The Dublin area is desperately in need of a maternity care overhaul, according to this article in The Independent:
A comprehensive assessment of the three main specialist hospitals identified serious
shortcomings in staffing and infrastructure and criticised the use of artificial means to speed up births — so women would give birth within 12 hours.
Women are given drugs such as oxytocin or have their waters broken to speed up labour despite the increased risk that a rushed birth will result in an emergency caesarean — which is three times more costly than a natural birth and carries increased health risks.
The review of maternity and gynaecological services by consultants KPMG, partly blames the inadequate number of delivery rooms for this practice of “active management”. But some obstetricians defend the practice as offering the best outcome for mother and baby.
The report also finds fault with the low number of theatres in the Rotunda, the Coombe and National Maternity Hospital in Holles Street (NMH), which account for 40pc of all babies born in Ireland.
“Gynaecology and obstetric services compete for the same theatre resource, meaning elective gynaecology work often gets interrupted for emergency deliveries. It also increases the risk of infection. This must be urgently addressed,” the report urged.
Lack of maternity care staff has been a problem for years in Ireland, with women sometimes left to labor alone due to the shortage of midwives.
Ireland’s Cesarean rate rose to 24.3% in 2006.
The following is an excerpt on choice from the KPMG report Independent Review of Maternity and Gynaecological Services in the Greater Dublin Areareferenced in the article:
Stakeholders, including service users, gave us a strong clear message that they want more choice in the way service users and their families’ access services. At present service user choice is limited in Dublin, although there have been some impressive inroads through the Early Transfer Home and Domino schemes. These are described in more detail later in the report. However, the majority of women mainly access a hospital based, consultant-led model of care for maternity services. The number of home births in Ireland as a whole is absolutely minimal, although we realise that presently only a minority of women wish to deliver at home.
International evidence clearly indicates that women should be offered choice. It is particularly obvious that there is significant potential for midwives to play a more prominent role in obstetrics. Co-located Midwife Led Units (MLUs) are common in the UK and further afield. We believe these are crucial for the development of maternity services and more patient choice in the GDA.
We are proposing greater choice for women and are proposing the creation of MLUs adjacent to hospital based obstetric units in our recommended model of care as well as the option to have a home birth. In addition, primary and community based services should be significantly expanded. We are also proposing a significant education and communication campaign both for service users and service providers on the range of choices available and the risks and benefits related to each.
As part of the independent review, KPMG drew upon different models available for delivering “optimal service” in maternity and gynecological care. They focused on Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden and the UK. The following tables show the evidence they considered.
What do you think? Is the U.S. on the verge of a maternity care makeover?