Childbirth is increasingly framed in a “consumer context” full of expectations that cannot be met, according to the head of the State’s biggest maternity hospital.
Doctors are increasingly caught between rising patient expectation and demands for greater productivity with reduced expenditure, Dr Rhona Mahony, master of the National Maternity Hospital, said.
“At times, it seems, we do not give sufficient regard to the unpredictability, the severity and the catastrophic potential of obstetric outcome.”
The challenges facing clinicians served to undermine patient care “in a highly punitive environment like ours,” she wrote in the hospital’s annual report for last year.
“If we are happy to invest millions in legal fees associated with litigation, then we must be happy to invest in adequate staffing and staff training.”
Critical
Dr Mahony was critical of press coverage of obstetric issues, dominated in 2014 by controversy over baby deaths at Portlaoise hospital.
Much of the coverage involved “heart-breaking cases of poor outcomes, intimate patient details on sensational front pages, confidential and sensitive reports leaked in draft form,” she wrote.
“Numerous recommendations, standards and guidelines were issued in the context of inadequate resources and staffing. We rarely hear the good stories although they far exceed the bad.”
Trust eroded
“As the level and cost of litigation rises and as the number of recommendations spiral, expectations increase and staff are asked to guarantee what cannot be delivered”.
Dr Mahony said staff needed to be cared for as well as patients. While medicine would never be error-free, mistakes could be reduced by having appropriate staff who were well trained and supported.
Ireland has one-third of the number of obstetricians it should have, she said. “We will not regulate, litigate, recommend or punish our way out of this deficit.”
Patient trust in the health system had been eroded, but trust has also been damaged between frontline doctors and hospital administrators, and these needed to be repaired, she said.
There were no maternal deaths in the hospital last year and the maternal mortality rate for 2012-14 was 3.7 per 100,000 births. This is about half the national figure, despite Holles Street being a tertiary hospital to which many difficult pregnancies are referred.
The corrected perinatal mortality rate was 3.7 per 1,000 births, compared to 6.1 nationally. During the year, 9,106 women gave birth to 9,309 babies.
