Ms Mary Leahy:

I thank the Chairman and members of the committee. The Irish Nurses and Midwives Organisation, INMO, has welcomed the launch of the country’s first national maternity strategy, Creating a Better Future Together for the period 2016 to 2026. Our midwives section has particularly welcomed the recognition within the strategy of the need to give pregnant women appropriate and informed choices supported by access to the correct level of care and support for their individual needs. Our midwife membership also welcomes the recognition within the strategy of the role of midwives in the natural childbirth experience. In particular, we welcome the recognition of midwives leading and delivering care within the multidisciplinary framework for delivering the care pathway intended for normal-risk mothers and babies. In that regard, we advise the committee that all audits of existing midwifery-led units, MLUs, confirm high-quality performance and high levels of satisfaction felt by mothers. My colleague, Mary Gorman, has experience of such a midwifery-led unit as she works in Our Lady of Lourdes Hospital, Drogheda. Ms Gorman can provide further details with regard to the effectiveness and potential of this service model.

In this regard, the publication of the strategy and, more importantly, its implementation should herald a move away from the current overly-medicalised models of care in existence across the country. It has long been the view of the INMO that current maternity services underutilise the potential of the registered midwife, thus minimising the choices for the woman. It is imperative, through the implementation of this strategy, that our maternity services utilise the expertise and autonomous practice of all health care professionals within the service in the interests of optimising the quality of the service and the supports to the mother and newborn baby. In that context, the organisation also fully endorses the recommendations within the strategy for the development of a community midwifery service. This development, which will see hospital midwives coming out into the community to provide ante and postnatal care, will represent a hugely positive development for mothers and babies, bringing the service to them rather than requiring them to come into a hospital for care and support.

The reality is that our current services are severely understaffed and the experience of the INMO is that there is a complete absence of workforce and manpower planning to address this critical staffing shortfall and to ensure a supply of midwives wishing to work within the Irish public health service into the future. This committee must understand that the implementation of the strategy, which everyone supports, is dependent upon an acceptance that as we remodel pathways of care and provide choice for mothers, there will be staffing resource implications, particularly in midwifery, which must be planned for, addressed and supplied.

A fundamental requirement with regard to workforce planning to realise and maintain the best-practice ratio is to increase the number of direct-entry undergraduate midwifery places by at least 25% or 125 midwives and, in addition, to expand the number of postgraduate midwifery places available across the country. The INMO believes this is self-evident but we are not aware of any plans to provide for this increase in supply. However, it must be noted that in recent years, a number of these postgraduate places have not been filled due to lack of applicants. This is yet another example of the service-wide issue of recruitment and retention which must be addressed if we are to establish and maintain safe practice levels.

On the more positive side, the committee should note that arising from a recommendation in the report on maternity services in the Midland Regional Hospital in Portlaoise, directors of midwifery have been, or are being, appointed to all maternity units and hospitals, numbering 19 in total. One important point to note about these appointments is that the post of director of midwifery will, in the context of implementing the maternity strategy, have a remit which spans both the maternity hospital and the adjoining community services. This is most welcome and is indicative of what should happen as the strategy is implemented and will provide governance to the enhanced community midwifery services referred to earlier.

We wish to acknowledge the dedicated work of the steering group leading to this forward-looking strategy. The INMO, and particularly our midwives section, commits itself to work with all concerned to deliver upon the strategy’s recommendations. The collective goal must be to ensure excellent standards of care in the environment chosen by the mother based upon her needs and preferences.