Maternity services in Northern Ireland: Review calls for overhaul

A review into maternity services sparked by the death of a baby has recommended an overhaul of the system in Northern Ireland.

Report author Prof Mary Renfrew identified “both serious weaknesses and real strengths” in current services and said “urgent transformation” was needed.

A review was recommended by a coroner who had ruled on the death of baby Jaxon McVey after failings at the Lagan Valley hospital in Lisburn in March 2017.

Jaxon’s mother Christine McCleery welcomed the report but said she still had concerns about the recommendation of midwifery-led standalone units, where specialist doctors would not be present.

Problems arose during Jaxon’s delivery at Lagan Valley’s midwifery-led unit.

Ms McCleery had developed a complication known as shoulder dystocia, which means the baby becomes stuck during the final stages of labour.

The inquest heard the boy’s stillborn death had been foreseeable and preventable.

Ms McCleery said the “extensive” report was great to see and it was clear that things were not what they should be.

However, on the issue of midwife-led units, she said the lack of immediate medical intervention meant mothers and babies were at further risk in emergencies.

Prof Renfrew, who spoke to women, families and staff, said her review was aimed at ensuring women, babies and families receive safe, equitable and quality maternal care.

Some women suffered what she described as unacceptable experiences which contributed to physical and emotional harm, sometimes causing long-lasting distress.

“We also heard from women about disrespectful communication and not being listened to was a really big theme,” she added.

However, she said there were also positive examples.

Many staff members were trying their best going over and above every day, but the problem was the wider system, she added.

The review said Northern Ireland was not alone in experiencing constraints to quality care provision for women and babies.

Unlike other reviews, the report details 32 recommendations for action and is accompanied by a five-year programme for change.

• Inequalities in care and outcomes, and inconsistent processes across Northern Ireland
• Northern Ireland does not have all the necessary structures and processes in place to effectively drive equitable, region-wide improvement
• A lack of framework for effective interdisciplinary education and training
• Staff working in silos and unclear accountability
• Limited scrutiny and evaluation
• Lack of information about women’s experiences of care and staff well-being
• Senior managers and governance unaware of the extent of problems

• Community midwifery hubs, midwifery units and home births should be fully supported and integrated seamlessly into wider maternity services
• A shared strategic vision with a regional framework for action
• A reconfigured relationship with women, families and communities ensuring respectful personalised care for all
• A consistent region-wide evidence-informed approach to planning, funding, standards provision, monitoring and review of services
• Better oversight through improved accountability, monitoring, evaluation and research
• A unified approach to education and training of all staff, including leadership development – especially for midwives

Prof Renfrew said she was not recommending any services closing and that it was more about services “shifting”, with people and trusts working more collaboratively.

There are no longer any freestanding midwifery-led units in Northern Ireland.

Northern Ireland has the highest rate of caesarean sections in the UK, which the review concluded placed increased demands on midwife care and hospital beds.

Health Minister Mike Nesbitt said: “There is a clear message that all of us involved in the health service must listen to women. I am listening and I agree that improvement is needed.

“Childbirth is a hugely significant life event for women, babies and their families and it is essential that they are provided with safe, respectful, kind, evidence-informed, multidisciplinary, individualised care across the continuum of care in all settings.”

Speaking in the assembly, Mr Nesbitt said a new maternity and neonatal partnership would be established to drive forward improvements.