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

2. 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

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

4. 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

5. 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. pp

6. 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

7. 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

8. 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 7
St Luke's Kilkenny, Wexford General, Midland Regional Portlaoise, Cavan General, Letterkenny General, Mayo General and Portiuncula Hospitals
Midland Regional Hospital Mullingar, University Hospital Waterford and University Hospital Galway 1
Our Lady of Lourdes Hospital Drogheda
University Maternity Hospital Limerick
Coombe Women & Infants, Rotunda and Cork University Maternity Hospitals
>9000
National Maternity Hospital

9. 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 %

10. 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, ,000 Births
above 8,000 births

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

12. 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

13. Consultation

14. 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

15. 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

16. 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

17. Health and Wellbeing Approach
Underpin Policy and Service delivery
Healthy Ireland
Breastfeeding Action Plan
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.

18. 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.

19. 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

21. 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

22. 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

23. 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

24. Make Every Contact Count
Thank You