March 09, 2003

Midwifery led care in Ireland

There are some hopeful developments in Ireland in the battle to de-medicalise birth in this otherwise very civilised country. In the north east, some smaller district maternity units were closed about 2 years ago, without any notice and women are now required to travel up to 30 miles to the main hospital in Drogheda. There was an outcry from midwives and women, but the call came too late. Staff too were also relocated into Our Lady of Lourdes and found themselves working in a very obstetric service, which was a complete contrast to the smaller, low tech GP units they were used to.

Now, at last, a midwifery-led unit is to be established in Drogheda. It will be a six bed unit, physically located between antenatal and postnatal wards (which is causing some consternation) and will provide the first real alternative to obstetric care for women in this area. Whilst management has supported its development, there is concern that the reduced number of private beds (necessary to make the required space), and the resultant drop in income, will put financial strain on the maternity budget. The midwives are aware of this potential threat (even before they open!) so the whole project will be evaluated by a PhD student who will be involved from the start, to monitor all outcomes, including costs and savings. The evidence from similar units in other countries has demonstrated that midwifery care is at best cost saving or worse, cost neutral, but in this case it may be necessary to pay particular attention to the less tangible financial benefits to be gained through better breastfeeding rates, fewer later hospital admissions, reduced infection rates, reduced costs for epidurals and other medications etc. This evaluation will provide a rounded financial picture.

The first women will be booked into the new unit in June, and births will be occurring from September onwards. There is still much to be done to prepare the area physically and it may be a race against time to be ready. The inclusion/exclusion criteria are still being finalised as well.

There are some very experienced midwives now working in Drogheda, refugees from the smaller units that were closed. Their frustrations at the current services and their limited role is palpable, and many are hanging out until the new unit opens. They will be an important part in its success as a system of mentorship and preceptorship will be needed to support the younger, less experienced midwives as they learn to assist births without the routine trappings of “active management” that they have come to accept without question. I hope their dreams of once again working as midwives, rather than obstetric nurses, come to fruition. Irish women certainly need their eyes opened as well, and midwives can take a leading role in humanising birth here.

Posted by andrea at March 09, 2003 05:44 PM

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