Dáil Éireann debate -
Wednesday, 10 Nov 1999

Vol. 510 No. 4

Written Answers. - Maternity Services.

Frances Fitzgerald

Question:

153 Ms Fitzgerald asked the Minister for Health and Children if all publicly and privately funded maternity hospitals or units compile annual clinical statistics on mortality and morbidity rates, obstetric interventions, for example, induction and acceleration of labour, electronic foetal monitoring, epidural anaesthesia and rates of operative delivery matters; if so, for whom these statistics are compiled; the form they take; and the purpose in this regard. [22954/99]

Frances Fitzgerald

Question:

154 Ms Fitzgerald asked the Minister for Health and Children if all maternity hospitals or units, both publicly and privately funded, are required by his Department to produce annual clinical statistics on mortality and morbidity rates, obstetric interventions, for example, induction and acceleration of labour, electronic foetal monitoring, epidural anaesthesia and rates of operative delivery matters. [22955/99]

Minister for Health and Children (Mr. Cowen)

I propose to take Questions Nos. 153 and 154 together.

My Department has no function in relation to privately funded maternity hospitals or units. National statistics on all live and stillbirths are collected as an integral part of the birth notification system. The Central Statistics Office provides information on variables such as period of gestation, birthweight and maternal age in its annual report on vital statistics. Detailed national statistics are derived from the birth notification system as part of the perinatal reporting system which is administered by the Economic and Social Research Institute on behalf of my Department. Data covers perinatal outcomes classified by parity, method of delivery, type of antenatal care, diagnoses and other relevant factors. The purpose of the report is to describe fundamental social and biological characteristics of mothers and their babies, to report on outcomes with particular reference to perinatal mortality and to highlight important aspects of perinatal care.

In addition, the three publicly funded Dublin maternity hospitals produce a detailed clinical report in relation to activity and outcome. Activity in these hospitals would be representative of almost 50 per cent of all births. In the case of the health boards, additional information is prepared and forwarded for audit purposes to the Royal College of Obstetricians and Gynaecologists.

Frances Fitzgerald

Question:

155 Ms Fitzgerald asked the Minister for Health and Children if he will direct all maternity hospitals or units, both publicly and privately funded, to produce annual clinical reports similar to those copyrighted by the major Dublin maternity hospitals in view of the number of caesarean hysterectomies at Our Lady of Lourdes Hospital, Drogheda, County Louth; and if he will require all these reports to be published in the interests of accountability and transparency. [22956/99]

Frances Fitzgerald

Question:

156 Ms Fitzgerald asked the Minister for Health and Children the structure and functioning of the reporting relationships between his Department and all public voluntary health boards and private maternity hospitals or units; his views on whether these arrangements are adequate in view of the Government's commitment to accountability, transparency and quality in service delivery and the number of caesarean hysterectomies at Our Lady of Lourdes Hospital, Drogheda, County Louth. [22957/99]

Minister for Health and Children (Mr. Cowen)

I propose to take Questions Nos. 155 and 156 together.

Under existing reporting requirements each health board is legally obliged to prepare and submit an annual report on its activities to my Department. Within each health board area the reporting relationship from service units to the board is a matter for each board to address, in compliance with its overall responsibility for service delivery. Maternity homes registered by the health boards under the Registration of Maternity Homes Act, 1934, must comply with the provisions of this Act and any regulations made under this Act.

I strongly support the production of annual clinical reports by health agencies as part of this process and see it as a valuable contribution to the development and promotion of a process of continuous quality improvement across health agencies. As the Deputy is aware, such an arrangement exists in the Dublin maternity hospitals.

There is no evidence that the situation which arose at Our Lady of Lourdes Hospital, Drogheda, which was operating at the time as a voluntary hospital, applies in the case of health board maternity hospitals and units. I am advised by the North-Eastern Health Board, which now has responsibility for services provided at Our Lady of Lourdes Hospital, that no caesarean hysterectomies have been carried out since late October 1998. I am further advised that the North-Eastern Health Board has made a range of important improvements at the hospital, with the full participation and co-operation of all relevant consultant and nursing staff, including revised protocols and procedures for the maternity unit and delivery suite to ensure that best practice is in place; all of the relevant hospital consultant and nursing staff are co-operating fully with the North-Eastern Health Board management in implementing agreed protocols and procedures including audits if these procedures; new arrangements for the management of ante-natal clinics, admission protocols regarding assessment and discharge of women who are in labour are in place; a twice-weekly reporting system is in place which involves consultants and midwifery staff; improvements in the consultative process regarding the management of midwifery and obstetric care; and the use of customer care satisfaction surveys.

Frances Fitzgerald

Question:

157 Ms Fitzgerald asked the Minister for Health and Children if he will issue a directive to all maternity hospitals to co-operate fully with independent home birth midwives by providing pre-natal and other services they may require in view of the continuing refusal of certain publicly funded maternity hospitals or units to provide standard pre-natal tests, for example, ultrasound scanning requested by independent midwives for their clients. [22958/99]

Frances Fitzgerald

Question:

158 Ms Fitzgerald asked the Minister for Health and Children if he will undertake a review of midwifery staffing levels in all maternity hospitals or units over the past ten years with a view to assessing whether patient safety is being compromised in these hospitals as a result of the shortage of midwives. [22959/99]

Minister for Health and Children (Mr. Cowen)

I propose to take Questions Nos. 157 and 158 together.

In relation to domiciliary births, an expert group was established under the auspices of the health board chief executive officers to consider approaches to domiciliary births. The expert group submitted its report to the chief executive officers at the end of 1998 and recommended a number of pilot projects. To facilitate the implementation of the expert group recommendations, appropriate funding was allocated to the relevant health boards in 1999. Following evaluation of the projects the policy, procedures and protocols necessary for domiciliary births will be developed.

I am advised by management in the maternity hospitals that prenatal tests, including ultrasound scanning have been available to independent midwifes and this service will continue in the future.

However, if the Deputy has a particular case in mind I will be happy to take the matter up with the relevant agency. I can assure the Deputy that I am committed to the provision of a comprehensive and equitable obstetric service within the public hospital sector.

I would like to point out that the recruitment of midwives is primarily a matter for individual employers. Last year a new nursing policy division was established in my Department. Its primary function is to ensure that there is an integrated and strengthened nursing function within my Department at this important stage in the development of nursing. A number of nurse researchers have been appointed to the division. One of these researchers has been specifically engaged to undertake a study of the nursing and midwifery resource. The aim of this project is to analyse the present position with regard to the nursing and midwifery workforce, and to devise a system for the projection of future needs and plan how these needs may be met. I might add that a further nurse, who will act as a professional adviser on midwifery to my Department, is due to take up appointment shortly.

Frances Fitzgerald

Question:

159 Ms Fitzgerald asked the Minister for Health and Children if, in view of the establishment of health board pilot schemes on home birth, the recently expressed endorsement of midwifery centred maternity care from the chairman of the Institute of Obstetricians and Gynaecologists (details supplied) and the increasing demand for community midwifery services, he will publish the report commissioned by his Department, and carried out under the aegis of the Coombe Women's Hospital, on the national survey of homebirth, Women and Birth, An International Study of Home Birth in Ireland. [22960/99]

Minister for Health and Children (Mr. Cowen)

This report was conducted, as the Deputy states, under the aegis of the Coombe women's hospital and funded by the Department of Health. The study relates to the period 1981-85 and was completed in 1992. In view of the time which elapsed between the commencement of the study and its completion it was decided not to publish the report.

The report was, however, made available to the maternity and infant care review group which considered, inter alia, the question of domiciliary births and made recommendations. Funding was provided in 1999 to the relevant health boards for the piloting of a number of the approaches suggested.