The master of Dublin’s oldest maternity hospital has attacked “sensationalist” and “out of context” reporting of high profile birth cases which served to frighten prospective mothers and families.
“It has now reached the point where the confidence of the public has been severely shaken and the quality of the services provided to our mothers and babies is questioned in the media on an almost daily basis,” according to Dr Sam Coulter-Smith of the Rotunda Hospital.
Tragic events, where they occur, need to be reviewed and examined but this should be part of a proper clinical governance system and should not be a “trial by media when the circumstances are not fully understood”.
Normality in obstetrics is not universal, he told the Oireachtas health committee. “It cannot be assumed that every woman will have a normal, uncomplicated pregnancy with a perfect baby at the end.”
Revelations in the media needed to be taken in context, which was that a hospital delivering 2,000 babies a year can expect to have between eight and 16 deaths per year. Half of these will be due to fetal anomalies or extreme prematurity and one-quarter due to unforeseen issues.
Dr Coulter-Smith said Ireland’s performance on baby and maternal mortality was very good, especially when account was taken of low staff levels and poor infrastructure. “I’m not sure how many more investigations, reports, recommendations are required or how many more adverse events will be required to get those who oversee and fund the health service to recognise the need to invest in the quality staff required to keep our mothers and babies safe.”
Many smaller maternity units do not have a critical mass of patients and cannot provide the full range of maternity services, he said. For example, it was only in the biggest hospitals that patients were offered routine 20-week scans or bereavement counselling by dedicated staff where a baby dies.
Dr Coulter-Smith said standalone maternity units should be a thing of the past and units needed to be delivering at least 4,000-5,000 babies a year to support the full range of services required for quality care.
Fetal medicine has evolved with time and problems can be identified earlier than ever before, he pointed out. “The issues around supporting these women and their families now assumes much greater importance. Some women will choose to travel abroad to terminate while others will choose to continue their pregnancies here. As obstetricians we need to be able to support women in their choice when facing this devastating situation.”
Current protection of life during pregnancy legislation was welcome and put some structure and guidance around what to do when a woman’s life was at risk. “However, that particular legislation does not assist us when faced with a woman carrying a baby with either a fatal abnormality or one where the anomaly is life-limiting.”
Dr Sharon Sheehan, master of the Coombe women's hospital, said waiting lists for gynaecology, often exceeding 18 months, were unacceptable but "we don't have the doctors to bring these waiting lists down".
Maternity facilities must be fit for purpose, she told the committee. “It is not appropriate to have bereaved mothers sharing a room or even a ward with newborn babies. It is not appropriate to have mothers who are miscarrying waiting alongside mothers with buggies returning for hospital appointments. But this is happening to some mother as I speak.”
