Alice-Mary Higgins (Independent) | Oireachtas source

I am replacing Senator John Dolan today. I thank the speakers very much for their very interesting and comprehensive answers to the questions. I will not ask again many of the questions, including that on fertility asked by Deputy Murphy O'Mahony.

I wish to highlight a couple of key points and ask the delegates for their thoughts. In a previous role, I worked with the National Women's Council of Ireland, which was deeply involved in consultation on the maternity strategy and would have welcomed it. One of the key elements was the question of choice for mothers. It is strong that there are options on supported care, assisted care, specialised care and the various strands. There is a vision of parallel facilities that allow dedication in one area but swift movement to another service, if necessary. Are the practical facilities beginning to be put into place to ensure the choice is practicable and that the movement between the strands, where necessary, is being managed? I would really appreciate an answer.

One of the key points the National Women's Council of Ireland found women were making was on having the option of midwife-led services, where possible. There is strong demand for greater midwifery resources.

I thank Ms Leahy. She outlined some obstacles resulting in people getting lost in the system. Potential midwives, at postgraduate or undergraduate level, are getting lost.

Could the delegates comment on another aspect in addition to the questions of recruitment, redirection and retention, namely the question of progression? There seem to be many concerns over how people can progress. What is the position on incremental recognition and remuneration? What are the ladders of progression for people entering midwifery, particularly if we want to encourage people to provide services such as out-of-hours care and clinical care? I refer also to progression separate from management. It is very strong that there will now be directors of midwifery but it seems that, in many cases, the only progression is into management. How is progression as a clinician or medical expert in practice in the field being supported? How could it be? What difference might it make?

Could the delegates comment on neonatal nursing and neonatal nursing care? There are concerns over this area. Postnatal care has been touched on. Perinatal psychology is very important. I understand that in the west, there is no perinatal psychologist. There are three part-time perinatal psychologists available in the country. My figures may be wrong. The number available represents a considerable concern and vulnerability. Could I hear comments on how the gaps in this area and areas such as lactation support put pressure on general nursing if the necessary specialised postnatal services are not available?

Let me cover the question of obstetricians and gynaecologists. I really welcome the debate we have had on the gynaecological supports. That has been key. I imagine a gynaecological strategy will be taken up with the HSE. Even in advance of that, it would seem there needs to some very clear measure in respect of the support services currently associated with the maternity strategy. What should be happening in the interim as we move towards having a gynaecological strategy? What kinds of demands should we be making to the health services in this regard?

On consultants, we are talking about very low numbers so it seems very ambitious to refer to in-house consultants. We know that when there are complications in pregnancy, they can be very sudden and catastrophic. As we have said in regard to 24/7 care, having a senior consultant available is the ideal. What are the delegates' thoughts on having in-house consultancy capacity? How far are we from that? Could it be achieved? Would it be valuable?

We have talked about the idea of dedicated resources, people being in parallel acute adult care in a general hospital and the need for dedicated ring-fenced resource and dedicated accountable management. If there is dedicated accountable management that is not just minding and guarding the budget but also responsible for ensuring that all the resources in a hospital, such as that in Cork, are made available on a practical level, would this in itself prove an incentive in respect of recruitment?

The fear of litigation has been highlighted. If there were an accountability structure and resources such as sonography, which allows for better diagnosis and a better-prepared birth experience, would they incentivise higher rates of recruitment and retention?

There are gaps in terms of choice and consent in our national consent policy, and the question of legal uncertainty has been highlighted. There are circumstances in which, even at birth or during pregnancy, legal advice should be sought. I wanted to mention this and am not necessarily asking the delegates to comment on it. I refer to legal advice in respect of the eighth amendment, for example. That is not necessarily what we are discussing here but this is still an area over which there may be a question mark in the delicate decisions around birth.