We must restore confidence in our maternity units
Before the recent RTÉ Investigations Unit probe into the Portlaoise baby tragedies, and even based on my own personal experiences, I firmly believed that Ireland was one of the safest places in the world to have a baby. Unfortunately I am now beginning to doubt this statement. When I met with some of the parents of the Portlaoise babies, Mark and Róisín Molloy, one of the many startling revelations which came out of that meeting was that their baby Mark’s death, as well as some of the other babies’ deaths, had not been reported to the National Perinatal Epidemiology Centre.
The NPEC was established by the then Minister for Health Mary Harney in early 2006 in the wake of the Lourdes Hospital Inquiry Report. This inquiry, undertaken by Judge Maureen Harding Clark, was tasked with finding out what happened at the Lourdes hospital in Drogheda and how Dr Michael Neary had been allowed to carry out caesarean hysterectomies over a prolonged period without anyone shouting ‘stop’. The report found that the three obstetricians who had in 1998 exonerated Dr Neary had “serious regret for their part in producing these reports, which were motivated by compassion and collegiality”.
When Minister Harney announced the establishment of the centre she said that “every time a mother gives birth in this country, the important interventions, the good outcomes and the complications will be recorded and analysed at a national specialist centre.” She went on further to state that “this is the first very important step in re-establishing trust and ensuring that services to mothers and their babies born in Ireland are based on the best possible research.”
Maternity Care
In 2014, eight years after the creation of the centre, we now know that the statistics used to provide information to the Minister for Health and the public at large concerning the standards of maternity care in Ireland are deeply flawed. Clinicians have no legal obligation to provide data to the centre in cases like the Portlaoise babies where a death occurs after birth, or in cases where a stillbirth occurs. The information provided to the centre is done on a voluntary basis and it appears clinicians in certain scenarios are not providing the information to the centre even when a death of a baby happens.
The Minister for Health under questioning from myself and my colleagues in the Reform Alliance, Billy Timmins TD and Denis Naughten TD, earlier in the week pledged in the Dáil that the Department of Health will conduct an audit of the maternity figures and how they are collected in individual hospitals. This is extremely welcome in the wake of the Portlaoise tragedies but the next step must be to impose a mandatory legal obligation on clinicians to provide all data for every time a mother gives birth in Ireland and that failure to so would result in sanction.
The scandals surrounding the Dr Neary affair led to a deep mistrust in Ireland about the standard of maternity care here and Minister Harney, to her credit, rightly put in place the tools to address that mistrust and give a much clearer picture of maternity care in Ireland. This noble objective however has failed, because certain clinicians or hospital management either wilfully, or negligently, have failed to uphold the whole purpose of the perinatal centre’s creation in the first place. The current Minister must, in the aftermath of the audit, put in place the necessary legislation to make the handing over of this data a legal mandatory requirement.
Mortality rates
Secondly, upon completion of the audit where discrepancies in data provided to the centre are found, UCC should then undertake a retrospective analysis on all the statistics they have published on the standard of maternity care in Ireland since their centre came into being. Only then can ministers honestly go on television and tell people that Ireland is the safest place in the world in which to have a baby.
The most recent international figures on child mortality rates for babies were compiled in 2012. This report is conducted as a joint project by the WHO, UNICEF, UN and the World Bank – all highly credible international agencies. Their report found that Ireland had one of the lowest rates in the world of four deaths per 1,000 live births. The latest international figures for stillbirths were conducted by the WHO in 2009 again demonstrating Ireland having the lowest rates in the world with three stillbirths for every 1,000 births. The one factor that both these reports have in common however is that they are reliant on national data which, as the Portlaoise case demonstrates, has shown itself to be flawed.
The question of the certainty of data surrounding stillbirths is a separate problem to babies that die after birth, and this arises because of the way in which birth certificates in Ireland are registered. In Irish law, parents are required to register the birth of their child no later than three months after his or her birth. All stillbirths in Ireland must also be registered, but again that requirement is on the parents.
While a hospital, midwife or medical practitioner can register a stillbirth if a parent has not done so within 12 months, this is not a mandatory requirement and it appears in some circumstances in Portlaoise hospital that the registration of stillbirths did not occur. There is equally no obligation on a clinician to inform a parent about the registration of their stillbirth child, so again the official rates in Ireland may well be distorted and may not be providing an accurate picture of the true rate of stillbirths here. This is something that the Minister for Health again needs to look at.
Demands
In the immediate aftermath of my meeting with Roisin and Mark Molloy in advance of the screening of the RTÉ Investigations Unit documentary, we set about drafting legislation, alongside Reform Alliance member Denis Naughten TD. This legislation, if passed, would enable the introduction of a regime in Ireland similar to the United States whereby doctors, without fear of holding themselves liable to future civil litigation, could from the outset acknowledge mistakes. Compensation could then be paid outside of the court process and parents would get answers in a much more compassionate and timely manner.
Sometimes in Dáil Éireann you have days where you feel politics works if used for its purpose, and not as a game. In the short space of five days after the showing of the RTÉ programme, much of the immediate demands of the parents of the Portlaoise babies had been granted.
When the parents of Baby Mark came to Dáil Éireann on behalf of all the Portlaoise babies to meet a cross-party group of TDs that I had arranged, the minister announced a few hours later on television that he was to order an independent HIQA inquiry into the babies’ deaths. The following day during a Dáil debate on the matter, the minister further announced there would be an audit of how perinatal data is collected, and finally on Saturday it was announced that there would be the introduction of an open disclosure regime into Ireland, in the wake of the Reform Alliance’s own call for such legislation.
None of these things would have happened were it not for the bravery and determination of all the Portlaoise baby parents. While it is no compensation for the heartache they have all suffered, hopefully the legacy of their campaign will result in an improved standard of maternity care in Ireland so that future tragedies can be prevented and needless additional distress eliminated.