Wednesday, 27 May 2015

Strategic review of the maternity services: the importance of service user representation

On Saturday 23rd May 2015, the Irish Times printed an article which highlighted a letter sent from the Institute of Obstetricians and Gynaecologists of Ireland to the Minister for Health Leo Varadkar about the Membership of the Strategy Review Steering Group.

AIMSI Ireland through their Chair Krysia Lynch has a place on the committee representing the views of service users. Also on the committee are two service users whose babies died in Portlaoise Hospital.

In the letter, Prof Robert Harrison, said his members were "dismayed about the make-up of the group". He stated that the presence of three obstetricians and no anaesthetists or critical care specialists, compared to nine people from a midwifery background and three lay people, “does not reflect a fair balance of those who work in maternity services today”.

The letter implies that those who work in the maternity services should dominate how future maternity services are delivered and planned. It  discusses ratios of those that work in the maternity services today and assumes wrongly, as it turns out, that obstetricians should have the majority of seats. There are many more midwives working in the maternity services than obstetricians; it is logical that the majority view around the table should be from midwives. Perhaps what the statement really means to imply is that obstetricians have grown accustomed to dominating discussions surrounding maternity services, and suddenly finding themselves not in a majority is unfamiliar and unwelcome territory.

The reporting of the letter in the Irish Times implies that the querying of the service users by Prof Harrison was insensitive and inappropriate given the way these women had been treated by the members of his own profession.

Whilst the comments re service users made in the letter received a lot of publicity, little commentary was made on the demands from the Institute of Obstetricians and Gynaecologists of Ireland for the inclusion of a critical care representative and  the inclusion of an anaesthetist representative; both of which were duly appointed following the request from the Institute. 

An interesting question that the letter does not address is whether the inclusion of two service users and one advocacy organisation is sufficient. AIMSI would argue (along with the other service users representatives) that 70,000 maternity care service users might deserve even more than two service users representing them. To this end AIMSI also wrote to the Strategic Review Committee suggesting the inclusion of a further consumer representative who had perhaps experienced a different model of care and a different outcome to those already included. AIMSI were told no further representatives could be added.

On Tuesday 25th May 2015 AIMSI issued the following statement:

"The recent comments in the Irish Times questioning the inclusion of two service users was unhelpful. This group might not be sitting if it were not for the experience of the service users on the committee. Their bravery in coming forward  and the support they received from advocacy groups is an important aspect of improving maternity services for women in Ireland, and AIMSI would if anything be advocating for more service user inclusion on the group"

The full article can be read here

The second article following Prof Harrison s resignation can be read here

Monday, 18 May 2015

SHOUT BACK - YOUR SAY: A Note on the Issue of Balance

AIMSI have received quite a few messages on our SHOUT BACK - YOUR SAY submissions; passionate pleas to include positive stories in the interest of balance.

AIMS Ireland spent 42 weeks highlighting positive, healthy birth in Ireland. (
42 weeks was well received, particularly by health care providers. However, during this campaign, many women contacted us who felt isolated; that their voice and experience was not represented.

SHOUT BACK - YOUR SAY represents a safe place for women to share their experiences which were not positive. These submissions are vitally important as they represent a voice which rarely has the opportunity to be heard; those who survive. AIMS Ireland passionately believe that experiences of abuse, disrespect, assault, unsafe care practice should not matter less simply because the woman and baby survive.  Yet these experiences are too often dismissed consistently by our politicians, policy makers, care providers, and media.

Baby alive. Mother alive. Non story. Regardless of the profound impact on the physical and psychological wellbeing of women, babies, families - the health and lives of all involved.

Assistance with complaints and birth trauma is the #1 reason why women make contact with AIMS Ireland. The SHOUT BACKs representing a small percentage of what comes into our inbox.

We need to be very careful that in a desire to create balance, we do not dismiss the experiences of women who have not had positive experiences. The SHOUT BACKs are difficult to read. They represent everything we hope to change in the Irish maternity system. These experiences are real and need to be heard in their own light, not buried. Its so important we do not dismiss these women's experiences by asking for the focus to change - to make us all feel more comfortable, by including positive stories.

It is in everyone's interests that these experiences are acknowledged and the courage that these women and families have shown in coming forward is respected. They are heartbreaking and very difficult reading but their place in the maternity care system is of huge importance; it is as a result of this opportunity to share, just at this particular time, that REAL change may come about.

Balance is about hearing and facing up to the difficult things. People are living with the repercussions of such treatment - often alone, isolated, while taking care of their young families - and up to now they have remained unheard and unacknowledged.

It is vital that we do not look back at this opportunity in 20 years time and say "if only we'd listened".