Tuesday, 11 March 2014

Portlaoise: "ground zero" of a failing maternity system?

AIMSI are horrified to hear of the recent death of a baby in Portlaoise over the weekend. Our thoughts are with the family and also the women who are booked into Portlaoise hospital and may be feeling scared, concerned, or anxious following the events of the past few weeks.

It is unclear as to if the baby died from natural causes or if the care/practice was a contributing factor. The results of the post mortem will tell us more.

The hospital is under new management, lead by the Coombe. AIMSI have been informed (unverified) that the former lead consultant from OLOL Drogheda - Maire Milner - has also been transferred to Portlaoise. So there has been a changing of the guards so to speak.

However, questions still remain on some of the findings from the Holohan Report and contributing factors:

Is Portlaoise a case of a few bad apples practicing individually unsafe care? A single maternity unit with an underlying culture of inhumane and detached care?

OR Is Portlaoise the "ground zero" for a maternity system with systematic failures and a culture of indifference to those working in and accessing services from management, policy makers, and the Department of Health? An under-prioritised branch of the health system which lacked provision for care options and was overlooked for investment by the current and former health ministers. A maternity system which is the result of years of over-stretched services, lack of choice, poor moral, and reports of bullying and fear hidden by a complete lack of transparency.

A maternity system which is:

* centred around a care model which is inappropriate for the majority of women - obstetric led vs midwife led

* routinely practices interventions without medical indication which are shown to do more harm than good for the majority of women - CTG, Syntocinon, ARM, episiotomy, caesarean section

* women and midwives report bullying and coercion

* local policy does not reflect evidence or best practice

* evidenced based care options, midwife led care (where available) is not self selecting and does not allow for individual assessment or informed choice

* informed consent/refusual is not recognised in the National Consent Policy

* local policy is not obligated to implement National Clinical Guidelines

* the system lacks transparency and accountability - no watchdog which enforces evidence based practice, guidelines

* the complaints system is grossly inadequate - women regularly report that complaints are not dealt with within the time frame of the HSE's own guidelines, replies are inadequate and do not address concerns, women are fobbed off with consistent replies stating that the unit needs more time to look into her complaint, leading to long time periods with no resolution, responses often provide little or no resolution or validation into the nature of the complaint "we are sorry you feel that way, our unit boasts a high maternal satisfaction percentage"

* large numbers of women contacting AIMSI report that notes have been changed retrospectively or are inaccurate

* maternity system is over-seen by a Department and Health Service Body who puts maternity services and choice low on the list of priorities and does not consult the concerns/opinions/interests/needs/desires of service users, midwives (obstetricians consulted but not midwives), and maternity advocacy groups representing service users which do not hold a conflict of interest.
Instead, consultancy and reviews should be open - not by invitation - to all service users as well as advocacy/support organisations, health care providers, and policy makers. Anyone who wants to lend their voice to the discussion should be welcomed, not shut out.
* a system in which a HSE risk manager argues that he does not see how refusing women individual assessment or informed choice/consent on their care options is a human rights violation
The Irish Maternity system has been neglected for decades and as a result is imploding.

We need an urgent investment in healthy care options for women & babies with immediate implementation of self-selecting, evidence based care, midwife led birth options - MLU, Birth Centres, Homebirth. There must be an immediate over-haul of the current obstetric led care options, so that women who need or choose this type of care receive the highest quality of services possible. Individualised healthy and positive birth - not birth high in morbidity, intervention, and over-crowded conditions. Women deserve time with their chosen care provider. Women and babies DESERVE to be invested in. Women must be supported to make the best decisions for her and her baby - treated with dignity and respect. Midwives must be respected to practice with autonomy - recognising their skills and qualifications. Not bullied into complying with routine intervention or demoralised by having to few colleagues to provide safe and evidence based supportive care to each woman.

There must be repercussions for individuals and maternity units who fail to provide evidence based care and healthy working environments for HCPs. There must be repercussions for units using inappropriate rates of intervention, units with large regional variations, who actively manage women in labour with sytocinon, who use episiotomy or refusal of choice inappropriately, who devalue midwives, - a demand for accountability and investment NOW.
There must be a change of culture. A change of priority. The Department of Health, Minister, and HSE must stop lying to women - to the public. Hold your hands up. Tell the truth. Stop firefighting.
The only way to prevent next week's tragedy is to be open, listen, and invest.

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