Director of Midwifery, Maureen Revilles and Dr Michael O’Connell, Clinical Director for Integration, Coombe Women & Infants University Hospital and Portlaoise Hospital, with midwifery staff.
By Conor Ganly firstname.lastname@example.org @laoisnews
After Portlaoise hospital's maternity unit went into meltdown in 2014 births plummeted and expecting parents understandably turned their back on the hospital in droves.
At the peak of its activity annual births surged past 2,000. This plunged by well over a quarter after it emerged that babies died in the unit that should have lived.
The unit's future was on the line in the aftermath of the crisis but a decision was reached not to shut down the unit. Instead a link was made with the Coombe Hospital in Dublin. Investment was made and staff were recruited. New tests, equipment and ways of operating were all introduced.
By the end of 2017 the birth rate was 1,531, an increase of 3% with an attendance of 1,517 mothers, an increase of 2.4% on the previous year.
It is the only maternity unit with significant increased activity. It is one of the busier units located in the smaller hospitals.
The figures are, arguably, evidence of the extensive changes that have been implemented to make Portlaoise maternity unit safer than before.
Key to the process is Consultant Obstetrician and Gynaecologist, Dr Michael O'Connell.
The Cork native has worked at the Coombe Women’s and Infants University Hospital since 2004. He was appointed as Clinical Director for Integration for the Coombe and the Midland Regional Hospital Portlaoise in 2014.
He does not have a clinical role and is based in Portlaoise two days a week. His job is to work with staff to develop Portlaoise's service and integrate with the Coombe.
Dr O'Connell says the return of first time mothers to Portlaoise now represents nearly a third of all births, up from 20% during the crisis. It is a critical milestone for the unit.
“There seemed to be a lack of condfidence among first time mothers, but we have managed turn the trend on that - that is really important for a maternity unit. To be sustainable you need to be back in the 30% mark and we are back in that bracket.
“People have seen that we have made tried to institute changes that are very patient centred,” he said.
The added plus appears to be the link with the Coombe. Dr O' Connell says that the vast majority of women deliver in Portlaoise but they have the backup of expertise in Dublin if needed while their majority of their care, including delivery, is provided in Portlaoise.
He said a restructure and streamlining of the early pregnancy unit has meant that a formal dating scan is offered to every woman between 9 and 12 weeks of pregnancy.
“What happens now is that when someone books with the hospital they have their history recorded by their midwife, they have a dating scan, booking bloods done. So, when they come and see the consultant three weeks later all that is done,” he says.
Added to this is availability of an anatomy scan which is available to less than half of pregnant women in Ireland. It is used to detect problems that could complicate pregnancy and delivery.
With the Director of Midwifery Maureen Revells, a midwife was selected and trained in the Coombe to carry out anatomy scans in Portlaoise.
In use since last December it has led to the transfer of two to three patients a month to the Coombe for specialist care.
“It is a good service and is working really really well. It is things like that, that have injected more confidence ,” says Dr O'Connell.
The consultant said his arrival coincided with the publication of a number of critical reports on Portlaoise.
“We have learned from those reports and instituted all the recommendations of those reports. From that perspective people see that there is a move forward.
“They see that this unit is as good, if not better than most other units at this stage,” he said.
He said positive feedback on the service has reached a point where there are more than double the number of complimements to the review of complaints.
He said the 'crisis' that engulfed the hospital forced an examination of how things could change whereby there was direct access to specialist care while developing services locally.
“The crisis brought about a new way of looking at thinking as opposed to the knee jerk reaction which would have been to close the place - a disaster - get rid of it and bring it all to the big centre,” he said.
He said a lot of what has happened in essence is the adoption of guidelines.
“In actual fact what we are trying to do is that the service you would get in the Coombe you will also get in Portlaoise and that is only right. It should be the same service you should get in any hospital,” he said.
Dr O'Connell attended a meeting with the now Taoiseach Leo Varadkar in 2015 in Portlaoise where many bereaved families told their stories.
“While I did want to learn from what happened in the past, I did not take any of those charts (of patients) and go through them in detail.
“My job was to learn from the past and look forward. I presented that to the families when the Minister met the families in the Killeshin Hotel.
“What I could add value to was to bring a confidence to the service,” he said.
He said he was struck by the impact of media coverage on staff but also the encouragement and welcome he received soon after he arrived in Portlaoise from local people who got to know who he was quickly.
He said working in a community hospital such as Portlaoise can make a job difficult because you have to look patients in the eye in public if problems have happened.
“At the end of the day none of us come to work to cause a problem.
“Adverse things happen. They happen in Portlaoise, the Coombe and they will happen in the future, but what we are trying to do is minimise those risks and have systems that minimise those,” he said.
He said the corrected perinatal death rate in Portlaoise of two last year has dropped to 2 per year which is in line with HSE set standards.
He says he does not minimise the impact of pregnancy loss but change has been instituted that has made a difference.
He said two consultants and two neonatalogists work between both hospitals as well as a midwifery skills development manager.
He said a lot of new staff have also come on board who have integrated well with older staff.
As to the future Dr O'Connell is adamant there can be no sudden changes.
“We've got to provide a safe service. Whatever somebody in office (political) decides, that service can't just stop tomorrow.
“If they decided tomorrow that the service is not going to be offered here any longer then it will have to be offered someplace else. There is no capacity anywhere else at the moment.
“If they decided it was going to be offered in the Coombe - unless they build a new wing in the Coombe, we still have to provide a safe service here.
“I'll leave that for others to worry about. If that changes we will adapt what we are doing to change if we need to but, as we stand at the moment, we have a full maternity and gynaecology service and that is what we are doing,” he said.
“Realistically, if we are to be very honest about it the national children's hospital is being built at the moment, the vast majority of any captial expenditure is going to that so there is not going to be capital expenditure to build a new wing on the Coombe,” he said.
Dr O'Connell said two alternative sets of plans have been drawn up for new outpatients departments beside Portlaoise hospital.
The smaller of the two would be exclusively used for maternity services, costing €3 million.
The bigger facility would be a new outpatients costing in the region of €15 million.
“We have agreement that that can go ahead but we don't have the funding.
“The funding is a big issue and at the end of the day, patient safety is critical. So, it would be unsafe for all of these women to go to the Coombe because it doesn't have the capacity,” he said.
He compares it to the situation in the midwest where two A&Es were closed without capacity being created in Limerick to accomodate the influx of patients.
“If we have learned anything we know that you can't force maternity services into a place that can't actually take capacity.
“You have to be very honest. If we can show that having a baby in Portlaoise is as safe as having a baby in the Coombe, the National Maternity Hospital or the Rotunda then it is sustainable. If we show that it is not, then it is not.
“That is the reality. The bottom line is would you want your wife coming here and and, at the moment, people are saying yes but that is because we have done a lot of work to make sure we have systems in place to make it extremely safe and any hint of an adverse outcome we look into in detail,” he said.
If he was to leave Portlaoise, Dr O'Connell believes that the systems are now in place to ensure that.
“My role is not to do the job, it is to facilitate it. That is what I have done.
,One of the big advantages when I came was that I was pushing against an open door,” he said.