Madam, - Few of us working in or concerned for the maternity services in Ireland would disagree with much of what Dr Gerry Burke writes (Letters, August 13th).
Nevertheless, there is no evidence to support Dr. Burke's assertion that ". . .the model of care available to private patients must result in better outcomes". While this "might" be the case in Ireland, evidence from other countries (eg Australia, Brazil) suggest the opposite to be as likely. Indeed, it is unfortunate that we do not have the Irish data with which to draw comparisons.
Additional consultant obstetricians are badly needed but this is only one part of the solution to improving our maternity services. No one model of care is suitable for all women.
Midwives, obstetricians, general practitioners and public health nurses all have their place and their role in the provision of maternity care. Every woman should experience the best possible care from the most appropriate professionals in the most appropriate setting based on her needs.
While it is often portrayed as such, the provision of maternity services is not, and should not be, about competition. For some women the most appropriate lead professional will be a consultant obstetrician, for others it will be a midwife, for others it will be a combination of professionals providing a shared model of care. For some women the most appropriate place to give birth will be the hospital, for others it will be the home and for others it will be a birth centre. All have their place and all are needed. - Yours, etc,
DECLAN DEVANE,
Lecturer in Midwifery,
School of Nursing and Midwifery,
Trinity College Dublin.
Madam, - I wholeheartedly agree with Dr Gerry Burke (August 13th) that provisions must be made to counteract the very serious problems in Ireland's maternity services.
Maternity care has been placed quite low on the list of priorities with Ireland's health services and as a result it has been left in a neglected and dangerous state.
As highlighted by Dr Burke, hospitals are filthy, overcrowded and understaffed.
There is very little opportunity for privacy for labouring women or on post-natal wards. Waiting times are long and facilities are tired and outdated.
However, I strongly disagree that doubling the amount of consultants is the way forward, as suggested by Dr Burke.
The two-tiered system is unequal, over-stretched and quite obviously not working. Around half of the women in Ireland choose private care for a variety of reasons. Shorter waiting times, the perception of personalised care, continuity of carer, and the chance to get a private room after birth are all reasons cited by a survey recently conducted by Aims Ireland.
Aims Ireland would like to see the future of Ireland's maternity care leaving behind the traditional two-tier system (public, semi or private care) and adopting a range of midwife-led options for women with low-risk pregnancies.
In accordance to WHO guidelines, 85 per cent of women will have low-risk healthy, normal pregnancies and births. It is recognised worldwide that the best care option for women with low-risk pregnancies is a midwife-led option.
Irish women should have access to continuity of carer with a midwife. This is currently only an option in Ireland for women who chose a home birth with an independent midwife. Continuity of carer would allow women to build a relationship with one midwife from the confirmation of pregnancy right through to the birth and six-week post-partum period.
Midwife-led options would include the expansion of MLUs, home birth hospital schemes, independent home births, and free-standing birthing centres in all regions of Ireland.
Midwife-led options are cost effective and would radically reduce the number of women choosing traditional hospital care.
This would free up hospital beds for high-risk mothers or women who prefer to give birth in the traditional hospital setting. - Yours, etc,
JENE KELLY,
Chair,
Association for Improvements in the Maternity Services,
Drogheda.