HEALTH MATTERS 33 baby boom
The model of care used in the two MLUs is one where midwives, working in partnership with the woman, are the lead professional. They provide care in pregnancy, shared with the woman’s general practitioner if desired, and refer any problems to the GP or obstetrician as necessary. When the woman commences labour, she comes to the MLU, which is a separate unit within the maternity hospital, and is welcomed into her room where she stays for the labour, birth and postnatal resting time. Each room has a bed, pull-out couch for her partner to sleep on, a birthing pool, birthing aids, television, and tea/coffee-making facilities available. Women’s satisfaction with the facilities was apparent in the study and 85 per cent of those attending the MLUs said they would recommend the care they had received to a friend, compared with 70 per cent of those having usual care. In labour, fewer women in the MLU group chose to have epidurals (19 per cent) than did those in the Clu (25 per cent). other methods of pain relief chosen included immersion in warm water in a birthing pool (24 per cent in mlu compared with three per cent in Clu). despite having fewer epidurals, 83 per cent of women in the MLUs expressed satisfaction with their pain relief, compared with 68 per cent of women in the CLU. At birth, women in the MLU had a higher rate of spontaneous pushing and 20 per cent used upright positions for birthing, compared with six per cent in the CLU. In addition, 13 per cent did not require any drugs to speed up the after-birth, compared with just one woman (0.2 per cent) in the Clu. The results of the study concur with
those from international research and the Cochrane review of midwifery-led care concludes that most women should be offered midwife-led models of care.
INDEPENDENT REVIEW OF MATERNITY & GYNAECOLOGY SERVICES IN THE GREATER DUBLIN AREA The HSE is committed to developing a strategic approach to maternity services nationally. The first stage in this work was the Independent Review of Maternity & Gynaecology Services in the Greater
MLU SERVICE USER
One mother, who gave birth in the Midwifery-Led Unit at Our Lady of Lourdes Hospital in drogheda in 2009, recently described the overall experience as “extremely positive”. She said the information pack given to expectant mothers was very informative and comprehensive. “Any concerns I had were dealt with in a very thorough and professional manner. I took a more proactive role in preparation for the birth and I feel this was due to the advice and encouragement I received while attending the MLU,” the woman said. She added: “I recall feeling an immediate sense of calm and relief as I entered the MLU in labour. Acknowledging the fact that it was my second labour I felt at ease and had little anxiety, feeling mostly positive, and
Dublin Area published last year. The review, conducted for the HSE by KPMG Consultants, sets out recommendations and provides a high level action plan to facilitate the delivery of the best model of care for primary, community and hospital maternity services, to make available safe, sustainable, cost effective, high quality maternity, neonatology and gynaecology care services. The publication of the Review followed a significant engagement and consultation with the main organisations and representative groups involved in the delivery of maternity and related services across the Greater Dublin Area. The review concluded that Dublin’s
coping well with my labour as it progressed. I was regularly informed of my progress and went on to have a normal delivery with no complications.” The woman said her time spent in the
MLU post natal was peaceful and private. “I was offered good support and encouragement in establishing breast- feeding and all related explanations were clear. So too was the advice and information I received on my discharge home. I felt that the follow up care for the week at home prior to discharge to the Public Health Nurse was also very attentive and thorough.” She concluded: “I do feel that the care
provided to me in the MLU was very personal and woman-centred, and I would strongly advocate referral to this service.”
current model of standalone maternity hospitals is not the norm internationally. It is well recognised that for optimal clinical outcomes maternity and gynaecology services are located with adult acute services. This allows the mother to access a full range of medical and support services should the need arise for for example, cardiac and vascular surgery, diabetes services, intensive care facilities, haematology services and psychiatric services among others. Therefore it is recommended that: • Coombe women & Infants university Hospital is co-located with the Adelaide Meath & National Children’s Hospital (AmnCH).
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