Ma­ter­nal mor­tal­ity no worse here

Irish Independent - - Let­ters & Edi­to­rial Com­ment -

■ I am con­cerned about mis­in­for­ma­tion be­ing cir­cu­lated in the me­dia in re­spect of an al­leged con­tri­bu­tion of the Eighth Amend­ment to ma­ter­nal mor­tal­ity and mor­bid­ity in Ire­land. An au­dit of ma­ter­nal mor­tal­ity and se­vere mor­bid­ity in Ire­land has been on­go­ing for some years, and is an im­por­tant mea­sure of qual­ity of care in ma­ter­nity ser­vices.

MDE Ire­land has been col­lect­ing data on ma­ter­nal deaths in Ire­land since 2009, and is a col­lab­o­ra­tion with the long-es­tab­lished UK-based Con­fi­den­tial En­quiry into Ma­ter­nal Deaths, con­sid­ered world­wide as the gold stan­dard for au­dit of such deaths.

All ma­ter­nal deaths are re­ported to the of­fice based at Cork Univer­sity Ma­ter­nity Hospi­tal. Def­i­ni­tions and method­ol­ogy are iden­ti­cal to that used in the UK, and ev­ery anonymised case is sub­ject to de­tailed re­view by in­de­pen­dent med­i­cal and mid­wifery as­ses­sors.

Since its in­cep­tion in 2009, MDE Ire­land has pro­duced reg­u­lar re­ports, most re­cently in De­cem­ber 2017. In our ex­pe­ri­ence, the ma­ter­nal mor­tal­ity rate in Ire­land has not been sta­tis­ti­cally sig­nif­i­cantly dif­fer­ent from the UK.

The rate for the tri­en­nium 2013-15 was 6.5 per 100,000 ma­ter­ni­ties, com­pared with 8.76 per 100,000 ma­ter­ni­ties for the UK.

Se­vere ma­ter­nal mor­bid­ity is also ac­knowl­edged in­ter­na­tion­ally as an im­por­tant qual­ity in­di­ca­tor of ob­stet­ric care and ma­ter­nal wel­fare, par­tic­u­larly in de­vel­oped coun­tries where ma­ter­nal death rates are rel­a­tively low. Data for Ire­land has been col­lected and sub­jected to anonymised anal­y­sis by the Na­tional Peri­na­tal Epi­demi­ol­ogy Cen­tre since 2011, and an­nual re­ports have been pub­lished.

Us­ing the val­i­dated method­ol­ogy of the Scot­tish Con­fi­den­tial Au­dit of Se­vere Ma­ter­nal Mor­bid­ity to fa­cil­i­tate in­ter­na­tional com­par­i­son, Ir­ish rates com­pare favourably with pub­lished Scot­tish data.

It is im­por­tant to state that none of the con­sec­u­tive re­ports pub­lished by these two na­tional au­dits of ob­stet­ric prac­tice raises any con­cerns in re­la­tion to the Eighth Amend­ment. The con­clu­sion is ob­vi­ous – there is no ev­i­dence what­ever of a higher risk of ma­ter­nal mor­tal­ity or se­vere mor­bid­ity in Ire­land as a re­sult of the Eighth Amend­ment.

All re­ports to which I re­fer are avail­able on the web­site.

Michael F O’Hare, MD FR­CPI FRCOG Con­sul­tant Ob­ste­tri­cian and Gy­nae­col­o­gist. Chair­man, Joint In­sti­tute of Ob­ste­tri­cians & Gy­nae­col­o­gists/HSE Work­ing Group on Ma­ter­nal Mor­tal­ity

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