THE CHRONIC AND dangerous understaffing of maternity units around the country is something many groups, including AIMS Ireland, have been consistently highlighting for years now. In March of 2014, INMO figures were revealed that showed not one maternity hospital in Ireland has staffing levels of midwife-to-women ratios that meet international safety standards. These standards state that on a yearly basis, one full-time midwife should be responsible for the care of 29.5 pregnant and birthing women – 25 women if the women are ‘high risk’.
What the INMO figures showed was that on average in Irish hospitals, each full-time midwife (or equivalent) was responsible for the care of 39 pregnant and birthing women. Portlaoise was the most critically understaffed unit, with each full-time midwife being responsible for the care of 55 pregnant and birthing women; nearly twice the amount of women they should be looking after for the bare minimum of safety standards to be met. Over 600 midwives would need to be hired immediately around the country for maternity units to be safe.
Units are stretched to the limits of their capacity and beyond
However Portlaoise was far from the only deeply unsafe unit on the list; Mullingar came a close second, at 50 pregnant and birthing women to each full-time midwife, and the Rotunda third with 48 women to each full-time midwife. The problem is of such long standing and so entrenched in maternity units that practices have even changed within units in a futile attempt to cope with numbers that just don’t add up; in the Rotunda, for example, often when women are in labour, rather than being attended by a midwife and provided with safe and reassuring one-to-one care, women are instead strapped to a CTG and left to labour in rooms alone while one midwife watches all the traces in a centralised location.
It is certainly not the case that Dublin maternity units are necessarily safer for women and babies than smaller units. There have been many horrific ‘medical misadventures’ in these hospitals of recent years; the unnecessary deaths of Bimbo Onanuga and Nora Hyland among them. The staffing ratios alone show that they are stretched to the limits of their capacity and beyond.
These hospitals are already dealing with far, far more births than they can safely handle; how then does it make any kind of sense to suggest closing maternity units in the Midlands, as many in the HSE have been doing, to funnel even more women into them? Particularly when it means that women in labour would have to travel possibly more than two hours to Dublin; this would inevitably mean more babies born before arrival and thus without care for either woman or baby during labour and birth. Many women who experience this find it very traumatic. It is unquestionably far from the safety of care women and families in the Ireland of the 21st century have a right to expect.
It is impossible to have enough contact with each woman
It is clear from the stories of bereaved parents in Portlaoise, as well as the stories of many other women and families around the country, that in many instances women and families who had suffered direct harm from doctors and midwives have that damage deepened and their hurt increased by the inhumane way in which they were subsequently treated.
Part of this is a problem of culture; this is the country and these are the maternity units of Mother and Baby homes, of symphysiotomies, of Michael Neary, all going unchallenged in an environment that insisted the doctor and midwives were not to be questioned and what happened to the woman giving birth, and in some cases the baby being born, was utterly irrelevant.
That said, it is simply untrue to say, as the Minister for Health did last week, that “it costs nothing to care”. What it costs is the cost of creating decent and safe working conditions for midwives. In order to care, midwives cannot be constantly and continually overworked to the point of exhaustion. It is impossible to have enough contact with each woman, to care for her as she deserves, and to provide the kind of safe and evidence-based care a midwife deserves to have the opportunity to provide, with the understaffing levels we see in Irish hospitals.
Why has nobody been listening?
AIMS Ireland frequently see recently qualified midwives, midwives who care deeply about the safety of women and babies and their experiences, emigrating to work in the UK, Canada and Australia, where they not only have security of employment but they also know they will be working in far safer environments.
Women who have suffered have been speaking out about the appalling treatment they experienced in Irish maternity units for years now; the AIMS Ireland SHOUTBACK campaign run in 2014 and 2015 is just one example of that. Why was nobody listening? Babies died, and still nobody listened. Why did it take the media’s interest for families to finally be cared for?
Women in Ireland matter. Babies born in Ireland matter. Families in Ireland matter. Their care and how they are treated during their births matters. When are we going to see the health services and the government behave in a manner that shows they understand these basic facts?
Sinéad Redmond is the secretary for the Association for Improvements in the Maternity Services (AIMS) Ireland (www.aimsireland.ie), an organisation which provide supports to women and families navigating the maternity services. Our mission is to highlight normal birth practices, which are supported by evidence-based research and international best practices, and campaign for recognition of maternal autonomy and issues surrounding informed choice and informed refusal for women in all aspects of the maternity services. Sinéad is also a software engineer, a mother, and currently pregnant.
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