Healthcare reform: Maternity service provision in Ireland

Kennedy, Patricia

doi:10.1016/j.healthpol.2010.04.002

Cited by 18 publications

(12 citation statements)

References 4 publications

(2 reference statements)

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“…Irish maternity services are highly medicalised, and based almost exclusively in hospitals [5]. Busy hospital environments cannot always provide optimal supportive environments for women [6].…”

Section: Introductionmentioning

confidence: 99%

“…Busy hospital environments cannot always provide optimal supportive environments for women [6]. Ireland has limited choice in models of care of maternity care for women little progress has been made to provide alternatives to the dominant hospital-based model of maternity care [5]. Increasing economic pressures have resulted in many health services in Ireland being scrutinised with an increasing drive toward centralisation of health services.…”

Section: Introductionmentioning

confidence: 99%

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Women’s preferences for childbirth experiences in the Republic of Ireland; a mixed methods study

Larkin

Begley

Devane

2017

BMC Pregnancy Childbirth

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BackgroundHow women experience childbirth is acknowledged as critical to the postnatal wellbeing of mother and baby. However there is a knowledge deficit in identifying the important elements of these experiences in order to enhance care. This study elicits women’s preferences for the most important elements of their childbirth experiences.MethodsA mixed methods design was used. An initial qualitative phase (reported previously) was followed by a second quantitative one using a discrete choice experiment (DCE), which is reported on here. Participants who had experienced labour, were over 18 and had a healthy baby were recruited from four randomly selected and one pilot hospital in the Republic of Ireland. Data were collected by means of a DCE survey instrument. Questions were piloted, refined, and then arranged in eight pair-wise scenarios. Women identified their preferences by choosing one scenario over another. Nine hundred and five women were sent the DCE three months after childbirth, with a response rate of 59.3% (N =531).ResultsWomen clearly identified priorities for their childbirth experiences as: the availability of pain relief, partnership with the midwife, and individualised care being the most important attributes. In the context of other choices, women rated decision-making, presence of a consultant, and interventions as less important elements. Comments from open questions provided contextual information about their choices.ConclusionsMost women did not want to be typified as wanting the dichotomy of ‘all natural’ or ‘all technology’ births but wanted ‘the best of both worlds’. The results suggest that availability of pain relief was the most important element of women’s childbirth experiences, and superseded all other elements including partnership with the midwife which was the second most important attribute. The preferences identified might reflect the busy medicalised hospital environments, in which the vast majority of women had given birth, and may differ in settings such as midwifery led care or home births.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Women’s preferences for childbirth experiences in the Republic of Ireland; a mixed methods study

Larkin

Begley

Devane

2017

BMC Pregnancy Childbirth

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“…Although midwifery-led care is thriving in some organisations and independently in certain areas the majority of births in Ireland (>99% (Cuidiu, 2011)) and England (>92% (Brocklehurst et al, 2011)) still take place in large, centralised, high-tech units under the care of an obstetrician, which has been a growing trend since the 1970's (Kennedy, 2010 (MacKenzie Bryers and van Teijlingen, 2010). Updated guidelines by the National Institute for Health and Care Excellence (NICE, 2015) also advocate that professionals promote home or midwifery-led units as the safest birthplace for all low-risk women.…”

Section: Structural Factors Of Maternity Care Affecting Riskmentioning

confidence: 99%

Can maternity care move beyond risk? Implications for midwifery as a profession

Healy

Humphreys

Kennedy

2016

British Journal of Midwifery

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Maternal and infant mortality rates are reassuringly low in developed countries. Despite this, birth is increasingly seen as risky by women, health professionals and society in general. In wider society, women are subjected to a litany of risks regarding birth, including sensationalising negative incidents by the media. Within maternity care, both structural and operational factors contribute to heightened risk perceptions. Women are processed through a system where risk-management strategies can take precedence over individualised care as health professionals attempt to protect themselves from implication in adverse outcomes and litigation. This results in increasingly interventionist care, depriving women of psychosocial safety in the birth process. Midwifery, as a profession promoting trust in normal birth, is threatened by this dominant medical model of maternity care and interventionist birth practices. Midwives need to act to reclaim their role in promoting normal birth, while balancing considerations of risk with the principle of woman-centred care.

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“…[1][2][3][4][5] There are concerns about clinical safety and quality, despite the fact that Ireland has one of the lowest maternal mortality rates in the world. 6 There are concerns about the cost of obstetric negligence claims, while the national caesarean section rate continues to escalate.…”

Section: Introductionmentioning

confidence: 99%

“…2 The Review of Maternity and Gynaecology Services in the Greater Dublin Area, for example, has recommended the creation of midwifery-led units adjacent to hospital-based obstetric units. 3 The Review also recommended the option to have a home birth and the Health Service Executive (HSE) has established a National Taskforce on Home Births.…”

Section: Introductionmentioning

confidence: 99%

What models of maternity care do pregnant women in ireland want?

O’Dwyer

Byrne

Kennedy

et al. 2011

Archives of Disease in Childhood - Fetal and Neonatal Edition

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The introduction of new models of care in the Irish maternity services has been recommended by both advocacy groups and strategic reports. Yet there is a dearth of information about what models of care pregnant women want. We surveyed women in early pregnancy who were attending a large Dublin maternity hospital. Demographic and clinical details were recorded from the hospital chart. Of the 501 women, 351 (70%) (352 (70.3%) of women wanted shared antenatal care between their family doctor and either a hospital doctor or midwife. 228 (45.5%) preferred to have their baby delivered in a doctor-led unit, while 215 (42.9%) preferred a midwifery-led unit. Of those 215 (42.9%), 118 (55%) met criteria for suitability. There was minimal demand (1.6%) for home births. Choice was influenced by whether the woman was attending for private care or not. Safety is the most important factor for women when choosing the type of maternity care they want. Pregnant women want a wide range of choices when it comes to models of maternity care. Their choice is strongly influenced by safety considerations, and will be determined in part by risk assessment. IntroductionThe organisation of the maternity services in Ireland is the subject of widespread discussion at present. [1][2][3][4][5] There are concerns about clinical safety and quality, despite the fact that Ireland has one of the lowest maternal mortality rates in the world. 6 There are concerns about the cost of obstetric negligence claims, while the national caesarean section rate continues to escalate. 7 There are misgivings about hospital facilities and it has been accepted that at least four large maternity hospitals need to be relocated on to the site of a general hospital. 3 There are concerns about the number and experience of midwifery and medical staff in the future with an ongoing dependence on overseas recruitment at the expense of less developed countries. There are considerable variations of clinical practice between hospitals and, perhaps, within hospitals. There are arguments in favour of rationalisation and the centralisation of maternity and neonatal services and, at the same time, a desire to bring services closer to the women in the community.

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Healthcare reform: Maternity service provision in Ireland

Cited by 18 publications

References 4 publications

Women’s preferences for childbirth experiences in the Republic of Ireland; a mixed methods study

Women’s preferences for childbirth experiences in the Republic of Ireland; a mixed methods study

Can maternity care move beyond risk? Implications for midwifery as a profession

What models of maternity care do pregnant women in ireland want?

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