Irish maternity services understaffed - average ratio of one midwife to 40 births

The results of a midwifery staffing survey, carried out by the INMO, confirm the health service has a critical shortage of midwives in all of our 19 maternity hospitals/units.

In addition, the survey found that the internationally recommended midwife-to-birth ratio of one midwife for every 29.5 births (1:29.5) is not in place in any of Irish hospitals or midwifery units. The ratios found by the survey varied in range from 1: 32 to 1:55, with a national average of 1:40.

The midwife-to-birth ratio of 1:29.5 is accepted by the NHS in the UK, the Royal College of Midwives, the Royal Colleges of Obstetricians and Gynaecologists, Paediatrics and Child Health and Anaesthetists, and the UK Independent National Audit Office.

Pictured at the press conference in INMO HQ were (l-r): Liam Doran, INMO general secretary, Claire Mahon, INMO president, Deirdre Munro, INMO Midwives Section, education officer

The results of the staffing survey can be seen in the Table. The survey findings confirmed the wide variation in staffing levels and underlined that the Irish maternity service needs more than 621 midwives to reach the recommended staffing level for safe and better care.

The survey, carried out in February, also confirms the following:

• The maternity unit in Portlaoise is the poorest staffed unit in the country, at a ratio of one midwife to 55 births and requires 33 additional midwives immediately to reach the recommended ratio
• The Coombe Women and Infants University Hospital, which is now the support for Portlaoise, is itself severely understaffed with a midwife to birth ratio of 1: 40. This must raise questions over its ability to look after high-risk pregnancies referred from Portlaoise
• Our Lady of Lourdes Hospital (maternity unit), despite numerous reports calling for improved staffing, remains grossly understaffed with a ratio of one midwife to 37 births. This level of understaffing is very disturbing in view of earlier serious incidents that were the subject of external investigation and subsequent commitments to implement a number of recommendations including improved staffing
• Galway, also the subject of recent reports and recommendations, remains severely understaffed at one midwife to 41 births
• Other major mater n i ty hospitals are all severely understaffed with ratios as follows:
• Limerick 1:34
• Cork: 1:37
• Rotunda 1: 48
• NMH, Holles St 1:39.

The staffing situation has been greatly exacerbated, over the past five years, arising from the loss of 5,200 (HSE figure) nursing/midwifery posts as a result of the ban on recruitment.

The INMO has worked extensively with the Royal College of Midwives (RCM) on the issue of staffing levels and midwife-to-birth ratios generally.

Speaking on the survey findings, Breedagh Hughes, director of the RCM Northern Ireland, said:

“The RCM fully supports the INMO in this campaign for better midwifery care. When faced with a similar situation a number of years ago in maternity units in Northern Ireland, immediate and robust remedial measures were put in place by the then Health Minister to recruit additional midwives and also to increase the number of training places to prevent the situation reoccurring in the future”.

It is worth noting that the midwife-to-birth ratio, in Northern Ireland, is 1:24. This stark difference in staffing levels, which must affect standards of care and the overall experience of the mother and baby, according to the INMO is “inexplicable” and cannot be justified.

The INMO was scheduled to meet with the Department of Health as WIN went to press to discuss this crisis. At this meeting, the Organisation was planning to seek the introduction of a range of measures including:

• Immediate lifting of the recruitment moratorium
• Immediate commencement of a national/international recruitment drive for midwives
• Immediate commencement of back to midwifery programmes, in all major centres, across the country
• Recommencement of postgraduate programmes, leading to registration as a midwife
• An increase, for a minimum of four years, in the number of undergraduate places, for the four-year midwifery degree programme, from the current 140 per annum to 200.

The INMO has also sought a meeting with the HSE.

In addition, the Organisation has written to the chairperson of the Oireachtas Health Committee, Jerry Buttimer, seeking an immediate meeting with the Committee to discuss the extent of this crisis and to seek the committee’s support for these measures to ensure better midwifery services.

Speaking on the staffing crisis, INMO general secretary Liam Doran said:

“This survey confirms we are over 621 midwives short of the number needed to deliver safe, better and high quality care to mothers and babies. Births in this country continue to be at a very high level, relative to the EU, and have increased by over 16% in the past decade while midwifery staffing numbers have been cut.

“It is also a fact that births are becoming increasingly complex, which, in turn, puts even greater demands upon midwives and maternity services generally.

“What is needed now is immediate action on the recruitment of additional midwifery staff. We do not need any more reports or reviews as best practice, in the form of midwife to birth ratio is now well accepted internationally and needs to be implemented here with out delay,” he said.

INMO president Claire Mahon, also speaking on the survey findings said:

“It is quite clear that cuts in midwifery staffing has a direct consequence upon the standard of midwifery care, available to mothers and babies. Money invested in maternity services is also money invested in the future health of this country. The first priority, of the Department and the HSE, must be to agree the initiatives we are proposing so we collectively work to achieve the recommended midwife to birth ratio nationwide”.