With a booming birthrate that has long been predicted, putting pregnant women in hotel beds is the least of the problems overwhelming our unprepared maternity hospitals, reports Róisín Ingle.
Surfaces gleamed, midwives smiled and brand-new babies were displayed as Minister for Health and Children Mary Harney opened the new Cork University maternity hospital yesterday morning. There were speeches about world-class facilities and state-of-the-art services, which may be greeted with raised eyebrows by those working in or passing through our beleaguered maternity system. A spokesperson for the new hospital, the only provider of maternity services in the greater Cork area, confirmed it had been designed to cater for around 7,000 births in the first year of operation. But the actual number of births in the region will exceed 8,000.
Our over-stretched and under-resourced maternity hospitals, particularly those serving the greater Dublin area, are straining at the seams. This week's revelation that pregnant women are being put up in hotel rooms is, according to the experts, the least of our worries. One master of a Dublin maternity hospital has told The Irish Timesthat there is now genuine concern for the safety of both mothers and babies, who are being put at risk by what he describes as the "emerging crisis" in our maternity hospitals.
THERE IS Anoisy scrum in the waiting room at the Coombe Women's Hospital in Dublin. Pregnant women, a few men and lots of children pass the time on hard plastic chairs, clutching pink cardboard folders while they wait to see a consultant. One woman, pregnant with her first child, says her appointment was for 8.45am but motions down the line to all the people who sit in front of her. She's been waiting here for more than an hour and a half.
"It'll probably be 12 before I am seen," she says. "That's the way it is. It doesn't matter what time you are told, you are always waiting a good bit."
There is acceptance in her voice. Pregnant Irish women without funds to pay for private health care have come to expect long waits. Women are aware of the possibility, however remote, that when they go into labour there may not be a bed for them in the delivery suite. They know that once on the labour ward they could be sharing a couple of toilets and showers with 30 others, or might have to travel to a private facility for a scan (the Coombe has recently been sending patients to Mount Carmel private hospital) because of the lack of ultrastenographers. In the packed maternity wards they learn to accept low levels of hygiene as par for the course.
As we learned this week, pregnant women may, in some cases, be accommodated in a nearby hotel instead of in a hospital. While it could be argued, as Prof Brendan Drumm, chief executive of the Health Service Executive (HSE), did yesterday, that the Rotunda's new measure is an innovative solution to the problem of overcrowding, this latest development has done nothing to inspire confidence among women hoping to give birth in safe, private and dignified circumstances.
There are more women giving birth now than at any time in the last 20 years. The main maternity hospitals are reporting this dramatic rise, but the level of services has remained almost unchanged. A look at the most basic demographic figures would have made one aspect of this increase easy to predict. The baby boom of the early 1970s inevitably meant that there would be more women in their 20s and 30s across the State at this point, many of them planning families. Another, less predictable, increase comes from the number of eastern European women in their 20s who moved here following EU enlargement in 2004.
In a letter to this newspaper last month, Dr Gerry Burke, a consultant obstetrician in Limerick - where births have doubled in the last 15 years - suggested that the overcrowding, under-staffing and lack of access to senior medical personnel all added up to a "woeful" service.
"Bed occupancy rates are around 100 per cent; it is impossible to maintain and clean properly wards that are constantly full. Hospital-acquired infections are inevitable," he wrote. "Typically, unless they have private insurance, mothers and their newborn babies are accommodated in wards of five beds and five cots, with only a single toilet and shower, with very little privacy . . .Ireland is reputedly among the wealthiest nations on earth. Is it impossible for us to provide a decent service for women having babies?"
Some suggest there is little equity in our two-tier system. It is likely that more women, particularly those at risk, are now paying for private or semi-private care because of concerns about the standards of treatment.
"There are people going private who can afford it, but more recently there are people going private, out of fear, who can ill afford to do so," says one senior doctor who doesn't wish to be named.
However, in the current climate, going private is no guarantee of superior treatment. One woman on private health care tells how she gave birth last year in an annex of the Rotunda, when there was no space in the delivery suite.
"On the same night a baby was born in a lift and another in a wheelchair," she says.
THE MASTERS OFthe three main maternity hospitals - the Coombe, the Rotunda and the National Maternity Hospital, Holles Street, between them responsible for 40 per cent of deliveries in the Republic - can be difficult to get hold of. It's not that they are ignoring journalists' calls, it's just that the demands on their time barely leave them a minute to spare. On Thursday night, though, at around 10pm, the master of the Coombe, Dr Chris Fitzpatrick, has a few minutes to talk. He wants to issue a warning about the state of our maternity services.
The Coombe delivered 8,084 babies in 2006, with that figure predicted to rise by 650 this year. Fitzpatrick is exasperated by a situation he thinks could have been avoided had the HSE and the Government heeded warnings about lack of services and taken action when faced with projected demographics.
"We are stretched beyond capacity at the Coombe," he says. "There is now a real concern for patient safety. We need more doctors, more midwives, more nurses, more support staff, more space and more infrastructural development."
He says the current problems would have come as no surprise to anyone working in the field. In the past three years there have been three reviews of the Coombe, all showing that more resources were urgently needed.
"The HSE was notified in advance through these reports with regard to the emerging crisis. It now has a moral imperative to act swiftly and decisively in the interest of patient safety," he says.
Asked whether he believes the strain on resources has contributed to increased neo-natal deaths in recent times, he says: "I think we have to be careful. All I can say is that there is a real concern with regard to patient safety . . . there is an urgency with regard to the situation at present."
Fitzpatrick is particularly concerned about the most vulnerable patients, very premature babies, who are at risk of death and long-term disability. When these patients require access to neo-natal and intensive-care units, the three main Dublin maternity hospitals act as a tertiary referral service for the rest of the country.
"There is overcrowding in these facilities in all three of the main maternity hospitals, so that poses an obvious risk of infection," he says. "In recent months there has been difficulty accepting the transfer of high-risk patients within the greater Dublin area because of overcrowding and manpower issues."
The implications are shocking.
"There have been circumstances in recent months where there have been no ventilators available in the greater Dublin area for high-risk babies," Fitzpatrick says. "It really is of increasing concern. There needs to be action on this crisis, which has been flagged well in advance."
Responding to Fitzpatrick's concerns, the HSE said that, during 2007, as part of its short-term action plan, it had allocated an extra €900,000 to maternity hospitals in Dublin. This included funding for the expansion of the "early transfer home" service and additional resources for neo-natal services in order to alleviate some pressure on the hospitals.
Fitzpatrick says that this pressure is increased by the fact that the three main maternity hospitals are "simply not designed to cope with the complexity of cases that we are now faced with". He adds that the number of medical doctors in the Coombe who are on call for after-hours obstetric care is similar to the number working in a facility that is four times less busy.
Our conversation ends abruptly when Fitzpatrick is called back to theatr. But he is back on the phone later to make "another important point", that there is particular pressure on services during times of simultaneous emergencies.
This is borne out by a young woman who, in the early stages of pregnancy this week, collapsed and was taken to the Coombe by ambulance. Linda Kavanagh (23), from Tallaght in Co Dublin, was bleeding and experiencing breathing difficulties but had to wait from 7pm to 2am to be seen by a doctor because there was, she says, "another emergency going on upstairs".
Also at the Coombe, a Co Meath woman, Hilda O'Shea (41), is expecting her seventh child. She says there is a marked difference in the standard of care now compared with when she had her first baby in 1985.
"I remember you were kept in much longer, there were empty beds around you and it just wouldn't have been as hectic," she says. "Now it's just a constant turnover of women, there never seems to be an empty bed and it's manic. I feel really sorry for all the staff running around trying to do their best. You hear of women who are in labour but there's nowhere to put them. More people seem to be induced now - it's just all different."
THE MASTER OFthe Rotunda, Dr Mike Geary, says his hospital has seen the largest increase in births due to the population explosion in north Co Dublin. With services under strain, he has been given more midwives, but says that until a plan is put in place for expansion or relocation, "we are in a bit of a vacuum . . . it's difficult to see light at the end of the tunnel".
Janette Byrne, of lobby group Patients Together, who broke the hotel story this week, points out that, with all the uproar about the health services in recent times, she has been surprised by the low number of complaints about maternity services.
"It could be that they slipped under the radar somehow with everything else that was going on, but, in saying that, some of our members have had complaints," she says. "One of the main concerns is about lack of privacy. One mother in Holles Street told of how, after being left in a corridor in the early hours of the morning after having her baby, she was later wheeled into a ward and had to share a curtain with another new mother. The two women were virtually on top of one another. And we've also had reports of dreadful hygiene standards in the maternity hospitals . . . it's just not good enough."
A HSE-commissioned review of maternity services - carried out by KPMG and due in a few weeks - should give a clearer direction in terms of strategy for the next five to 15 years. But while he welcomes such forward thinking, Chris Fitzpatrick is adamant that there is no time to lose.
"We cannot wait for the implementation of that report. The situation is too urgent. Something needs to be done now," he says.
IT'S WORTH POINTINGout that there are some women who are having happier experiences during pregnancy and childbirth. Tally Garry, from Co Wicklow, who is expecting her second child in three weeks, is part of Holles Street's Domino scheme, which is run by a team of midwives.
"You don't feel you are on that conveyor belt, your dignity is preserved and you are not being patronised," Garry says. "You are cared for in your community or your own home by women who have had babies themselves. Everything happens as naturally as possible. I'd definitely recommend it to anyone who is wondering what direction to take."
From the midwives' perspective, programmes such as Domino or the "early transfer home" schemes run by the main maternity hospitals represent one solution to the current crisis. Practising midwife Deirdre Daly, who also lectures in midwifery at Trinity College Dublin, moved back 10 years ago after spending years working in the North. It soon became obvious to Daly that, on this side of the Border, all pregnant women, regardless of their health status, went to hospitals for care from the outset of a pregnancy, even though, as she points out, "for most women, having children is a healthy process, and healthy women don't need to be treated in hospitals".
"Listening to midwives, they are dreadfully frustrated about not being able to give the levels of wholesome care they were trained to give, because it's just so busy," she says. "They are almost having a crisis of conscience because, as a midwife, you know what you should be doing, and you are doing your best in the circumstances, but you could be doing so much more, and the women and their families could be accruing many more benefits."
She paints a picture of an ideal maternity service in which the majority of pregnant women would be treated in their homes or communities, cared for as individuals in an environment where their needs are met, as opposed to the needs of institutions. She says this approach would take a lot of the strain off hospitals.
"Not one woman's name would appear on a consultant's chart that doesn't need to be there," she explains. "This is what every woman in Ireland deserves and it's what they could have if we organised and managed our services differently."