It’s been another rough year for Ireland’s maternity services. As the recommendations of various reports begin to shape a new focus for the future, it’s safe to say the scandals of the past at least brought us closer to fully acknowledging a crisis was raging on the labour ward.
Nobody understands the challenge ahead more deeply than Dr Rhona Mahony, Master, National Maternity Hospital, Holles Street. We caught up with Dr Mahony, a consultant obstetrician, gynaecologist and specialist in foetal and maternal medicine, (and the first woman to head a Dublin maternity hospital) to talk “women’s things”, the realities of pregnancy and birth and the challenges facing Irish obstetricians.
As a mum of four herself, Dr Mahony believes more could be done to protect the next generation…and the brave women delivering it.
“There’s a tendency to dismiss matters relating to pregnancy and gynaecology as almost “women’s things” and somehow not important. They’re unbelievably important. We basically deliver the next generation. Every single person is born, not just women but men as well and while most pregnancies end positively and the outcomes are excellent, it’s a very complex and high risk area. You have two lives, maybe more, really united in a complex physiology so there’s tremendous potential for risk and for adverse outcome. Our complications can be really unpredictable and they can happen really suddenly.
I don’t think we appreciate the risk in obstetrics sufficiently and therefore it needs to be an area that’s really resourced. We do very well still (our outcomes, when we compare them internationally, really are very good) but the women coming through our doors are changing. We have older women, we have women with various diseases, women with obesity. Women have had more surgeries, previous Cesarean sections for instance, so we’ve got to be ready for that. We’re all familiar with the labour where everything’s going beautifully, everyone’s very happy and suddenly the atmosphere changes and we might have a big haemorrhage on our hands or a major complication.
We all need to work together and make sure that as a country, we really pay attention to maternity services. It’s just so important that these services are adequately staffed, that we have the infrastructure, that we have really good hospitals specifically designed for women. It should be a national issue, not just ‘women’s things’.
In terms of challenges facing obstetrics we have the usual ones; infrastructure, we work in old hospitals (we’re making plans for three hospitals in Dublin so hopefully that’ll be a very exciting development). Then we need to look at staffing levels: we’re not adequately staffed. We know that we have the lowest number of obstetricians in the OECD. We’ve a low number of midwives as well, that’s got to be addressed. You must make sure the front line is equipped. Obstetrics is all about time and emergency. It might feel routine to us, but in fact, technically, these are all emergencies, day in, day out.
The big worry I have now is morale. We’ve had a bad rap in the last while, a lot of scandals in the paper. It does have an effect on staff who are under resourced and really doing their best. We are highly punitive in Ireland and if the environment is always about punishment and not about learning and building things up, then it can be very negative for the staff. A lot of them are young people, seeing a lot of adverse outcome and feeling responsible, which is very difficult for them and yet they are expected to work excessive hours in very high volume, high risk environments. Ultimately that can have a very negative effect on the staff, particularly if they feel they’re not supported. As a country, we’ve got to pay attention and make sure that these people who are bearing this risk on our behalf and who are brave enough to go into the labour room and deal with a haemorrhage at 3am in the morning are supported.
There’s an assumption that all adverse outcomes are somebody’s fault. That’s just not the case. Obstetrics in fraught with complications, it’s not always somebody’s fault. The staff are not always able to prevent these complications. We often have difficulty dealing with them because they are very challenging, technically.
It’s fantastic, being pregnant. It’s an amazing roller coaster. But labour’s tough, the physical reality of having a baby is tough, so I’d recommend organising a bit of help for yourself around the time of delivery. Any of the favours you’ve ever done anyone? Call them in for around that time! Aside from taking folic acid, not drinking or smoking and generally looking after yourself, another thing I’d advise looking out for is loneliness. I had my babies before any of my friends and I really felt a bit lonely at times, having coffee on my own and talking to my tiny baby! It’s very important that we look out for each other, call new mums and drop in. It’s also very important for pregnant women to talk to each other and build a network of support.
Pregnant women are amazing, they’re so important in society; they’re bringing the next generation of people in. I think they deserve enormous love and support. We could all be more aware that it’s not easy, physically or mentally. In those weeks where women need extra support, people can really make a difference.
Sex education in schools really needs to change. We tend to learn the biology and it stops there. We need to follow on that education and talk about pregnancy and what is appropriate, sexually. With the internet now, it’s a jungle out there and kids are getting all this information and have a new expectation about sex, often from pornography. I can see that over time the whole idea of intimacy and respect could be broken down. We need to equip our children for a different age, sex education has got to catch up with real life.
