Ms Breda Kerans:

I thank the chairman and members of the committee. The first recommendation of the national maternity strategy was that an implementation plan be set in place within six months of the strategy being published. It is our understanding that there is still no implementation plan in place. If an implementation committee has been formed, we have not been invited to participate. For the women and their families currently using the services, the national maternity strategy has changed nothing so far.

Speaking as a rural service user, I would like to highlight three things to the committee. Firstly, the options of care and birth choices in Ireland remain a postcode lottery. This is especially true for women living in rural areas where choices are currently extremely limited, where individual clinicians are able to determine ethos and approach to care and where the threat of hospital closures and the need to travel even great distances in labour remains very real concern. We would urge the Minister to ensure that timely access to maternity services remains an option for all rural women, and the threat of small maternity unit closures is removed. We understand that in Northern Ireland rural smaller units became alongside birth centres if they were unable to maintain full tertiary services. Other options also exist and are referred to in our briefing document.

Secondly, the woman’s experience still remains undervalued and is rarely used as a learning tool. The need to fully and independently audit women’s experiences is vital and is alluded to in the recently published national standards for safer better maternity care. This should be acted on without delay.

Thirdly, the area of informed consent remains a concern for women. Last year a woman was taken to the High Court - Ms B v. HSE - in an effort to override her right to informed choice and informed refusal. Ms B won her case. In order to avoid further such cases, at expense to the taxpayer, and threats to women of the High Court, we would like to see the strategy’s recommendations regarding informed consent and informed refusal implemented in all care settings as soon as possible.

It is our view that many aspects of the maternity strategy could be implemented by restructuring services. While some areas are resource-heavy, many are not. It is our view that the national maternity strategy will be unlikely to be implemented in full. The primary reason, in our opinion, is not due to lack of resources or funding, but due to the threat that the strategy poses to the status quo. It is also our view that, despite the admirable intention to place the woman and her family at the centre of care, the strategy’s recommendations are being cherry-picked to selectively increase resources in particular areas of maternity care at the expense of others.