Border Counties Maternity Services Forum

BY MÍCHEÁL MacDONNCHA

The withdrawal of maternity services is the first step in a process which could lead to the complete closure of Monaghan General Hospital and other such county hospitals around the country. This was the stark message at the Forum on Maternity Services in the Border Counties held in Monaghan town last week.

Despite the united cross-party support of Monaghan County Council - which secured a petition of 35,000 signatures , most of the adult population of the county - the North Eastern Health Board Executive announced the closure of the Maternity Unit at Monaghan General Hospital from 1 March last. The Minister for Health and Children Mícheál Martin refused to intervene and the unit closed, with mothers forced to travel to Cavan and Drogheda for maternity services. It was obvious at the Forum last week that anger and resentment at this decision, especially among women, is unabated and there is a determination to restore and upgrade the Maternity Unit at Monaghan.

``The attitude of the current Executive of the Health Board is simply not acceptable and it must be challenged'' said Councillor Brian McKenna (Sinn Féin), Cathaoirleach of Monaghan County Council, which sponsored the Forum. Formally opening the day, he introduced Caoimhghín Ó Caoláin, who has led the efforts of the Monaghan members of the Health Board to save the maternity service. He told the Forum:

``Our experience of the closure of Monaghan Maternity Services has strengthened our firm belief that there are no monopolies of wisdom with regard to healthcare provision. The primary consideration must always be the needs of health service users. They are the only vested interest group that matter.''

He said their objective is the ``restoration and development of the consultant delivered service and unit that we have enjoyed in recent decades, the provision of a Paediatric Department at Monaghan General Hospital and access for mothers-to-be to an epidural service if they so request''. He pointed out that they ``offered a platform for people representative of a range of views on the best provision of these services and while all our speakers subscribe to the view that we should, can and must have a Maternity Unit at Monaghan General, they are not all agreed as to how that service can be best delivered''.

Monaghan GP Dr Eamonn Duffy spoke of the effects of the closure on mothers and on the hospital. They had been promised full antenatal care in Monaghan but this has not happened. Already the life of a woman who could not make it to Cavan Hospital in time after complications in her pregnancy was saved in Monaghan. ``Mothers in labour and in distress have to indulge in a game of lottery to get a bed,'' said Dr Duffy.

The Monaghan experience is paralleled across the border in County Tyrone, where Eithne McCord is chairperson of the South Tyrone Action Group, which opposed the withdrawal of maternity units at Omagh and Dungannon hospitals. ``Who is affected by centralisation?... It is the less well off. The people who make these decisions for rural areas live close to large maternity units in urban centres. They can go private,'' said Eithne McCord.

She pinpointed how the closure of the maternity unit at Dungannon led to the step by step withdrawal of other services - gynaecology, surgery, accident and emergency, and laboratories to the point where the hospital is now a ``glorified health centre''. As a result, Craigavon Hospital is overloaded and staff are at ``breaking point'', with patients on trolleys. ``Beware of `temporary' closures and what might happen next,'' warned McCord.

In discussion from the floor, mid-wife Mary Flora, formerly of Monaghan Hospital and now in Cavan, said that the increased workload in Cavan was leading to a ``quick turnover'', with women being encouraged to leave hospital before they feel ready. Women with no access to private transport have to get a bus from Monaghan to Cavan and a second bus to the hospital. Staff time is taken up arranging taxis. Another woman said it was time the women of Monaghan ``stood up to the head buck cats!''

The Secretary of the Louth County Hospital Action Group, Cllr Arthur Morgan (Sinn Féin), expressed his solidarity with people in County Monaghan. He stated that Irish taxpayers are prepared to pay the price for a decent health service.

Guest speakers Marie O'Connor and Philomena Canning gave fascinating talks on the neglected place of midwifery in healthcare. They challenged the medical orthodoxy that treats pregnancy as an illness and determines the organisation of the health services to suit the needs of predominantly male consultants. Marie O'Connor pointed to the high rate of births on the way to hospital in Ireland and cited one baby born ``in a politician's clinic''! She said that obstetrics - the study of complications in childbirth - now requires a high degree of centralisation and this was driving the closure of smaller units, thus discriminating against rural women.

Philomena Canning highlighted the negative portrayal of midwifery and the need for women to be fully informed about all the options for childbirth, including home birth, and for those options to be available.

Dr. John Murphy of the National Maternity Hospital used statistics to show the advances in care of the newborn since the 1960s, with infant mortality greatly reduced. He said that women wanted the full range of services available and a balance needed to be struck between ``local needs and safe delivery''. Significantly, he highlighted the role of litigation in all this, with medical insurers determining many issues on the basis of likely court cases. The final push for the closure of the Monaghan maternity unit came, in fact, when the Health Board's insurers withdrew cover.

Richard Porter of the Royal United Hospital in Bath, England, said ``one size does not fit all in maternity services''. He claimed that current levels of obstetric care are not sustainable and there needs to be an increased role for midwifery, as was the case in the area served by his hospital.

Professor Patrick Darcy, Visiting Professor of Nursing at the University of Ulster spoke of the ``domino effect'' of the closure of maternity units on other services. He said that there was a ``changing relationship of knowledge'' between lay people and professionals. Lay people were being excluded from decision-making and there was a breakdown of trust. This must be restored.

The final guest speaker was Dr. Liam Grogan of Beaumont Hospital in Dublin. Like previous speakers, he noted the ``depletion of services'' that followed on from the withdrawal of maternity units. There were constant changes in medical technology and these needed to be taken into account. He acknowledged that many decisions were made in the interests of the large institutions.

The Forum presented a wide range of sometimes contrasting and often complex views. What was clear to this writer was that the decision to close the Monaghan maternity unit was ultimately a political one. It is up to the Health Board and the Health Minister to make such decisions based on the best advice - and the advice can obviously be diverse depending on the sources and the interests they represent. But what was not taken into account were the wishes of the users of maternity services in County Monaghan - the women and babies actually affected by the decision.

In his concluding remarks Councillor Brian McKenna summed up the feeling of those in attendance at the seminar when he demanded: ``Put it back, thief!''