Women are to be given far greater choice in making arrangements for giving birth as part of a radical 10-year strategy for transforming the country’s maternity services.
The vast majority of births will be led by midwives in place of the existing obstetrician-led system and more ante-natal and post-natal care will be provided at home. More home births will also be facilitated, according to the Government’s draft National Maternity Strategy 2016-2026.
The majority of women whose pregnancies are considered low or normal risk will give birth in a “low intensity birth centre” or at home without routine access to epidurals, electronic fetal monitoring or oxytocin, according to the report. Responsibility for the woman’s care in this setting would be assigned to a midwife manager.
Women who choose these interventions would have to transfer to a “high-intensity birth centre” (labour ward), though in an emergency the necessary critical services would be brought to the woman.
Under an alternative care pathway, medium and high-risk pregnancies would be delivered in such high-intensity birth centres, where responsibility for care would rest with their obstetrician. Women would switch between care pathways if they wished to, or in the event of an emerging risk.
The strategy, which was commissioned in the wake of the death of Savita Halappanavar three years ago, seeks to "normalise pregnancy and birth as far as possible" as well as facilitating a choice of birth settings "where it is safe to do so".
The strategy proposes the establishment of a new community midwifery service which would operate as an out-reach service from hospital and work alongside public health nurses and GPs.
The document suggests that in future there should be about 100 additional consultant obstetricians appointed as well as significantly more midwives.
Pre-conception consultation
It proposes that women could be offered a pre-conception consultation and a post-natal check-up by their GP after three months as part of an extended Mother and Infant Care scheme.
The strategy does not propose closing any of the Republic’s 19 maternity units but it says smaller maternity services cannot, and should not, operate in isolation as standalone entities.
“They cannot sustain the breadth and depth of clinical service that the populations they serve require, without formal links to larger units,” the strategy says.
More than 1,300 submissions were received by the 30-strong implementation group appointed by Minister for Health Leo Varadkar last March to draw up the strategy.
