Pat Daly, partner and medical negligence solicitor at Cantillons Solicitors in Cork, writes on the controversy around the new National Maternity Hospital.

There has been a lot of controversy about the location for the National Maternity Hospital over the last few weeks. As a Solicitor who specialises in medical negligence cases, I would urge the various stakeholders to grapple with this thorny issue once and for all so that the women of Ireland can have confidence in the maternity services provided.

Unfortunately, I have come across families who have had very negative outcomes and experiences in relation to maternity care. The most devastating and distressing cases are those involving maternal deaths. There is a perception that the incidences of maternal death is not a common occurrence. Unfortunately, this is not the case. Prior to commencing practice in Ireland, I was a Solicitor in London. In my career I have dealt with five maternal death cases. Three in the UK and two in Ireland and I cannot articulate in words the impact that a maternal death has on the family unit. According to the latest statistics published by the Confidential Maternal Death Enquiry Ireland between the years 2012 - 2014 there were a total of 22 maternal deaths in that period. Behind every statistic there is a family unit that has been devastated by the loss of a young woman in the prime of her life. Frequently, the baby survives and the husband has to contend not only with the death of his wife, but he then has to nurse a new baby. If there are other children in the family the husband has to singlehandedly provide childcare and run the family home, whilst trying to earn a living. There is an emotional, social, physical and economic impact to the families.

There are three standalone maternity Hospitals in the greater Dublin area. The Rotunda Hospital, the National Maternity Hospital and the Coombe Hospital which are separate from acute Hospitals. These hospitals are tertiary referral hospitals so if a woman has a complicated pregnancy, she will be referred there for specialist care. However, complications in pregnancy can give rise to the most acute life threatening conditions and these hospitals are not able to provide the necessary multidisciplinary services to provide support to a high risk patient via access to ITU, radiological and transfusion services. Desperately ill women have to be transferred to acute general hospitals by ambulance. However, the transfer of an acutely ill woman poses immense challenges for the clinicians that could be avoided if the maternity hospital was attached to an acute hospital. It appears to be accepted that the standalone maternity hospitals are not the norm internationally and it is no longer considered as international best practice.

There are frightening statistics lurking in the background about obstetric care. There are 19 maternity hospitals in Ireland who submit data to the National Perinatal Epidemiology Centre. This information is collated and again the 2014 Annual Report was published recently. The findings highlighted a staggering 18 per cent increase of severe haemorrhage following the birth of babies since 2011. It is hard to imagine that there has been an 18 per cent “increase” in serious maternal haemorrhages, but that is what recent statistics appear to show. What is even more alarming is that the clinicians/researchers cannot give an explanation for why there has been such an increase. There has been a suggestion that perhaps there was under reporting in the past and that the actual incidents of maternal haemorrhaging is possibly, if not probably, on a par with what it has been over the recent number of years. The explanation for “increase” of 18 per cent in serious maternal haemorrhages, is as a consequence of the now mandatory reporting of adverse incidents which is being operated by the HSE. If that is true, it would seem to suggest that these matters were just not reported, either to the HSE, or to the patient/next of kin, in the past. If that is so, I find that of concern. It means that a conscious decision was made, by a significant number of Obstetricians and hospitals not to record the fact of significant maternal haemorrhage. Alternatively, and perhaps benignly, there was no system in place for recording such matters. This, again, is an equally worrying situation.

One way or the other, the incidents of maternal haemorrhage, as of now is (and probably was for some time), alarmingly high. If a woman haemorrhaged in a Dublin obstetric hospital or in another obstetric hospital around the country that is not attached to a main acute hospital she would not have immediate access to a multi-disciplinary team and would need to be transferred. Everybody wants safe, high quality maternity services in Ireland, so it is imperative that this situation is not allowed to continue before there are other women who will bleed to death.