That Dáil Éireann:
- the need for Ireland’s maternity services to be as safe as possible for women and babies, including the need for women to be listened to and respected;
- the hard work, skill and dedication of all staff across Ireland who provide maternity services;
- the growing crisis in maternity care for reasons including:
- outdated and inadequate hospitals;
- limited diagnostics;
- poor staffing ratios;
- insufficient parental supports;
- wide geographic variations; and
- lack of community-based options for mothers;
- the deep concern these pressures are resulting in for current and expectant mothers and fathers; and
- the increased burn-out and stress for clinicians, together with a retention and recruitment crisis and chronic staff shortages;
- that the 2008 KPMG Independent Review of Maternity and Gynaecology Services in the Greater Dublin Area identified the need for maternity services to be co-located with adult acute services;
- the repeated announcements from 2013 onwards, including in the Capital Plan 2016-2021 and the National Maternity Strategy 2016-2026, that Dublin’s three maternity hospitals and Limerick’s would be relocated, with:
- the National Maternity Hospital to St. Vincent’s University Hospital campus;
- the Coombe Women and Infants University Hospital to the St. James’s campus (to happen in parallel with and be tri-located with the National Children’s Hospital);
- the Rotunda Hospital to the Connolly Hospital campus at Blanchardstown; and
- Limerick Maternity Hospital to the University Hospital Limerick campus;
- the lack of progress on these essential projects, including:
- on-going delays regarding the National Maternity Hospital; and
- no progress and no budget allocation to begin the relocation process for the other maternity hospitals;
- the numerous reports into localised maternity care issues in recent years, including Portlaoise and Portiuncula hospitals;
- the lack of progress in implementing various recommendations from these reports;
- the clinical, patient and political buy-in to the National Maternity Strategy 2016-2026, and the lack of implementation of that strategy, with no new development funding for it in 2019;
- the lack of progress on numerous issues raised in recent years by midwives, including staffing ratios, working conditions and pay inequalities, with:
- just two midwifery-led units in place; and
- a shortfall of 200 midwives below the recommended safety-levels in the National Maternity Strategy 2016-2026;
- Ireland’s low-rate of obstetricians per capita, being the third lowest in the Organisation for Economic Cooperation and Development, and being further exacerbated by a high-level of unfilled posts; and
- the rise in State payments in compensation for incidents in maternity units, up from €4 million in 2007 to almost €120 million in 2017; and
- a definitive time frame and funding deployment for the relocation of the stand-alone maternity hospitals;
- progress to start in 2019 on all projects not yet commenced;
- a guarantee from Government that new public maternity hospitals will not have separate external or internal entrances, nor separate facilities within the hospitals, for private patients;
- funding and a task force to implement the National Maternity Strategy 2016-2026, including choice around birth, types of antenatal care, access to anomaly scanning, breast-feeding, counselling services, public health, domestic violence supports and
appropriate staffing levels;
- an active clinical programme for the development and review of clinical guidelines for maternity services;
- an immediate statement of maternity services available at all sites, including prenatal screening, access to foetal medicine, counselling, genetic testing and laboratories being used;
- investment in community-based pathways to ensure choice for mothers;
— indemnity to cover practice nurses who give antenatal care;
- measures to address the chronic staff shortages, including ending pay disparity; and
- investment in a national foetal magnetic resonance imaging (MRI) programme and bereavement care.
"I was treated like a slab of meat" - that was Róisín's testimony. "The registrar fell asleep while debriefing me after I had had a haemorrhage" - that was Lucy's experience. "I was baldly told there is no heartbeat, your baby is dead" - that was testimony from Anne. "My baby died seven days after birth, I was left in the ward with mothers and their babies while I was sick and childless" - that is what happened to Breda. Eileen recalled that her daughter miscarried while sitting on a chair. Helen has shared the following: "My baby was so disfigured from the forceps that she was taken away for chromosomal testing, a doctor came in, looked around and said, "Oh my God, what a mess, clean this up"."
Earlier this year, the country listened in horror as women from all over Ireland shared their experiences of maternity care on RTÉ's "Liveline" and the conclusion was, once again, that women are not being believed. So if no one is listening or believing the mothers, is anyone listening or believing the midwives or the doctors?
Here is what one midwife wrote:
I am in such pain following the "Liveline" coverage of women's experience of care in Irish maternity services. It is never anything short of horrifying to me that women and their families are being so profoundly hurt by experiences that ought to be, at a bare minimum, infused with dignity, respect, safety, and care.
Dangerous and unsafe is what one consultant said to me in the last two days. Another said that Ireland is not in the top 20 countries in which to give birth. Dr. Peter Boylan, former master of the National Maternity Hospital, referred to an appalling indictment of State failure. He was referring to the standard of care at the hospital in which Savita Halappanavar died. There are many other reports on other hospitals and experiences. Multiple failures were identified in a report into baby deaths at Portiuncula Hospital. The report examined the delivery and neonatal care of 18 babies and found problems with staffing, training and communication. It noted: "a significant delay between the first signs of concern and the decision to intervene".
Midwives, doctors and a host of other professionals want the best for their patients, for mums and for babies. They are doing their damnedest, but it is becoming impossible and they are burning out. There are not enough of them for a start. Right now in Ireland we have 200 midwives fewer than the number agreed in 2016 in the maternity strategy to be the safe level of midwives. We have the third lowest level of obstetricians anywhere in the developed world. By definition, if we have fewer than the recognised safe staffing levels, then our service cannot be safe. For the staff, many find themselves working in outdated buildings with outdated equipment in cramped and confined spaces, as obviously do the mums and their babies.
Just today the master of the Rotunda Hospital was forced to go public and ask for urgent assistance to build a new wing amid what he describes as "an intolerable patient safety crisis". We should listen to him. I was in the Rotunda Hospital recently and they shared with me the fact that there was a fire in the neonatal intensive care unit caused by old wiring in the walls. They said it was a miracle that no baby was hurt.
Elsewhere staff are working on MRI machines that are 21 years old that are meant to be replaced after ten years.
What of the new maternity hospitals? Four are promised but none has been delivered or even started. The National Maternity Hospital in Holles Street is meant to be on the St. Vincent's University Hospital campus by now but this has not happened. The University Maternity Hospital Limerick is meant to relocate to the University Hospital Limerick campus but that has not happened. The Rotunda Hospital is meant to relocate to the Connolly Hospital campus but nothing has happened.
In 2015 the then Minister for Health, the now Taoiseach, Deputy Varadkar, promised that the Coombe Women and Infant University Hospital would move to St. James's Hospital in parallel with the children's hospital and would be "well under construction" by the following year, which was 2016, but nothing has happened. In fact, there is not even a budget this year to begin the planning and design phase, which can take years.
What of the 2016 national maternity strategy? It is a good strategy, it is a solid plan and it has buy-in from patients, doctors, midwives and from politicians. As has become so common, there was a shiny brochure and a slick launch but nothing has happened. The new hospitals are not progressing. There is no new funding this year. In a €17 billion health budget, there is no new funding for progressing new parts of the national maternity strategy. Community-based delivery options are not being supported and in most parts of parts of the country, they do not exist. Diagnostic machines are not being replaced and there is a huge variation in the level of diagnostics and scanning available to mums, depending on where they live in the country.
In writing this motion, we listened to women, to midwives and to doctors. They said that maternity care must be safe and of an equal standard for all mums and babies, regardless of how much money people earn, that the new maternity hospitals are needed now where women can be treated with the best medical care and in appropriate settings where they can be afforded dignity and that there must be community-based options for women who do not want to use the acute system for delivery and they must have supports through pregnancy and afterwards and this includes counselling services and public health programmes like breastfeeding, which are under-funded and under-supported at this time.
This country has a dark history when it comes to women's reproductive health, and it is not solely the fault of this Government. Every party that has been in government in this State has to take some responsibility for that dark history and we must do something about it together. Think of the scandals with which we have been dealing, including symphysiotomy, CervicalCheck and the mother and baby homes, all of which relate to women's reproductive health. Nothing is happening in regard to maternity care. Brilliant healthcare professionals are burning out. They are trying to keep things going but they will not be able to do that for much longer. Mums and babies deserve better as do dads and our healthcare professionals. We are capable of much better than is currently happening. This motion, if passed, but much more importantly, if implemented, would begin to achieve exactly that.
I commend the motion to the House.