Four years after the death of Savita Halappanavar convulsed Ireland and sent shock waves around the world, has Ireland become a safer place to have a baby?
Savita’s tragic death on October 28th, 2012, was followed by a slew of reports that made recommendations for change at hospital level and nationally.
New systems were introduced to ensure that the warning signs of complications in pregnancy are spotted earlier, and that infection is dealt with more quickly. More training, resources and staffing were provided. Arrangements for handling patient notes, and for staff handovers, were reformed.
The Saolta University Hospital Group, which includes University Hospital Galway, where Savita died, says 22 recommendations made in various reports have been fully implemented, while work is ongoing on another 12.
Maternity strategy
Nationally, the long-awaited national maternity strategy was published last January with promises that the interests of mothers will be put first as part of a long-term vision for the service.
Progress has been made, but nowhere near as much as was promised. Resourcing is a huge issue – obstetricians say they need twice as many consultants as we have at present, and thousands of midwives are also needed to bring staffing ratios into line with international best practice. Even where the money is available, recruiting qualified staff is a challenge.
We have also been slow to build much-needed new maternity units. The planned move of the National Maternity Hospital from Holles Street to St Vincent’s is way behind schedule because of a turf war between the two institutions.
Similar moves by the Rotunda and Coombe hospitals to modern premises are also years away.
The years since Savita died have been marked by repeated controversies over mishaps affecting mothers and their babies. Individual incidents will always happen, but the scandal of baby deaths in Portlaoise hospital showed just how far the system has to go to improve standards across the board and to ensure women are treated with respect and compassion at all times.
Fluctuating standards
Within the Saolta hospital group, completion of an investigation into a cluster of baby deaths at Portiuncula hospital in Ballinasloe has been repeatedly delayed, to the understandable frustration of the families involved.
Still today your chance of getting a 20-week foetal anomaly scan depends on where in the State you live, as not all of the 19 maternity units provide this service, regarded as routine across the Irish Sea.
Standards vary across the service, and there are good grounds for concern over the quality of training and expertise in some smaller units.
Saolta is the flagship hospital group in the Republic. It was also in the eye of the storm following Savita’s death in Galway. Not surprisingly, it benefited from a special focus within the health service, designed to ensure maternity services were upgraded.
The departure of the two senior midwives drafted in to implement this strategy raises serious questions about the level of progress actually made.
Sources say issues such as patient safety, clinical risk, the need to make delivering women the focus of care, and working relationships between midwives and obstetricians were issues raised behind the scenes.
Arrangements for treating women experiencing difficulties in early pregnancy, such as bleeding, at University Hospital Galway were also a focus for concern, because this could mean women suffering miscarriages were being treated close to others with ongoing pregnancies.
It is clear that things are not as rosy in the garden as has been depicted in recent years, and there are still clear stumbling blocks to improving the system to the benefit of patients.