Bríd Smith (Dublin South Central, People Before Profit Alliance) | Oireachtas source

In the context of the debate, people will vividly remember Joe Duffy's series of programmes in April on the experiences of women in maternity hospitals. It received responses from many hundreds of women who contacted the show and had negative and often harrowing experiences of giving birth in Irish hospitals. It was one of the largest responses the "Liveline" show had ever had, with many women wanting to share their experience publicly. We must ask ourselves why the experiences have been so poor for so many women. It is not just because the midwifery or nursing staff in the ward with them at the time treated them badly, or a combination of that and a failure of resources and services provided by the State, or even the deeper issue of the paternalistic delivery of services. What is known as active management, which it was decided in the 1960s would be pursued, has positive outcomes but, importantly, it also means the labour process is sped up by breaking the waters and using synthetic hormones. By its nature, it leads to more interventions during labour and results in a highly prescriptive and medicalised birth process. It can also leave women feeling ignored, disrespected and disempowered. Many women make the point that they feel safer and better and have better outcomes during birth if the team who cares for them is midwifery led.

The problem also stems from the failure of the Government and previous Governments to staff and resource properly maternity services. From the recent nurses' strike, we know there is a crisis in the recruitment and retention of nurses and midwives but I am unsure whether the deal that ended the strike will result in an improvement in that regard.

There was a recent tragic case in Cork where a mother and child died. This highlights how chronically under-staffed and over-stressed are much of our maternity services. This is not to claim that tragedy directly related to the staffing issue but the staffing issue was very clearly highlighted as, that evening 31 patients on a labour ward were being cared for by three nurses, which is really stretching the resources. These ratios, however, are not confined to that case and are systemic across maternity and other services. Again, during the recent strike, many of us who spoke to nurses and midwives on the picket lines were struck by the fact that what distressed them more than the lack of pay parity and the inequality between their grades was the danger they had to live with putting their patients in on a daily basis as a direct result of the lack of staff and resources.

The core problem many women face is structural and deep and, in many cases, goes back to an attack on public services and on nurses by this and other Governments. Addressing these issues in isolation is impossible as they are embedded in the general undermining of our health service through ongoing privatisation and the building of a two-tier health system. In that context, I was struck by part of the motion and the amendment, which calls for a guarantee that the new maternity hospital will not have separate external or internal entrances, nor separate facilities within hospitals. This issue, I would argue, is very important. It is not about maternity hospitals having separate entrances and exits for private or public, but the fact we have a two-tier health service, with private and public mixed together. It is a fact the ratio of nurses and midwives and access to essential services and resources often differ between these two health services. The fact we have privatised the health system and continue to do so is very disturbing. It needs further discussion and further opposition within this House.

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