HSE Home Birth Service Clinical Professional Seminar & workshop for healthcare professionals

National Strategy for Maternity Services National Strategy for Maternity Services. DOH Creating a Better FutureTogether:2016 – 2026 A Woman Centred Approach Sheila Sugrue (RM,RN RMT BNS, MSc Midwifery) National Lead Midwife ONMSD

Very Proud to be associated with the National Maternity Strategy First of its kind

Background 1951 Minister for Health Dr Noel Browne proposed Mother and Child Scheme Universal health care for mothers and children for the first time Resistance From Church and Medical Profession(Kennedy and Einasto, 2010) Proposal abandoned Shaped maternity services for the next 50+ Introduction of Maternity and Infant Care Scheme

Mother and Infant Scheme 1954 Assumption that Care is provided by the GP and the Obstetrician led to under-development of midwifery provided/led services A fee entitled women private care/choice/continuity of carer Private Health Care 1956 A few attempts to address it Kinder Report 2001 Blueprint for Women Centred care Introduction of Midwifery Led Units KPMG Report 2008 Reference: Kennedy P. (2012) Change in Maternity Provision in Ireland “Elephants on the move” ( Kennedy P. (2012)Change in Maternity Provision in Ireland “Elephants on the move. Economic and Social Review Vol 43 No 3. pp377-395

Drivers Adverse Events Media Coverage International Maternity Policy Trends Need to Restore Public Confidence Willingness for Change Women Asserting their needs Unique opportunity to focus on health and wellbeing Making every Contact count

Current Irish Maternity Services Consultant Led and Hospital based 4 Stand alone Maternity Hospitals 15 co-located hospitals Competing for resources Voice Diluted 2 MLU Number of Births expected to decrease until 2020 Home Births – Planned HSE – Number have increased year on year with 180 births recorded in 2015

Number of Maternity Hospitals/ Units Number of Births Number of Maternity Hospitals/ Units Hospitals <1500 3 Sligo General, South Tipperary General and Kerry General Hospitals 1500 - 2000 7 St Luke's Kilkenny, Wexford General, Midland Regional Portlaoise, Cavan General, Letterkenny General, Mayo General and Portiuncula Hospitals 2000 - 3000 Midland Regional Hospital Mullingar, University Hospital Waterford and University Hospital Galway 3000 - 4000 1 Our Lady of Lourdes Hospital Drogheda 4000 - 5000 University Maternity Hospital Limerick 5000 - 8000 8000 - 9000 Coombe Women & Infants, Rotunda and Cork University Maternity Hospitals >9000 National Maternity Hospital

Expectant Women Average age giving birth: 32.3 yrs Nationalities: 15.5% EU outside Ireland 6.6% Non EU Health and Wellbeing 20% Smoke/Drink 25% Obese Breastfeeding Rates: - 56% initiated in 2013 (Australia 96% and UK 81%) with 35% recorded at 3 months PHN visit Complex pregnancies: Require increased support Low birth weight and pre-term births increased Perinatal Mental Health: Prevalence reported 11.4-28.6%

Female Population Ages 15–49 up to 25,000 25,001–40,000 40,001–60,000 60,001–130,000 over 130,000 up to 2,000 Births 2,001 - 5,000 Births above 8,000 births

Process First Maternity Strategy Chair: Ms Sylda Langford 31 members – multidisciplinary Service Providers Consultation – Professional and Public > 1,300 submissions May 2015 –January 2016

What did women and professionals want Public Consultation Who: What works well?: Not Working Well How can services be improved? Partnerships Facilitate Choice Implement evidence based policies and practice Ensure continuity of care Standardise the System

Consultation

Not Working Well. How can services be improved? Poor quality, inconsistent antenatal and postnatal care Poor Communication Limited Mental Health Support Poor Breastfeeding support in hospital and community Standardise health promotion advice and information for pregnant women Make it available on-line Devise and roll out public health campaigns Provide better quality breastfeeding information and education Advice must be consistent, clear and impartial Implement evidence based policies Make every Contact Count

National Maternity Strategy PRINCIPLES Access to safe, high quality, nationally consistent woman-centred maternity care Health and Wellbeing Approach is adopted Develop a culture of normality Integrated service available Maternity Services appropriately resourced Strong effective leadership, management and governance arrangements Delivered by a skilled and competent workforce

What Women Want Choice Continuity of Care Control Express preferences Linked to information sharing Availability of options Continuity of Care Form relationships Emotional and Physical connection Journey Control Being listened to

Health and Wellbeing Approach Underpin Policy and Service delivery Healthy Ireland 2013-2025 Breastfeeding Action Plan 2016-2020 Preconception Empowerment of women Preconception GP Visit Antenatal Care Holistic approach to women’s healthcare needs –responsive and timely and in appropriate environment Integrated and appropriately structured maternity care Specific groups may need focused attention Information – readily understandable – should be assessed Postnatal Care Mother baby attachment facilitated and supported Continuity of care/carer Appropriate referrals Unplanned pregnancies. Conveyor belt system with long waiting times.

Health and Wellbeing Approach 2 Breastfeeding Evidence of very low rates Provide better quality Information and education Importance of dedicated staff Postnatal support Develop KPIs/Metrics Bereavement Improve and standardise bereavement care HSE will implement Standards for Bereavement Care Following Pregnancy Loss and Perinatal Death 2016 Establish trained bereavement teams in each maternity unit/hospital.

Model of Care - Choice Suite of maternity choices – preferred pathway of care Involves – a clinical risk/need assessment Individualised approach Proposes 3 care pathways Supported Assisted Specialised

Supported Care Homebirths Alongside birth centres Care provided by Community Midwifery team Integrated Service Part of the Maternity Network Agreed National Standards Clear pathways for any change in risk profile

Implementation National Women and Infants Health Programme Requires a detailed Plan and Timetable Finalised within 6 months Care provided by Multidisciplinary teams Each woman will have a named appropriate health care professional according to her needs Maternity Network Defined patient safety and quality framework Leadership, governance, clinical commitment, clinical effectiveness approaches DOM in 19 Units Group DOM- 13 in post HIQA - Standards for a better Maternity Service –Dec 21st Establish a new Community Midwifery Service

National Women and Infants Health Programme Dedicated Expertise Response to HIQA Report into Portlaoise Lead, Manage and Organise Maternity Services Provide oversight and support for service providers All services developed coherently Funding made available through the Programme Programme Director member of HSE Leadership Team

Make Every Contact Count Thank You