Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

The second Maternal Death Enquiry, MDE, Ireland report has just been published at UCC. It makes the point that due to the relatively small number of maternal deaths in Ireland, fluctuation in annual mortality rates is inevitable and should be treated with caution so rates for maternal deaths, MMR, occurring in Ireland are presented in the UCC report over three-year periods. For the three years from 2009 to 2011, the maternal mortality rate was 8.6 per 100,000 maternities, while for the three years from 2010 to 2012, the maternal mortality rate was 10.5 per 100,000 maternities.

It is clear that the apparent increase in mortality rates between the years 2010 and 2012 is not statistically significant and is similar to that of the UK. For the years 2009 to 2012, 38 maternal deaths, occurring during or within 42 days of pregnancy end, were reported to MDE Ireland, of which ten were classified as direct deaths - due to obstetric causes; 21 were classified as indirect deaths - due to pre-existing medical or mental disorders which were exacerbated by pregnancy, and the remaining seven were attributed to coincidental causes - not due to direct or indirect causes. Thus, the majority of deaths were from indirect causes, namely, from pre-existing disorders exacerbated by pregnancy.

The report states that for the years 2009-2012 case ascertainment by MDE Ireland - direct, indirect and coincidental - was four times that of the civil death registration system as per information recorded by the CSO. It also states that this is not unique to Ireland as underestimation of maternal deaths using civil death registration systems, even in developed countries, has been acknowledged by the World Health Organisation. The majority, 60%, of direct maternal deaths occurred in an intensive care unit, ICU, with no direct deaths occurring outside the hospital setting. Women born outside of Ireland were over-represented in reported deaths, reflecting UK findings of an increased risk of maternal death among migrant ethnic minorities. There was also a suggestion of an increasing maternal death rate mong older women. Based on these findings, MDE Ireland makes nine recommendations.

I am inquiring this evening as to whether the Department of Health and the HSE propose to act on these nine recommendations which are: that all health care professionals within the Irish maternity services should be aware of recommendations and lessons contained within the recent UK report, 'Saving Lives, Improving Mothers' Care - Lessons learned to inform future maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009-2012; that all maternal deaths occurring during or within in one year of giving birth, ectopic pregnancy, miscarriage or termination of pregnancy should be notified to MDE Ireland in order to support the enquiry process; that a question on pregnancy status at time of death, similar to that on the medical death certificate, should be added to the coroner's death certificate; that interpretative services should be used to ensure that the care of any patient is not compromised by lack of communication and misunderstanding; that in the absence of co-location, establishment of a more effective communication system between general hospitals and maternity units in the event of a maternal death is necessary; that women with medical disorders should receive preconception advice and ideally have their medical conditions optimised prior to pregnancy - this will need to be provided by their GPs and specialist physicians in conjunction with the obstetric services; that pregnant patients with pre-existing medical and mental health disorders should undergo risk assessment at booking and should be afforded high priority by colleagues in other medical disciplines when referred for assessment; that maternity medical staff should review and audit current practice concerning the prevention and treatment of thromboembolic disease, giving consideration to the national guideline, and that consideration should be given to provision of a perinatal psychiatry mother and baby unit in Ireland.

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