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Midwifery matters - Achieving high quality care

Deirdre Munro urges midwives to have a stronger voice and to support one another through challenging times

Maternity services in Ireland are journeying through an extremely troublesome period. Women, their partners and families are nervous and question the ability of our maternity services. Midwives work under stressful conditions, often exhausted and anxious. It is reported that Irish birth rates are slowly decreasing, but, inversely, dependency levels are increasing, along with maternal age and other complexities such as diabetes, obesity and other medical conditions.

Due to the government moratorium on recruitment, which is compounded by a significant number of retirements, staffing levels have reduced in Ireland over recent years. The INMO recently reported on midwifery to birth ratios in 19 maternity units in Ireland (see pages 6-7). Regrettably, not one Irish maternity unit achieved the Birthrate plus UK recommended ratio of 1:29.5 in a hospital setting.

The mean ratio reported in Ireland is 1:40. Calculating staffing levels with birth ratios alone is by no means a ‘dream equation’ and is debated as a biased measurement . Ideally, midwifery staffing levels should be calculated utilising birth rates in addition to preconception care, fertility and total pregnancies.

Currently, Irish maternity services are being reviewed and according to the Health Minister Dr James Reilly a new ‘National Maternity Services Strategy’ will be published later this year. In the meantime, as midwives we need to take a deep breath, remain calm and find inner strength to support women and each other in our daily work. Hopefully then a quality maternity service may follow, along with more staff.

A reflection
We need to continue caring, being kind to women, our colleagues, ourselves. We need to continue respecting women, our colleagues, ourselves. We need to continue practicing safe midwifery care. We need to continue practicing competently, with dignity.

We need to continue researching, sharing up-to-date information and really listening. We need to continue expressing concerns speedily, openly, honestly and escalate concerns. We need to continue being confidential and professional.

We need to continue solving problems as a team and courageously try new ways

We need to focus on the positives. We need to stop ourselves and our colleagues wallowing in negativity. We need to say ‘well done’ and ‘thank you’ more often. We need to keep trying.

System failure
The term ‘system failure’ in maternity care seems vague and callous aptly described by Don Berwick in his letter to the NHS: “the abstract concept of a ‘system’ that fails has concrete meaning in the life of every doctor, nurse, or therapist who couldn’t find a crucial test result, became exhausted when staffing was inadequate to meet patients’ needs, or watched a patient get an infection in a hospital”.

The UK patient safety review by Berwick recommends four guiding principles:

  • Place the quality and safety of patient care above all other aims - The safest and best route to lower cost
  • Engage, empower, and hear patients at all times
  • Foster wholeheartedly the growth and development of all staff, especially with regard to their ability and opportunity to improve the processes within which they work
  • Insist upon, and model in your own work, thorough and unequivocal transparency, in the service of accountability, trust, and the growth of knowledge.

Midwives recognise the need for systemic change in maternity services. The goodwill and best intentions of midwives need to be nurtured and valued. We need to achieve maternity care goals as a team, utilising quantitative measures as a guide map rather than the target.

Better maternity care can only be achieved if blame is abandoned as a measuring tool. Our shared primary goal of high quality maternity care is achievable only when transparency and fairness is deemed essential.

Clearer role definitions in maternity care – including structured ‘add-on projects’ – may facilitate higher quality performance and pave the route for responsibility and accountability, while strengthening maternity care.

Midwives need protected time to obtain career-long learning, thus facilitating interpretation and application of modern methods of quality planning and quality improvement in maternity care.

Stronger voice
It is time to revitalise midwifery in Ireland. It is time for midwives to have a stronger voice. We need to use our voice to create the agenda and to steer policy. We need to highlight the need for more staff, to facilitate safe midwifery care and to protect time to educate and learn.

We need to brain storm to create and develop innovative solutions. We must remember that we are not alone; we have each other.

Deirdre Munro is the newly elected INMO Midwives Section education officer and ICM invited Irish observer, Prague 2014

Midwifery matters - Achieving high quality care


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