LAST UPDATE | 17 May 2022
THERE HAS BEEN considerable debate over the last few days on the meaning of “fit for purpose” in the context of the proposed move of the National Maternity Hospital (NMH).
On one side of the debate is an opinion that because the NMH has new labour ward rooms and operating theatres they are fine and can continue to work on Merrion Square for years. On the other side, an extreme opinion is that NMH is just not safe at all, with all the distressing, emotive images that this conveys.
It worries me that the language being used in this debate is so emotive, because whilst imperfect we shouldn’t cause alarm for mothers currently using Holles Street with hyperbolic and unhelpful wordplay.
Why the need for new campus?
When we say that the NMH is no longer fit for purpose, it is because we are trying our hardest to provide a 21st-century service in a 20th-century hospital not built for these purposes.
The wonderful NMH team maintains a very high standard of care and it will take several years to move to the new campus during which up to 100,000 people may need care between the hospital and our community teams. They will receive it, but the rooms they will be treated in will be small, the wards will be crowded, and the levels of privacy less than they deserve.
The new theatre and labour wards we have built are but temporary solutions, rooms shoehorned into a small campus in the city centre that is clean but congested. We have listened to people who talk about their experiences, and it is for these reasons that we advocate for them.
Of the four large maternity units, the three in Dublin (NMH, the Coombe and the Rotunda) are all standalone. Only Cork University Maternity Hospital (CUMH) shares a campus with a general hospital. We listened to medical, midwifery and nursing colleagues in CUMH and designed a maternity hospital that would be physically linked to the general hospital.
Who is this for?
We have listened to women who need intensive care services and must travel in an ambulance to a general hospital four kilometres away, leaving their babies behind. We listened to their partners who talked about the difficulty of going from one place to another. We have attended unexpected births in general hospitals, intensive care, wards and emergency departments.
This is a lonely place, knowing that the extended team we normally work with are a car journey away rather than running down a corridor. We listen to people, and we advocate for them.
We listened when women wanted their partners with them for an antenatal visit. We were constrained by the physical limitations of the building, but partners are back now that Covid infection rates have fallen.
We don’t want to return to limiting visits again if there is another pandemic – partner support is essential. We want people to have individual rooms if inpatients, and space if attending outpatients.
We listened to women who need to travel to a general hospital for a surgical opinion, such as if they have a breast abscess, appendicitis, or kidney stones. We listened as they explained how difficult it is to leave their baby behind or to interrupt breastfeeding. If they need surgery, they want to travel down a corridor rather than an ambulance. We listened to them, and we advocate for them.
The new campus
When we move to Elm Park, the campus we will share with St Vincent’s, we will continue to offer midwifery-led clinics, community midwifery, home birth services and all the services we provide to normal at-risk people. We know that people want these options.
Our care for pregnant people with medical issues – diabetes, cancer, cystic fibrosis, hypertension – or women who develop complications in pregnancy will only improve. We know that people want this support, this multidisciplinary care. We listen to people, and we advocate for them.
Our colleagues abroad consider it medieval not to have maternity, gynaecology and neonatal services co-located with general medical, nursing, paramedical and ancillary services.
One final note: We can appreciate that words used to criticise the status quo at the NMH may cause concern to people and families using our services. We are a team of dedicated clinicians, administrators, cleaners, porters, catering staff, medical scientists and I want to reassure our patients that we can and do provide safe care, and we are proud to work here.
But we also know that it can and should be so much better: the women of Ireland are entitled not just to safe care, but to the highest standards of care.
For these reasons, we will continue to listen. We will continue to advocate.
Professor Mary Higgins is a Consultant Obstetrician & Gynaecologist at the National Maternity Hospital.
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