MOTHERS and babies face significant risks in the country's main maternity hospitals which are struggling with overcrowding and outdated facilities.
The ongoing hazards in the major hospitals are revealed in confidential correspondence and reports seen by the Irish Independent.
The documents unveil the extent of the pressure on hospitals which are expected to suffer another cut in funding in 2012. They reveal:
The Rotunda Hospital
• Rotunda chiefs told the HSE that its gynaecology ward had to serve as an "overflow" for both pregnant and post-natal mothers. It meant that women who had lost the baby in early pregnancy had to endure being in the same ward as mothers who gave birth to healthy newborns.
• There were 200 instances where pressure on the labour ward meant women could not get pain-relief during labour.
• The HSE did not give the go-ahead for a blood expert or haematologist despite the significant number of women at serious risk of blood loss.
• The software in the hospital computer system is ageing and at risk of going down, leaving staff to collect patient data manually.
The Coombe Hospital
• Hospital officials said four mothers were sharing the same labour room and this posed a "clinical risk" of infection and led to difficulties in inserting epidurals.
• It also highlighted "high-risk scenarios" where women needing emergency surgery had to be taken by trolley then lift to theatre.
National Maternity Hospital
• Bosses at Holles Street wrote to the HSE in July to warn about fire safety problems. An emergency fire escape stairwell is still under construction.
• And a request to install a fire escape bed lift had to be shelved due to lack of funds.
The hospitals have coped with a surge in births in recent years, with deliveries rising from 65,425 in 2006 to 73,724 last year.
The revelations come two years after this newspaper exposed the frantic and persistent pleas for funding in letters from doctors and managers in the hospitals to the HSE.
Since then, some limited capital funding has been given to the hospitals to improve areas such as neonatal care and ward upgrades.
However, these hospitals are still housed in old buildings which were never designed to cope with the complexities of modern maternity care.
Correspondence between the hospitals and the HSE unveil the extent of the pressure on the hospitals which are expected to suffer another cut in funding in 2012.
The Coombe Hospital, in a business plan to the HSE, said four mothers were sharing the same labour room and this posed a "clinical risk". This left them at risk of infection and led to difficulties in inserting pain-relieving epidurals because of the cramped space, said the submission.
It also highlighted the risks of having to transfer women from the labour ward to a theatre on an upper floor in the event of an emergency. This amounted to a "high-risk scenario" where the patient was transferred via lift to a theatre table while an emergency team attended her and the baby. The Rotunda Hospital told the HSE that last July was its busiest month ever when 808 babies were delivered. The gynaecology ward has to serve as an "overflow" for both pregnant and post-natal mothers.
Master of the Rotunda, Dr Sam Coulter Smith, moved to highlight the failure to go ahead with the appointment of a haematologist, despite the risk of women suffering serious blood loss.
The busiest maternity hospital in the country, Holles Street, had to write to the HSE in July about fire safety problems, warning about the age and structure of the building which needs constant maintenance. A new master arrives tomorrow when Dr Rhona Mahony takes over the busy hospital for the next seven years.
All of the hospitals appealed to the HSE to proceed with the recommendations of a KPMG report in 2008, which called for them to be moved to new buildings on the site of general acute hospitals in Dublin.
A further €4.5m in funding was approved by the HSE for the Coombe Hospital last October and work began in November on new developments, including an obstetrical theatre and four labour/delivery rooms. But it will be more than a year before the project is finished.
A spokeswoman for the HSE told the Irish Independent that it was continuing to "explore" the building of three new maternity hospitals in Dublin.
However, the construction of the new national children's hospital is a "priority".
Last night a spokesman for Health Minister James Reilly acknowledged that there are "immense" financial difficulties facing the health service.
He said: "Mr Reilly is fully aware of the difficulties faced by the maternity hospitals in Dublin". He hoped there would be progress on "mapping out the pathway" to relocating the maternity hospitals in 2012 but Mr Reilly must cut €800m from the health service next year.
"The determination will be to deliver the maximum funding to frontline services, including maternity hospitals."