Lifestyle Health

Friday 23 March 2018

Lives at risk as midwife ratio in our maternity units 'unsafe'

Minister for Health James Reilly
Minister for Health James Reilly

Eilish O'Regan, Health Correspondent

MOTHERS and babies are being put at risk in maternity units which are at breaking point as they struggle with a severe lack of midwives.

No maternity unit has the recommended safe ratio of midwives to births – and Portlaoise hospital, where four babies died over six years, is the worst hit.

The moratorium on recruitment has led to a shortage of 621 midwives across the country, despite a predicted birth rate of nearly 69,000 this year.

The figures emerged in a survey by the Irish Nurses and Midwives Organisation (INMO), which described the shortage in several of the 19 hospitals as "critical".

The survey measured staffing levels against the internationally recommended ratio of one midwife to 29.5 births.

INMO president Claire Mahon warned: "It is quite clear that cuts in midwifery staffing has a direct consequence upon the standard of midwifery care available to mothers and babies."

It found the ratio in Irish hospitals varied from 1:39 in Holles St in Dublin to 1:55 in Portlaoise, which needs an additional 33 midwives. The overall national ratio is one midwife to 40 births.

Other units which are under strain include University Hospital Galway, where Savita Halappanavar died in 2012. It has a ratio of 1:41 births and needs another 32 midwives.

The maternity unit in Our Lady of Lourdes Hospital in Drogheda, which has been at the centre of major controversy in the last decade, has a ratio of 1:37 births.

"This level of understaffing is very disturbing in view of previous serious incidents which were the subject of external investigation along with pledges to implement a range of recommendations," said the report.

The ratio in Limerick Regional Hospital is 1:32 births and it is even higher in Cork University Hospital at 1:37. The Rotunda in Dublin has 188 midwives, but the ratio to births is 1:48. The report pointed out that the Coombe Maternity Hospital in Dublin, which has supplied staff to Portlaoise in the last week after the Midlands unit was deemed unsafe, is itself coping with a ratio of 1:40.

It points out that in Northern Ireland, where there were 25,269 births in 2012, there are 1,040 midwives, with a ratio of 1:24.

But even if a recruitment campaign started tomorrow to fill all the vacancies, it would take five to six years to secure enough experienced registered midwives, said Liam Doran, head of the nurses' union.

"It struck me as rather ironic and sad that a week after the details about Portlaoise were aired on television, that posts for midwives there were advertised," he added.

He believes the doctors and nurses employed in maternity units will work hard to ensure patients are safe – but he warned that it is impossible not to find a link between adverse incidents and staff who work under such constant pressure.

Staffing shortages mean that nurses find it difficult to be released for training courses, and this was a feature of the systems in Portlaoise, he added.

Both Health Minister James Reilly and Chief Medical Officer Dr Tony Holohan have said while staff shortages contributed to the problems in Portlaoise, they did not provide an explanation for major failings.


The staffing situation has been greatly exacerbated over the past five years, arising from the loss of 5,200 nursing/midwifery posts as a result of the ban on recruitment.

Mr Doran said the future of some maternity units was likely to come under scrutiny, with some changes to midwife-led centres for low-risk births.

"It is also a fact that births are becoming increasingly complex which, in turn, puts even greater demands upon midwives and maternity services generally," he said.

"The stark difference in staffing levels compared to Northern Ireland must affect standards of care, and the overall experience of the mother and baby."

The Health Service Executive is to undertake a national examination of midwifery staffing levels nationwide, a move which was prompted by the recent report into baby deaths at Portlaoise.

Irish Independent

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