AIMS Ireland - An election opportunity

Published: Sunday, February 13, 2011

The Association for Improvements in Maternity Services Ireland, AIMS Ireland, welcomes the upcoming 2011 General Election and would like to offer you an exciting and rare election opportunity.

AIMS Ireland is a non-profit, voluntary organisation with charity status. AIMS Ireland offers support, complaint, and information services to women as well as campaigning for improvements in maternity services, the implementation of normal birth practice, and evidence-based care.

AIMS Ireland participates as a consumer representative in numerous HSE steering committees and the Our Lady of Lourdes Consumer Group, and is frequently invited to address midwifery-related conferences and student midwives. AIMS Ireland also conducts independent self-selecting surveys with service users to provide insight on issues relating to maternity care from the woman's perspective.

AIMS Ireland enjoys a large following consisting of a diverse background of individuals. AIMS Ireland members and followers include mothers, fathers, grandparents, academics, medical professionals, nurses, midwives, students, researchers, and individuals from many different ethnic minorities, economic, and social backgrounds.

As with past elections, AIMS Ireland would like to give each political party running in the 2011 Election the opportunity to address our diverse member base and followers on party manifestos specific to Maternity Care and how your party intends to improve maternity care in Ireland. We ask each political party to put forward key principals within its manifesto for publication on the AIMS Ireland website, AIMS Ireland discussion boards, AIMS Ireland Facebook pages, and other member lists we publish maternity related information on. This is an opportunity for your party to directly address a wide population of voters. See attached factfile.

Key Facts Affecting the Irish Maternity System Which Women and Midwives want YOUR Party to Address:
- The number of births registered in 2009 was 74,278 (CSO, 2010)
- The Republic's rate of 16.8 children born per 1,000 inhabitants in 2009 was the highest in Europe; the EU average was 10.7 (Irish Times, Sept 11, 2010)
- The percentage of spontaneous deliveries fell from 64.5 per cent in 1999 to 56.6 per cent in 2008 for total live births, (for maternities 65.0 per cent in 1999 and 57.4 per cent in 2008). The trend in delivery by caesarean section has increased from 20.4 per cent in 1999 to 26.7 per cent for total live births in 2008, (for total maternities 20.0 per cent in 1999 and 25.9 per cent in 2008). (ESRI Perinatal Statistics, 2008)
- The ESRI Perinatal Statistics 2008 shows an increase in interventions such as Caesarean Section and Assisted Delivery by Forceps and Vacuum:
* Spontaneous deliveries: 65.0% in 1999 to 57.4% in 2008
* Caesarean section: 20.0% in 1999 to 26.7% in 2008
* Forceps: 4.2% in 1999 to 2.5% in 2004 to 3.7% in 2008
* Vacuum extraction: 9.9 % in 1999 to 12.6% in 2008
- The Same ESRI report shows that first time mothers in Ireland have a 27.3% chance of a Caesarean Section, 7.2% chance of a forceps delivery, and a 21.4% chance of a vacuum extraction. (ESRI Perinatal Statistics, 2008). The WHO recommends that the rate for Caesarean Sections should not be higher than 10% to 15% and that a rate of over 15% does more harm than good.
- "In 2008 approximately 1 in every 200 births were stillborn and 1 in every 470 live births died in the first week of life. Despite improvements in reducing perinatal mortality in recent decades, the perinatal period continues to be a time of relatively high risk." (ESRI, Perinatal Statistics, 2008)
- The shortage of midwives in the main Dublin maternity hospitals is running at around 30%. Midwives are delivering nearly double the number of babies that they ought to be. The risk of serious adverse events has increased significantly. Women are forced to birth and labour without dignity in public spaces.
- Despite the worrying levels of critical staff in maternity services (down 30%) and other health sectors due to financial constraints within the health sectors, a recent Parliamentary Question (PQ No 1294/11 ) Liam Woods ,National Director of Finance, has confirmed that at 28.01.11 there are 110 staff employed at administrative and managerial levels in the Health Service Executive earning over €100,000 a year. The PQ in full is as follows: PQ No 1294/11: To ask the Minister for Health and Children the number of persons employed at administrative and managerial levels in the Health Service Executive as distinct from clinical staff, currently earning over €100,000 a year.
• VBAC (Vaginal Birth After Caesarean Section) rates in Ireland depend on the individual units, ranging from 60-70% to less than 5% (The Irish Caesarean and VBAC Guide, Donegan, 2010). The internationally accepted rate for VBAC per unit is 70%.
- Women surveyed by AIMS Ireland are dis-satisfied with the lack of choice in Ireland; ie only consultant-led care within maternity hospitals. Provisions for Midwife-Led Care must be implemented in accordance with international best practice recommendations which show that the majority of women benefit from Midwife-led care over Consultant led care. Evidence has shown that low risk women attending consultant led care have an increased risk of adverse affects over those who attend Midwife-led care. Ireland currently only has two Midwife-Led Units. Other midwife-led care options include the DOMINO and Community Midwives Schemes out of the National Maternity Hospital (NMH), the Rotunda, Wexford General Hospital and Waterford Regional Hospital, and through limited home birth schemes. Midwife-Led Care is cost effective, safe, and women report better birth experiences over conventional consultant-led care.
- A 2007 case study of NMH's DOMINO scheme found that 5,500 bed days were saved by Community Midwifery Services (Early Transfer Home and DOMINO). The study also found Caesarean rates are significantly lower, e.g. 2007 LSCS in NMH 18.92%, LSCS in DOMINO NMH 5.86%
- The MID-U study, which investigated services within the Drogheda and Cavan Midwife Led Units, reported: "Women's satisfaction with the facilities was apparent in the study and 85% of those attending the MLUs said they would recommend the care they had received to a friend, compared with 70% of those having usual care. Although facilities in the MLUs were quite luxurious, the cost of care for each woman was €332.80 less than in the usual hospital system."
- Home birth is more cost effective. The average uncomplicated vaginal birth costs 68% less in a home than in a hospital, and births initiated in the home offer a lower combined rate of intrapartum and neonatal mortality and a lower incidence of Caesarean delivery (Anderson & Anderson, 1999)
- Non-interventionist, one-to-one care, as provided by midwives, rarely leads to litigation. In 30 years, fewer than five awards have been made against self-employed midwives, and these awards amounted to less than half a million between them. Contrast this with a bill of €400 million in past claims incurred by obstetricians. Midwifery care is also more cost effective. Any birth involving medical intervention costs more, with no benefit to normal healthy mothers and babies. One baby in every four is born by Caesarean section: Caesarean is less safe than normal birth. And it costs three times more.
- According to an HSE report, many small local units are set to lose "inpatient" services due to a shortage of junior doctors and critical medical staff. This will include maternity services for many local units forcing women to travel greater distances and put women at risk of roadside births.
- The same shortage of junior doctors affects women requiring medical assistance; ie early pregnancy assessment, epidural in labour, etc.
- The Irish maternity system has brand new state-of-the-art birth pools, paid for by taxpayers, available in Rotunda, Cork and the MLUs in Drogheda and Cavan. Birth in water has been shown to reduce medical intervention, reduce perineum damage for women, shorten labours, and women labouring in water require less pain medication. However, these pools are closed to use despite a "ban" on waterbirth being lifted over two years ago.
- The Irish maternity system does not recognize women's rights or autonomy; ie informed consent and informed refusal. 75.6% of women surveyed by AIMSI felt consent was a major issue of concern in the Irish maternity system. Ireland has not adopted international guidelines which respect and protect the woman as the key decision maker in her maternity care.
AIMS Ireland 2009 Survey, "What Matters to YOU?"
75% of respondents were not happy with their care options and wanted more choice in midwife-led care.
46% of respondents either had difficulty in accessing information about what care options were available to them, or were unaware of their care options.
Just 9% of respondents knew they had access to a Home Birth option.
20% of respondents said that their wishes in their birth plan were not respected.
Over 50% of respondents who breastfed said their support and information was average (20%) or poor (32.5%).
36.5% of respondents said that their psychological well-being was not addressed at any time by their care providers (GP, consultant, midwife, and PHN).
AIMS Ireland Survey, 2007 "Availability of Information and Consent"
96.3% of the respondents said they would like to see information booklets readily available in all maternity units, health centres and GP surgeries outlining maternity-related procedures, tests, treatments and benefits/risks.
75.6% of respondents stated that they felt that consent is an issue of concern in the Irish maternity system.
57.6% of respondents stated they were not given the option to refuse a procedure, test or treatment.
Key Principals for Maternity Care Which Women and Midwives Want YOUR Party to Implement:
* Lift the freeze on hiring critical midwives - stop the brain drain and ensure women have safe, supportive, one-to-one care.
* Ensure that provisions for new maternity hospitals provide dignified and private labour and birthing facilities - a private room for every labouring/birthing woman.
* Open the birth pools in Cork, the Rotunda, and the MLUs in the Northeast for labouring in water and water birth.
* Implement midwife-led services and community-based maternity services regionally across Ireland with expanded admissions criteria. Evidence recommends that the majority of women benefit from midwife-led care over obstetric-led care.
* Ireland's current criteria for midwife-led care are neither inclusive nor based on individual assessment. Providing more choices outside of obstetric-led care is cost effective and frees up beds in hospitals for women who need or chose consultant-led care.
* Allow equal opportunity for the establishment of free-standing birth centres.
* Recruit appropriate levels of medical staff in order to provide efficient, un-rushed, and supportive care to women requiring anesthetics in labour, early pregnancy scans, tests, etc.
* Implement National Guidelines for Maternity Care in Ireland which respect women's rights and autonomy as per international standards (e.g. NICE guidelines)
* Implement a self-regulating midwives board to protect the profession and autonomy of midwives.
* Support and accept amendments by AIMS Ireland and other organisations on sections 40 and 24 of the Nurses and Midwives Bill.
* Support and facilitate the urgent call for a comprehensive, publicly accountable and transparent review by the Oireachtas Health Committee on the maternity services in Ireland. This would need to be similar in nature to the 1992 Winterton Committee review carried out by the House of Commons. This led to a UK Department of Health framework policy, Changing Childbirth, a major reorientation of maternity services that opened up the pathways to evidence-based midwifery-led care.

A comprehensive review here in Ireland would need to take the shape of public submissions and public hearings of all interested groups, including existing HSE expert groups, by the Health Committee. This would be a democratically accountable process in line with our Constitution.

Please see 20 reasons to amend sections 24 & 40

AIMS Ireland looks forward to your reply and participation.

Please send manifestos to chair@aimsireland.com
Kind Regards,
Jene Kelly
087 681 9095
Krysia Lynch
087 754 3751
Co-Chairs of AIMS Ireland