James Reilly (Dublin North, Fine Gael) | Oireachtas source

Statistics on the causes of death are based on civil registration and compiled internationally by the World Health Organisation, WHO. In the WHO's most recent world health statistics annual report 2012, Ireland had the 13th lowest rate of maternal mortality out of 178 countries reporting data. Maternal mortality is a rare occurrence in Ireland. It must be understood that since there are usually fewer than five such deaths per annum, rates can appear to fluctuate significantly from year to year.

This is particularly so in percentage terms. For example, an increase in deaths from two to four in a given year would lead to an apparent 100% increase in the maternal mortality rate. As such, reports based on data from different years can appear to be contradictory.

It is generally recognised internationally that official vital statistics can result in an underestimate of maternal deaths. In particular, indirect obstetric deaths resulting from previous existing disease or diseases that developed during the pregnancy may be missed in the official statistics. For this reason, Ireland established a confidential maternal death enquiry, MDE, system in 2009. In doing so, it linked itself with the United Kingdom's confidential MDE, which has been acknowledged as the gold standard for maternal death inquiries in recent decades.

It is important to emphasis that if data from a confidential MDE are used, the results can only be compared with the results from other similar inquiries. The recently published report of Ireland's confidential MDE for the 2009-11 period cannot be compared with the civil registration-based rates of other EU countries that do not have MDE systems. Comparisons with the UK's MDE for the 2006-08 period showed that Ireland's rate was approximately 30% lower than the UK's. However, caution must be exercised in interpreting this data because, even when aggregating three years of data, for example, 2009 to 2011, the number of deaths remains small and the rates will be subject to significant fluctuation.

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Variances noted between various reports are a combination of differences in ascertainment - how maternal deaths are identified or found - and definitions. For instance, the international comparisons in table 2 of the MDU report reflect such differences in definitions, calculations, etc. The CSO figures in that table are for 2009 only, are based on live and stillbirths and are based on the date of notification of the death to the CSO. The MDE Ireland figures in that table are for the 2009-10 period, are based on hospitals identifying all women who died of direct and indirect causes and are based on the date the woman was delivered. It is important to state that no matter what definitions are used or how case ascertainment is conducted, Ireland continues to be a safe country for a woman to give birth in and our safety record compares favourably with other developed countries.

The purpose of any confidential inquiry worldwide is to learn lessons about how we provide improved care in the maternity services, which impacts on maternal outcomes. The recent MDE report for Ireland makes a number of valuable recommendations in respect of clinical care and the improved ascertainment of cases. The recommendations will be taken up by the HSE-institute joint working group on maternal mortality. In the short term, the national clinical care programme for obstetrics, which was put in place subsequent to the instigation of the work on this report, will collaborate with health professionals to ensure that all learning from inquiries into tragic events related to pregnancy will be incorporated into service delivery to continue to ensure that care for mother and babies is as safe as possible. As outlined in the MDU report, since its inception, MDE Ireland has promoted dissemination of recommendations from inquiry reports in order to inform health professionals and to improve maternity services.

I would like to emphasise the importance and benefits of confidential MDE reports in advancing quality and safety within the maternity services and such work will be taken into account in the implementation plan for the new patient safety agency.

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