A new HSE-commissioned report has recommended a major restructuring of obstetrics and gynaecology services around the State as well as a significant increase in consultant numbers and the provision for the first time of publicly funded assisted reproduction facilities.
The report, produced by the Institute of Obstetricians and Gynaecologists for the HSE, has proposed that the State be divided into five clinical maternity networks with most catering for around 11,500 births per annum.
Within each network there would be a referral centre which would provide a neonatology service and deal with women at particular risk of severe obstetrical or medical complications.
The report says women likely to require delivery at less than 32 weeks should generally be transferred to the referral centre from their local maternity hospital in advance of the birth of their baby.
The final report of the sub-group of the institute which drew up the document says the maternity networks should have common protocols, standards, clinical guidelines and pathways of care. It says there should be a joint approach to clinical audit, incident reporting and clinical training.
"Women should be able to receive their care as near to home as possible and they should also know in advance, if a problem were to arise with their baby, where and how care will then be provided. Women should still have the option of attending a hospital of their choice [ outside their own network]," the report states.
The report proposes that University College Hospital Galway should be the referral centre for the west and northwest region. This network would also comprise Portiuncula Hospital, Mayo General Hospital, Sligo General Hospital and Letterkenny General Hospital.
The maternity unit at Cork University Hospital would be the referral centre for the south. This network would also include Kerry General Hospital, Waterford General Hospital and the South Tipperary General Hospital in Clonmel.
The National Maternity Hospital in Holles Street, Dublin, would be the referral centre for a third network and would also include Wexford General Hospital and St Luke's in Kilkenny.
The Coombe Women's Hospital would also be a referral centre for a network which would include Portlaoise General Hospital and Mullingar General Hospital.
The Rotunda Hospital would be the referral centre for another network which would also include Cavan General Hospital and Our Lady of Lourdes Hospital in Drogheda. The report points out that Our Lady of Lourdes Hospital already provides a full neonatal intensive care service.
The report proposes that Mount Carmel Hospital in Dublin and St Munchin's Maternity Hospital in Limerick should participate in a Dublin network.
It says the proposed development of the new National Children's Hospital co-located with a maternity hospital had the potential to alter the referral patterns in a number of sub-specialties, particularly in the Dublin region.
The report says there should be 24-hour, on-site, on-call consultant obstetric cover in the labour ward of maternity units handling 6,000 or more deliveries each year.
"It is envisaged that units will require a complement of at least 20 consultants on the roster to be able to provide 24-hour labour ward cover," the report states.
It maintains that gynaecology services should be based on the network system with complex elected cases managed in hospitals with a full range of medical and surgical specialties. It says assisted reproduction services should be publicly funded - such services are currently provided by eight private centres.
