Dr. Krysia Lynch:

I thank the Chairman and members of the committee for the opportunity to present here today on behalf of the Association for Improvements in the Maternity Services Ireland on the national maternity strategy for Ireland 2016-2026. When we were invited to participate on the steering committee of the national maternity strategy by the then Minister for Health, Deputy Leo Varadkar, we were in a position to inform the steering committee on the views and opinions of women and their families based on our 2014 survey of 2,832 users of the maternity services in Ireland. All the main issues highlighted in our survey were replicated in the public consultation carried out as part of the national maternity strategy, and we refer the joint committee to them. AIMS Ireland was delighted to see the strategy published in January 2016 and hopes to see its full implementation. As the public consultation showed, the key issues for users of Ireland’s maternity services are: choice in model of care; geographic equity in the provision of care; the importance of informed consent; partnership and trust between caregivers and service users; the lack of midwifery-led services, despite the overwhelming international evidence to show it is the safest model of care for women experiencing a straightforward pregnancy; the lack of community midwifery and home birth services; sub-optimal breast-feeding support; an inadequate provision for peri-natal mental health; the lack of service user representation at local, regional and national levels; and the lack of adequate advocacy and audit services. AIMS Ireland welcomes the inclusion of all these aspects in the recommendations of the national maternity strategy. There are several areas which we feel need to be implemented without delay.

Firstly, all women, irrespective of where they live, should have access to the three pathways of care - supported, assisted and specialised. These should be available in the three different settings outlined in the strategy, namely, at home, at an alongside birth centre and at a specialised birth centre. The latter already exist in all our units, but an alongside birth centre is only currently available in a handful of units, and there is only one unit offering a home birth service at present.

Secondly, we urge the Minister to implement the recommendations associated with peri-natal mental health. Outcomes and safety of maternity care are generally measured in terms of physical mortality. The experience of giving birth is both physical and emotional. We feel that women’s emotional well-being also needs to be evaluated and addressed in terms of safety and outcomes. The area of peri-natal mental health remains particularly under-resourced, yet admittedly conservative figures show antenatal depression and anxiety rates of 17% to 18% and post-natal depression at 18% to 19%. While there are current plans to invest in specialised mental health services, women with sub-clinical conditions such as depression or anxiety will not be covered under these plans. We see the need for improved provision in this area as vital.

Thirdly, the most frequently commented on area in the public consultation related to the sub-optimal provision of breast-feeding support. Breast-feeding is a building block for the future health of the nation. We urge the Minister to ensure the implementation of the national breast-feeding strategy and also ensure that adequate importance is placed on the breast-feeding recommendations within the national maternity strategy.