The Government should review maternity services across the country, an expert group that examined care provided to a number of women and babies at Portiuncula University Hospital in Ballinasloe has urged.
On foot of a report published by the HSE on Wednesday, expectant mothers whose pregnancies are defined as being “higher risk” are to have their antenatal care moved from Portiuncula to other locations.
The report found that events similar to those that led to the reviews at Portiuncula could be replicated elsewhere.
The expert external group said if obstetric care was to be provided in a hospital, “then the full range of support services should be available, provided by staff with the appropriate skill set and training to allow them to keep up their own clinical skills and to train non-consultant doctors, nursing and midwifery staff”.
[ Portiuncula review: How can the same issues occur at the same hospital again?Opens in new window ]
The definition of a high-risk pregnancy is not clear cut, but often includes mothers who are older, have gestational diabetes, those with a high body mass index and women who had caesarians in previous pregnancies. However, this will be subject to a decision by treating clinicians.
The expert group said Portiuncula hospital in Co Galway delivered 1,400 babies annually. It said a unit of such size “cannot provide the full range of maternity and newborn services”.
The expert group said it strongly recommended a review into the way maternity services are delivered across the country.
Throughout this year, it was announced a total of 12 reviews were taking place into the care given to women and babies at the Ballinasloe hospital .
Five of these reviews have been completed, five are under way and a further two are due to begin.
The reviews were commissioned after five cases of neonatal encephalopathy (NE) requiring therapeutic hypothermia (known as neonatal cooling) were identified in a close time period. NE is an impairment of neurological function.
In a summary the external group said the five cases of NE requiring therapeutic hypothermia had occurred in a relatively short period. It made the incidence of cooling approximately one in 200 while the incidence would be expected to be of the order of one in 1,000 deliveries.
“It is worth noting that this cluster of cases and higher incidence relating to this period of time is significantly higher than in the preceding two years.”
It said the issues that were the subject matter of their report “are ones which, by virtue of their nature, are ones that could plausibly arise in other similar-sized maternity units”.
Units delivering the number of babies along the lines of Portiuncula “find it difficult to attract permanent members of medical staff and rely heavily on locum consultants”, it said.
“It is operationally challenging and there are significant clinical risks in providing maternity services in this way. In addition, it is difficult to continue to provide a service which meets the expectations of parents in a modern society, in units with such small numbers of deliveries. It is not possible to train midwives and doctors to an acceptable level of competence with such little on-call clinical exposure.”
A previous inquiry into maternity services at Portiuncula hospital was established in early 2015 with James Walker, professor of obstetrics at the University of Leeds, appointed to head it.
The findings of the Walker report, published in May 2018, identified multiple serious failures including staffing issues, a lack of training and poor communication among maternity staff, which contributed to the death of three babies.
The new external review group said in Wednesday’s report that it was “disappointing that the clinical issues identified previously in 2018 have recurred”.
The external group comprised consultant obstetrician/gynaecologist Dr Sam Coulter Smith, consultant neonatologist Dr Pamela O’Connor and retried director of midwifery Marie Corbett.
Dr Pat Nash, regional clinical director, HSE West and North West said: “We are fully committed to implementing the recommendations laid out in the five reviews and will take all steps necessary to ensure we are providing the best care possible to the women and babies receiving care at our hospital. Much of this work is well advanced through the work of the external management team and Women’s and Children’s Network.”
Tony Canavan, regional executive officer, HSE West and North West, said: “The management team appointed in January to oversee and manage maternity services in Portiuncula University Hospital (PUH) remains in place and are working on a programme of improvements, many of which relate to the recommendations. Our focus remains on ensuring the safety and wellbeing of women and their babies.”
