- Strategy aims to improve safety & quality in general and standardise care across all units
- Recommends a Health & Wellbeing approach to give babies the best start and improve women’s health
- Ensure that a woman’s choice is facilitated to the greatest extent possible
- Improve staffing levels and facilities in maternity units and in the community
Minister for Health Leo Varadkar has launched Ireland’s first National Maternity Strategy – Creating a Better Future Together – which is a roadmap for the improvement of services over the next ten years.
The Strategy sets out to build on the good maternity services we already have in Ireland and restore confidence in them by raising quality and making them as safe as possible across all units, and by creating a partnership approach with expectant mothers.
Speaking at the launch, Minister Varadkar said: “I am delighted to launch the country’s first National Maternity Strategy. It was my privilege to present it to Government for approval. This Government has made considerable investment in our maternity services in recent years and the Strategy provides further evidence of our very firm commitment to the development and improvement of services. It sets out a vision of maternity services that is about safety, quality and choice, and that places women very firmly at the centre of the service. I will advocate for it and work for its full implementation. In fact, we’ve already started.”
The Strategy identifies four priorities:
· A Health & Wellbeing approach should be adopted to ensure that babies get the best start in life. Mothers and families should be supported and empowered to improve their own health and wellbeing;
· Women should have access to safe, high-quality, nationally consistent, woman-centred maternity care;
· Pregnancy and birth should be recognised as a normal physiological process, and insofar as it is safe to do so, a woman’s choice in pregnancy and childbirth should be facilitated;
· Maternity services should be appropriately resourced, underpinned by strong and effective leadership, management and governance arrangements, and delivered by a skilled and competent workforce, in partnership with women.
The Strategy will be delivered through a new National Women & Infants’ Health Programme, and care in each case will be offered by multi-disciplinary teams. A new community midwifery service will be developed. Expectant mothers will be offered choices about their care during pregnancy and birth, ranging from home birth to specialised assistance, depending on the level of risk involved in each case.
The strategy was drafted by a 31 member Steering Group. The Chair of the Steering Group Sylda Langford said: “The way the Steering Group came together and agreed a new approach, augers well for the future of maternity services in Ireland. I urge them all to become champions for the strategy within their own service, and help ensure that it is implemented with the same driving passion that was so prevalent at our meetings.”
The HIQA Report into the death of Savita Halappanavar recommended that a strategy be developed to implement standard, consistent models for the delivery of a national maternity service that reflects best available evidence, to ensure that all pregnant women have appropriate and informed choices, and access to the right level of care and support.
The vision for maternity services, articulated in this Strategy, is for an Ireland where: “Women and babies have access to safe, high quality care in a setting that is most appropriate to their needs; women and families are placed at the centre of all services, and are treated with dignity, respect and compassion; and parents are supported before, during and after pregnancy to allow them give their child the best possible start in life.”
Consequently, each mother or family will be offered choices about their maternity care according to whether they are classified as either normal-risk, medium-risk or high-risk, and their care will be delivered by a particular team:
· Supported Care: This care pathway is intended for normal-risk mothers and babies, with midwives leading and delivering care within a multi-disciplinary framework. Women in this pathway will give birth in an Alongside Birth Centre; women in this care pathway may also choose a home birth.
· Assisted Care: This care pathway is intended for mothers and babies considered to be at medium risk, and for normal risk women who choose an obstetric service. Care will be led by a named obstetrician and delivered by obstetricians and midwives, as part of a multi-disciplinary team.
· Specialised Care This care pathway is intended for high-risk mothers and babies and will be led by a named obstetrician, and delivered by obstetricians and midwives, as part of a multi-disciplinary team. Women in the Assisted Care or Specialised Care pathways will give birth in a Specialised Birth Centre.
The Strategy also sets out the following actions:
In order to provide safe, evidence-based, accessible care to all mothers, babies and families, maternity services must be in a position to respond to the increasingly diverse and complex needs of the population.
Leadership, governance, clinical commitment and clinical effectiveness approaches are required to deliver safe quality maternity care at all levels. Each maternity network will need a defined patient safety and quality framework. This means that every service or hospital will require a dedicated patient safety and quality leadership and oversight function.
Currently, maternity care in Ireland is largely consultant-led and hospital-based; the new model of care now proposed represents a fundamental overhaul of services. The Strategy recommends that maternity services should be woman-centred, and provide integrated, team-based care, with women seeing the most appropriate professional, based on their need. Every woman will have a named lead healthcare professional who will have overall clinical responsibility for her care.
All pregnant women need a certain level of support, but some need more specialised care. The Strategy proposes an integrated care model that encompasses all the necessary safety nets, in line with patient safety principles, which delivers care at the lowest level of complexity needed, yet has the capacity and the ability to provide specialised and complex care, quickly, as required.
It also recommends that dedicated emergency obstetric teams be provided in each maternity unit, and that a maternal retrieval service should be available alongside the existing neonatal retrieval service.
As a first step, the Programme will be required to develop and manage a detailed implementation plan and timetable, to deliver on the Strategy’s required actions. The plan will be finalised within six months of the publication of the Strategy.
Model of care
Currently, maternity care in Ireland is largely consultant led and hospital based; the model of care now proposed represents a fundamental overhaul of services. The Strategy recommends that maternity services should be woman centred, and provide integrated, team based care, with women seeing the most appropriate professional, based on their need. Every woman will have a named lead healthcare professional who will have overall clinical responsibility for her care.
The Strategy recognises that all pregnant women need a certain level of support, but that some need more specialised care, and proposes an integrated care model that encompasses all the necessary safety nets, in line with patient safety principles, which delivers care at the lowest level of complexity needed, yet has the capacity and the ability to provide specialised and complex care, quickly, as required.
The Strategy classifies pregnant women and babies into three risk groups; normal-risk, medium-risk (requiring a higher level of oversight), and high-risk (requiring a more intensive level of care, either throughout or at particular stages of care). A choice of pathway of maternity care will be available based on this risk profile. A woman will be supported to make an informed choice on her care pathway and will have her care delivered by a particular team.
All care pathways will strive to support the normalisation of the birth process as much as possible, and will lend themselves to a shared model of care with the GP, as provided for by the Maternity and Infant Care Scheme.
Women in the Supported Care pathway will give birth in an Alongside Birth Centre; women in this care pathway may also choose a home birth. Women in the Assisted Care or Specialised Care pathways will give birth in a Specialised Birth Centre.
Implementation of the Strategy will largely fall to the new National Women & Infants Health Programme. This will involve examining existing arrangements and putting the necessary architecture and processes in place to ensure the delivery of safe services, in line with the vision articulated in this Strategy. Workforce planning, including analysis of training needs, will be an important aspect of its work.
Smaller maternity units will be supported to deliver safe services in maternity networks with larger hospitals in their hospital group, as has already happened in the Dublin Midlands Hospital Group network, comprising the Coombe Women & Infants Hospital and Portlaoise Hospital. The Programme will work with maternity networks and individual maternity units to ensure that maternity service provision is remodelled on the lines proposed, and that a culture of continuous improvement is fostered throughout the service.
Members of the Steering Group
1) Ms Sylda Langford (Chairperson)
2) Professor Cecily Begley, Chair of Nursing & Midwifery, Trinity College Dublin
3) Ms Mary Brosnan, Director of Midwifery, National Maternity Hospital
4) Ms Teresa Cody, Principal Officer, Department of Health
5) Professor Colette Cowan, CEO, University of Limerick Hospital Group
6) Ms Sinead Curran, Dietitian, PBAI
7) Dr Miriam Daly, Director, Women’s Health Programme, Irish College of General Practice
8) Professor Declan Devane, Professor of Midwifery, NUI Galway
9) Ms Mary Gorman, CMM11, Our Lady of Lourdes Hospital, Drogheda
10) Dr Colm Henry, HSE National Clinical Advisor & Group Lead for Acute Hospitals
11) Ms Dawn Johnston, Group Director of Midwifery, Saolta Hospital Group
12) Ms Susan Kent, Deputy Chief Nursing Officer, Department of Health
13) Ms Shauna Keyes, Service User Representative
14) Dr Krysia Lynch, Chair, AIMS Ireland
15) Dr Kathleen Mac Lellan, Director of Patient Safety and Clinical Effectiveness, Department of Health
16) Ms Roisin Molloy, Service User Representative
17) Dr John Murphy, HSE National Clinical Lead for Neonatology
18) Dr Meabh Ní Bhuinneain, Consultant Obstetrician and Gynaecologist
19) Mr Pat O Dowd, HSE Assistant National Director, Primary Care
20) Dr Michael Power, Clinical Lead, National Critical Care Programme
21) Ms Joan Regan, Principal Officer, Department of Health
22) Ms Mary Reilly, CMM11, Cavan General Hospital
23) Ms Grace Rothwell, Hospital Manager, South Tipperary General Hospital
24) Professor Jane Sandall, Chair in Social Science and Women’s Health, King’s College London
25) Ms Monica Sheehan, Director of Public Health Nursing, Kerry Community Care Services
26) Dr Sharon Sheehan, Master, Coombe Hospital
27) Dr Dubhfeasa Slattery, Head of Clinical Risk, State Claims Agency
28) Dr Jeremy Smith, Clinical Lead, National Clinical Programme of Anaesthesia
29) Ms Sheila Sugrue, HSE National Lead for Midwifery
30) Ms Pauline Treanor, Secretary & General Manager, Rotunda Hospital
31) Professor Michael Turner, Clinical Lead for Obstetrics and Gynaecology