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Galway midwives set the standard
The midwives of University Hospital Galway believe they know how to improve maternity services for women of this county and beyond.
And they are awaiting the outcome of the new National Maternity Strategy currently being finalised in the hope that it will back them up.
“We are really hoping midwifery-led care will become the norm for all low-risk pregnancies,” explains Jennifer Duggan, clinical midwife manager at UHG. Last year 38% of women who delivered at the Galway unit came through the midwives’ clinics – staffed by just six women, one of them working part-time.
If there was a change of focus, there would need to be a change of resources to expand services run by the midwives.
The Minister for Health Leo Varadkar announced last April the appointment of a steering group to prepare a new National Maternity Strategy that will “put the needs of mothers, babies and their families at its centre”.
Maternity services have been under the spotlight like never before.
Horrific stories have served to undermine the confidence of pregnant women, some of them all too close to home.
The death of Savita Halappanavar at University Hospital Galway in 2009 sparked an international outcry and an avalanche of reports. The deaths of a number of babies at Portiuncla Hospital – with others left seriously deprived of oxygen – is currently the subject of an independent investigation. Publication of the report into “twelve adverse perinatal events” between 2008 and November 2014 at the Ballinasloe facility has been delayed until the end of the year at the earliest.
There are currently five antenatal clinics being run outside of the city, in Tuam, Oughterard, Doughiska, Gort and since last month Athenry.
While the two scans for public patients – one at twelve weeks to give an accurate due date and between 18 and 22 weeks to detect anomalies – are still carried out at UHG, all other checks can be carried out in the community.
In 2014, 499 women had their antenatal care in the community, reducing stress levels of pregnant mums trying to beat traffic and find scarce parking in a jammed packed city campus.
They also get the opportunity to see the same midwife all through term, at an allotted time and in the more relaxed atmosphere of a country clinic. They often feel more able to discuss pressing concerns around their new arrival and become educated about what to expect, reveals Jennifer.
It has the added advantage of taking the pressure off the unit at UHG and frees up consultants to see women with complications.
The early transfer home service allows women who have had a problem-free birth to be discharged within hours of the baby being born and getting all postnatal care in the comfort of their homes.
So instead of being crammed in a six-bedded ward with screaming babies and exhausted mums, they get to sleep in their own beds, eat home-cooked food while a pair of midwives visit them at home for up to five days after birth, giving advice, support, feeding tips and all the usual tests carried out in the maternity ward.
The scheme when it first started off in 2009 had around 9% of eligible women taking part. Last year 398 women were cared for at home – out of 2,900 deliveries.
It still only operates in the city and parts of Oranmore and Claregalway.
Extensive research backs up the case for midwifery-led care.
Trials on more than 16,000 women found that women who receive continuous care from midwives throughout pregnancy and birth fare better than women cared for by a combination of obstetricians, GPs and midwives.
The study carried out by NUI Galway and three British universities and published in the Cochrane Library in 2013 found that those cared for by a small group of midwives throughout pregnancy were less likely to give birth pre-term and required fewer interventions during labour and birth than those whose care was shared.
Women under midwife-led support were found to be happier with the care they received, had fewer epidurals, fewer assisted births and fewer episiotomies. They were “no more likely” to have a Caesarean birth, but were in labour for about half an hour longer on average. Women at low risk and high risk of complications participated in the study.
Ireland differs from countries such as Britain and Australia where midwives are the main providers of care to pregnant women. Here 95% are booked directly into the care of a consultant obstetrician.
“Hospital care in Ireland is obstetric-led in practice and policy and includes many routine interventions which increase distress to babies in labour and increase the risk of adverse effects on women, for example higher rates of induction, amniotomy (breaking the waters), epidural analgesia and use of oxytocin,” according to Jene Kelly from the Association for Improvements in Maternity Services (AIMS Ireland).
“Some practices may not be routine for every woman, but are frequently in use despite risks. For example recent research by the American College of Gynaecologists has shown the use of oxytocin – for induction of labour or to ‘speed-up’ labour – poses an independent risk to babies and increases neonatal intensive care admissions.”
Minister Varadkar acknowledged there was a clear need to provide reassurance in terms of safety, quality and choice.
There was a 22 per cent rise in the number of maternal deaths in 2010-2012 – making it higher than in the UK, according to the Confidential Maternal Death Enquiry.
In the same period, the birth rate here has also increased dramatically – by approximately 30% from 2000 to 2012, with the greatest number of births recorded in 2009. In Galway the peak birth rate was in 2008 when 3,600 babies were born.
According to a recent opinion piece by consultant obstetrician and gynaecologist at the National Maternity Hospital Dr Peter Boylan, the recommended midwife to patient ratio is 1:30, the recommended consultant to patient ratio is 1:350.
Consultant numbers would have to almost double to achieve the recommended level, while an estimated 600 additional midwifery posts are needed to achieve the ratio.
Significant state investment is required to address ‘shocking’ inequalities that leave cancer patients in the West at greater risk of succumbing to the disease.
A meeting of Regional Health Forum West heard that survival rates for breast, lung and colorectal cancers than the national average, and with the most deprived quintile of the population, the West’s residents faced poorer outcomes from a cancer diagnosis.
For breast cancer patients, the five-year survival rate was 80% in the West versus 85% nationally; for lung cancer patients it was 16.7% in the west against a 19.5% national survival rate; and in the West’s colorectal cancer patients, there was a 62.6% survival rate where the national average was 63.1%.
These startling statistics were provided in answer to a question from Ballinasloe-based Cllr Evelyn Parsons (Ind) who said it was yet another reminder that cancer treatment infrastructure in the West was in dire need of improvement.
“The situation is pretty stark. In the Western Regional Health Forum area, we have the highest incidence of deprivation and the highest health inequalities because of that – we have the highest incidences of cancer nationally because of that,” said Cllr Parsons, who is also a general practitioner.
In details provided by CEO of Saolta Health Care Group, which operates Galway’s hospitals, it was stated that a number of factors were impacting on patient outcomes.
Get the full story in this week’s Connacht Tribune, on sale in shops now, or you can download the digital edition from www.connachttribune.ie. You can also download our Connacht Tribune App from Apple’s App Store or get the Android Version from Google Play.
On the eve of completing his 150th marathon, an odyssey that has taken him across 53 countries, Loughrea’s Marathon Man has announced that he is planning to hang up his running shoes.
But not before Jarlath Fitzgerald completes another ten races, making it 160 marathons on the occasion of his 60th birthday.
“I want to draw the line in 2026. I turn 57 in October and when I reach 60 it’s the finishing line. The longer races are taking it out of me. I did 20 miles there two weeks ago and didn’t feel good. It’s getting harder,” he reveals.
“I’ve arthritis in both hips and there’s wear and tear in the knees.”
We speak as he is about to head out for a run before his shift in Supervalu Loughrea. Despite his physical complaints, he still clocks up 30 miles every second week and generally runs four days a week.
Jarlath receives injections to his left hip to keep the pain at bay while running on the road.
To give his joints a break, during the winter he runs cross country and often does a five-mile trek around Kylebrack Wood.
He is planning on running his 150th marathon in Cork on June 4, where a group of 20 made up of work colleagues, friends and running mates from Loughrea Athletics Club will join him.
Some are doing the 10k, others are doing the half marathon, but all will be there on the finishing line to cheer him on in the phenomenal achievement.
Get the full story in this week’s Connacht Tribune, on sale in shops now, or you can download the digital edition from www.connachttribune.ie. You can also download our Connacht Tribune App from Apple’s App Store or get the Android Version from Google Play.
From the Galway City Tribune – An impassioned plea for a ‘masterplan’ that would guide Galway City into the future has been made in the Dáil. Galway West TD Catherine Connolly stated this week that there needed to be an all-inclusive approach with “vision and leadership” in order to build a sustainable city.
Deputy Connolly spoke at length at the crisis surrounding traffic and housing in Galway city and said that not all of the blame could be laid at the door of the local authority.
She said that her preference would be the provision of light rail as the main form of public transport, but that this would have to be driven by the government.
“I sat on the local council for 17 years and despaired at all of the solutions going down one road, metaphorically and literally. In 2005 we put Park & Ride into the development plan, but that has not been rolled out. A 2016 transport strategy was outdated at the time and still has not been updated.
“Due to the housing crisis in the city, a task force was set up in 2019. Not a single report or analysis has been published on the cause of the crisis,” added Deputy Connolly.
She then referred to a report from the Land Development Agency (LDA) that identified lands suitable for the provision of housing. But she said that two-thirds of these had significant problems and a large portion was in Merlin Park University Hospital which, she said, would never have housing built on it.
In response, Minister Simon Harris spoke of the continuing job investment in the city and also in higher education, which is his portfolio.
But turning his attention to traffic congestion, he accepted that there were “real issues” when it came to transport, mobility and accessibility around Galway.
“We share the view that we need a Park & Ride facility and I understand there are also Bus Connects plans.
“I also suggest that the City Council reflect on her comments. I am proud to be in a Government that is providing unparalleled levels of investment to local authorities and unparalleled opportunities for local authorities to draw down,” he said.
Then Minister Harris referred to the controversial Galway City Outer Ring Road which he said was “struck down by An Bord Pleanála”, despite a lot of energy having been put into that project.
However, Deputy Connolly picked up on this and pointed out that An Bord Pleanála did not say ‘No’ to the ring road.
“The High Court said ‘No’ to the ring road because An Bord Pleanála acknowledged it failed utterly to consider climate change and our climate change obligations.
“That tells us something about An Bord Pleanála and the management that submitted such a plan.”
In the end, Minister Harris agreed that there needed to be a masterplan for Galway City.
“I suggest it is for the local authority to come up with a vision and then work with the Government to try to fund and implement that.”
Families queue up for school’s offer of free house
West has lower cancer survival rates than rest
Galway minors continue to lay waste to all opponents
Gardaí and IFA issue a joint appeal on summer road safety
Marathon Man plans to call a halt – but not before he hits 160 races
