6 steps towards a kinder maternity service
Many of the experiences women have shared are not a rare occurrence, nor are they coming to light for the first time. We have known for years that pregnant people in Ireland have not been listened to, have not been trusted with decision-making about their own bodies, have not been treated kindly or with compassion or dignity and have not been at the centre of their care despite all the HSE platitudes. We also know that many women are subjected to non-consensual procedures during childbirth.
What needs to change?
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1 We need to ensure that care is truly person-centred, not clinician-centred or hospital policy-centred, but centred on the individual needs of each family. This may require communication and diversity training.
2 We need to listen to women and treat them with dignity, compassion and respect. We need to ensure that pregnant people and their families are trusted to make their own decisions about their care and are genuine equal partners in their care. We need to rebalance power dynamics and ensure that everyone caring for a pregnant person acknowledges that person to be the expert in their own body
3 Informed consent is vital. We need to ensure that all tests, procedures and practices come with full informed consent. Telling the patient what you are doing in the middle of enacting the procedure is not informed consent. Childbirth can be a very vulnerable time, and women should never feel that they were violated in any way during the process.
4 We need to review the HSE 'Your Service Your Say' facility. This is not working for users of the maternity services. Women who have had difficult experiences are seeking validation of their experience, not clinical debriefs. We need to have more birth reflection midwives in all maternity units such as the successful scheme in the Coombe hospital in Dublin.
5 We need additional resources. We need more midwives, we need more doctors and we need more facilities, and to do this we need more funding. More personnel will enable a greater amount of time allocated to each woman and family. In particular we need to improve the ratios of women to midwives in postnatal care settings. Women need a lot of support after giving birth and at present many larger hospitals only have four midwives looking after 35 women.
6 We need to implement the National Maternity Strategy. This will enable greater choice in the types of care models women can avail of. It will ensure equity of access to services for all women irrespective of where they live in the country and it will ensure a greater emphasis on care in the local community where midwives will have more time to spend with women preparing them antenatally and supporting them postnatally.
Krysia Lynch chairs the Association for Improvements in the Maternity Services (AIMS Ireland)