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The Midwifery Led Unit in Drogheda

It was exciting to hear that the Midwifery Led Unit (MLU) is finally operating here in Drogheda. This project has been under discussion for a number of years and each time I have visited they have been hoping that it would be starting “soon”. It is now open in two centres, Our Lady of Lourdes Hospital in Drogheda and the Maternity Unit in Cavan, a town nearby. They are approaching their 100th birth in Drogheda and 40th birth in Cavan.

This project is rather unusual, in that it has been set up as a randomised controlled trial. Women who meet a very strict criteria for entrance are randomly allocated to standard care or MLU care and the aim is to recruit around 1800 women into the study. If the results provide positive, the intention is to roll this type of service out across the country, enabling some of the smaller hospitals to stay open, as midwifery services.

In preparation for the study, two birth rooms were prepared in Our Lady of Lourdes Hospital, so that women could labour in “birth centre” surroundings. I haven’t seen these as yet, but may be able to sneak a look today before I leave.

Although this style of care is proving popular wit the women, there are some real problems. The hospital in Drogheda is experiencing staff shortages, and the midwives in the MLU are regularly being taken away from their centre to staff other areas of the maternity unit. This means that there are times when there are too few midwives staffing the MLU - surely a potential risk, both in absolute terms and also for the effectiveness of the study. Many of the midwives I’ve spoken to have expressed concern at this policy, and resent the lack of support from mainstream hospital managers.

The other major problem is that this is a study project, with a limited time frame and a separate budget. Unless there is a very firm commitment from the Government, the Hospitals and the Department of Health, there is a strong chance that the funding will be withdrawn and the MLU will close as soon as the study is complete. This was a common outcome in the UK, when the many pilot projects established after the release of the Cumberledge Report in 1992 were closed as soon as their funding ran out. Many pregnant women found themselves suddenly without a promised service, and many midwives were pitched back into mainstream midwifery when they were beginning to establish themselves as autonomous practitioners in their own dedicated units.

It would be a tragedy if this was to happen in Ireland, a country not known for its innovative approach to maternity services. This project is a worthwhile first, and even if the results are outstanding (in terms of birth outcomes and satisfaction of the women) it seems to already be subject to resistance at top levels. The midwifery team and the doctors who are part of the study are enthusiastic, but this may not be enough to save them when it comes to finding the money to keep the service open once the study is complete.

I have suggested that the midwives become politically active, collecting and cultivating support at the highest levels possible. This “insurance” may become necessary, and it is useful to let management know that the community wants this service to continue, right form the start. The women who have used the MLU will be best source of support and the planned party to celebrate the first 100 births will be a good opportunity to enlist their support.

I have also encouraged them to learn from the experience of other midwifery services who have faced similar problems. There have been many, and picking up a few tips from them would make sense. It is hard to re-establish a closed service - better to prevent it from being closed in the first place.

Posted by andrea at June 23, 2005 05:50 PM