due to the sudden and unpredictable nature of some pregnancies it is inevitable the smaller units will continue to be faced with pressing emergencies and the signs may be very subtle.

This is where the plan to give doctors and nurses working in the smaller units more training in the bigger hospitals can help reduce risk.

They see more of these women whose condition can rapidly escalate.

It's all about minimising risk as much as possible although it can never be removed entirely.

Inadequate training frequently emerges as a contributory factor in baby death reviews.

Others are poor practice in basics such as one team going off duty and not properly handing over a patient to the next.

The mandatory publication of monthly statistics by all maternity hospitals and units now, in the wake of a Hiqa recommendation, is a key measure.

It increases the chance of clusters of errors in a particular hospital being picked up early and acted on to avoid the possibility of more tragedies.

Irish Independent

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