32 HEALTH MATTERS baby boom
Midwifery Services Changing Amid Baby Boom
Our midwifery services are changing as the number of births continues to rise. Dr Maria Fleming, HSE National Planning Specialist (Maternity Services) and Sheila Sugrue, National Midwifery Lead, provide an insight into areas where changes are taking place.
I
reland experienced a ‘baby boom’ during the decade between 1999 and 2009 with the number of births here rising from just over 50,000 to almost 75,000, according to HSE figures. Statistics indicate that the high birth rate is set to continue over the next eight-to-ten years. The increasing birth rate has placed particular pressures on our maternity services. The delivery of maternity services is changing. Maternity and gynaecology services must meet the needs of women who, in the 21st century, are much more engaged with participating in their care with their lead caregiver. Maternity services often refer to women-centred care and this can be achieved by developing a culture of professional multidisciplinary collaboration and fully involving the users of the service. Here we look at two areas where change is taking place – the development of midwifery-led care and the recent recommendation that maternity and gynaecology services in Dublin are located with adult acute services. According to the Central Statistics Office, 2008 saw the highest number of live births registered here since 1896 (75,065) – an increase of 4,445 on 2007. The 2008 total is 41 per cent higher than in 1999 when 53,354 births were registered.
DEVELOPMENT OF MIDWIFERY-LED CARE The HSE is currently studying the details of a report which compared consultant-led maternity care in the North East with a new model of care provided by midwives. The report was commissioned by the HSE and conducted by the School of Nursing and
Midwifery, Trinity College Dublin. The study involved 1,653 women having babies in the north-East from 2004 to 2007, and compared the usual consultant-led maternity care with a new model of care provided by midwives in two integrated midwifery-led units (mlus) in our lady of Lourdes Hospital, Drogheda and Cavan General Hospital.
“according to the central statistics office , 2008 saw the highest number of live births registered here since 1896 (75,065) – an increase of 4,445 on 2007.”
The two MLUs, the first such units in Ireland, were opened in response to recommendations made in the kinder Report (2001), to provide more choice in maternity care in the North East. The study was carried out with the full support and co-operation of medical and midwifery staff in both units in the region. The study showed that midwifery-led care, as practised in these units, is as safe as consultant-led care, but uses less intervention in pregnancy and childbirth. The number of babies needing resuscitation at birth, or admission to the special care baby unit, was the same in both groups. Six out of every ten women (59 per cent) having the usual care in the consultant-led hospitals (Clus) had their baby’s heartbeat monitored continuously in labour by an electronic monitoring machine, compared with 38 per cent of women in the MLUs. Almost half of the women in the Clus (49 per cent) had their labours speeded up by either having their waters broken or having oxytocin, a hormone, given intravenously by ‘drip’, compared with one third (34 per cent) of women in the MLUs.
Birth Statistics
55,000 60,000 65,000 70,000 75,000 80,000
2006 2007 2008 2009
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