Policy Spotlight. In this occasional series, we highlight policy ideas and initiatives that can help make Ireland a more properly pro-life place; making pregnancy and parenthood easier and supporting women and babies.
One of the outcomes of the tragic death of Savita Halappanavar was the development of a wide set of recommendations, with the aim of ensuring that such a dreadful event did not occur again in Ireland. As HIQA pointed out in their enquiry into the death of Mrs Halappanavar, there was a ‘disturbing resemblance’ between the circumstances that led to her death and those that led to the death of Tania McCabe in 2007.
You’ve probably never heard of Tania McCabe because her death, and the death of her son Zach, caused nothing like the media storm that the Halappanavar case in 2013 caused. Suffice to say that she died from septic shock following premature rupture of membranes (in other words, her waters breaking early) and there were many deficiencies in her care, just like Mrs Halappanavar. After her death, a suite of recommendations were made on foot of an enquiry into the circumstances surrounding her death. However, HIQA ‘noted with concern that only five of the 19 maternity hospitals/units were able to provide a detailed status update on the implementation of recommendations from the Tania McCabe report’ in their subsequent report into Mrs Halappanavar’s death.
It is perhaps for this reason that the recommendations made in the wake of Mrs Halappanavar’s death were given a bit more priority. Some relate to clinical protocols during pregnancy: for example, it used to be the practice that IV antibiotics were administered twenty-four hours after a woman’s waters broke, but that has been reduced to eighteen hours. However, many of the recommendations relate to staffing or infrastructure, and require investment over a number of years. The deaths of several babies shortly after birth in Ireland, particularly in hospitals in the midlands, also point to the need for substantial investment and improvement in our maternity services. Therefore, an entire ten-year strategy for maternity services in Ireland was developed and launched in 2016: The National Maternity Strategy.
As far as I am concerned, the strategy itself is brilliant. It emphasises childbirth as a natural, normal physiological event, something that is so important in the effort to normalise pregnancy and parenthood.The strategy states at the outset that ‘all care pathways should support the normalisation of pregnancy and birth and women should be encouraged, and supported, to make their individual experience as positive as possible’.
The Strategy also provides clear priorities and targets across a wide range of services spanning our entire maternity care system. For example, the Strategy explicitly states that ‘All women must have equal access to standardised ultrasound services, to accurately date the pregnancy, to assess the foetus for ultrasound diagnosable anomalies as part of a planned Prenatal Foetal Diagnostic Service, and for other indications if deemed necessary during the antenatal period’. This is a particularly important goal as best clinical practice is that all women should have two ultrasounds per pregnancy, one at around 12 weeks to date the pregnancy and a full anomaly scan at around 20 weeks. The anomaly scan can reveal whether the baby is growing at a healthy rate and whether the placenta is doing its job well and in a good position, as well as giving information about whether the baby has conditions such as spina bifida or hydrocephalus that would require interventions before or immediately after birth. The outcomes for these babies can be significantly improved, and their lives even saved, if this information is available in advance. However, not all women receive an anomaly scan – some hospitals provide them to all women, some don’t. The importance of standardised ultrasound services for all women has been repeatedly raised and the National Maternity Strategy finally made a concrete commitment on this.
Unfortunately, so far, the implementation of the Strategy has left a lot to be desired. I gave birth to my third baby in November, and felt so sorry for the other mothers I met and interacted with while I was pregnant who were giving birth in Limerick, Cork or other hospitals that didn’t provide an anomaly scan as standard. Most paid for one privately, as they felt the scan was too important to miss.
I’m also lucky enough to have given birth in Dublin, where consultant-led and midwife-led care are both available to all low risk women and their babies, as well as a publicly-funded homebirth service. Unfortunately, this range of services is currently also only available in certain geographic areas. Many women have no midwife-led unit near them and even fewer women have the option of a homebirth. Strategic Priority 3 of the National Maternity Strategy seeks to end this, explicitly stating that ‘Women will be offered choice regarding their preferred pathway of care, in line with their clinical needs and best practice’ and also that ‘Normal risk women can choose to receive care in an Alongside Birth Centre or in a Specialised Birth Centre. A home birth service, integrated within the maternity network, will be available to normal risk women in line with national standards’. Unfortunately, five years on, we seem to be moving backwards: far from expanding midwife-led care, the midwife-led unit in Cavan hospital was due to be closed last summer, and this decision was only reversed after intense public pressure. Up to twenty pregnant women were left with no confirmation on their plans for a homebirth, despite being clinically approved for a homebirth, due to administration inefficiency from the HSE. And five years on from the launch of the Strategy, there are still no Alongside Birth Centres in Ireland, despite strong demand for this service.
The failure to progress implementation of the Strategy resulted in the resignation of Mark Molloy, one of the patient advocates on the HSE Board last year, only six months after he had been appointed. Mr Molloy’s son, also called Mark, died in Portlaoise hospital due to failings in the care provided to Mark’s mother Róisín during labour and delivery. In his resignation, Mr Molloy specifically referenced the failure of the HSE to follow through on their commitment to provide the funding necessary to implement the National Maternity Strategy. While the funding required was originally provided and ringfenced, it was later diverted to fund the provision of abortion throughout Ireland.
You couldn’t make this up. The many excellent recommendations that were made in the wake of Mrs Halappanavar’s death, which would have resulted in better standards of care for every pregnant woman and their babies, were swept aside, and instead the funding was used to end the lives of (at least – some of the women were surely expecting twins) 6,666 babies in the first year after repeal.
The improvement of maternity services in Ireland should concern everyone. Women and their babies require access to safe, quality care, during and after pregnancy, and the National Maternity Strategy was a wonderful step forward in making that happen. Pro-life people have an extra grievance that the implementation of the Strategy has been sacrificed in favour of abortion, but even those who support abortion provision in Ireland should still be shocked at the manner in which this has played out. The Strategy should be implemented in full and pro-life advocates should play their part in ensuring this happens as soon as possible.