(Wednesday 9 October 2013) The Association for Improvements in the Maternity Services Ireland (AIMS Ireland) today welcomed the HIQA report into the safety, quality and standards of care of Savita Halappanavar and called for the HSE to immediately conduct a full review of maternity services as recommended in the report.
Commenting on the report, Krysia Lynch, Co-chair of AIMS Ireland said: “The findings of the HIQA report indicate a failure at all strata of responsibility to provide basic levels of adequate and appropriate care to Savita Halappanavar which would have saved her life. What is also of grave concern to AIMS Ireland is the number of failures at national level identified in the report including timely access to maternity services, inadequate staffing levels for safe care, a maternity care model that hasn’t been revised in 59 years despite numerous national and international reports and recommendations, a lack of accountability and governance, an absence of reviews of clinical practices in units and the lack of a national maternity services strategy, all of which we have seen recommended on previous inquests without reform. “
The 2007 Safer Childbirth Document recommends that midwife to woman staffing levels are never to exceed 1:28 for low risk women and 1:25 for high risk women, in order to ensure that women are safely looked after and not left alone in labour. Irish ratios drastically exceed these recommendations and were seen to be contributing factors into the deaths of Tania McCabe, Bimbo Onanuga, and now, Savita Halappanavar. Recent research in Ireland has shown that there is are marked regional variations in obstetrical intervention for hospital birth, therefore, it is difficult to determine how and where interventions are more or less frequently adhered to within maternity services. Regional variations in obstetric interventions across Ireland essentially present women with a ‘geographic lottery’ in terms of their maternity care. There is no standardised care.
Krysia Lynch “The HSE and Department of Health have seen numerous recommendations and reports of unsafe practice in Irish maternity services in the recent decade, all of which have fallen on deaf ears. Ireland purports to be one of the safest Countries to have a baby… yet these incidents of gross neglect continue. The current midwife to woman ratio is patently unsafe. Maternity units have reported midwife to woman ratios of 1:43, failing not only international recommendations but those resulting from previous investigations following the deaths of Tania McCabe and Bimbo Onanuga.” Lynch continues, “Ireland is a nation of numerous reports and recommendations. Report , after report, after report come to the same conclusions with absolutely no preventative action from the HSE or Department of Health.”
AIMS Ireland strongly refutes the calls today to increase the number of obstetricians in the Irish maternity services as a reactionary measure to this report. AIMS Ireland states, “We need an over-haul of the maternity care model in Ireland. Our maternity services are 90% obstetric-led and lack continuity of carer. Outdated practices are of no benefit to the majority of women. High quality robust evidence, including the recently published Cochrane Review on midwife-led care, shows that the large majority of women benefit from a Midwifery-Led care model, not obstetric. Obstetric-led care has a very important place in Irish maternity services and should be available for women who want or need this type of maternity care, however, in failing to provide evidence based care options, valuable resources are being over-utilized as women have no option but birth in under-staffed and over-crowded consultant led units.”
AIMS Ireland stresses, “Today we have heard repeated calls for yet more of the same – an increase in obstetricians. Where are the midwife led units and birth centres? Ireland needs to wake up and listen to the evidence. This is an opportunity to review our maternity care model and provide women with evidence based midwife led care models in every Irish unit.”