‘Radical system-wide change needed in maternity services’ (2024)

Co-ordinated system-wide change is urgently needed to radically improve maternity care in Northern Ireland, an independent review has found.

‘Radical system-wide change needed in maternity services’ (1)

Professor Mary Renfrew

The review was led by Professor Mary Renfrew and makes a series of recommendations to transform services across all settings and ensure better outcomes and experiences for women, babies and families.

Professor Renfrew said: “Northern Ireland is not alone in experiencing substantial challenges to quality maternity care but there is now a real opportunity for NI to create a system that works for all.

“This review has found both serious weaknesses and real strengths in the current provision of midwifery and wider maternity care for mothers and their babies.

“It proposes an ambitious evidence-based plan to transform maternity services for all women, babies and families and to improve safety and quality and tackle inequalities across Northern Ireland. It includes requirements for the safe provision of community midwifery units and home births, regional strategic developments to support staff and ensure safe, quality and equitable care and services, improved data and monitoring, and building for the future.

“Key requirements include acceptance by senior leaders that radical change is needed, together with investment that reflects the level of need.

“At the heart of the changes must be a new relationship with women, families and communities, with an enabling environment for all staff and students, and better informed, better implemented monitoring, commissioning and governance.

‘What happens in pregnancy, birth, and following birth affects women, babies, and families for the rest of their lives. Improving maternity care must be a priority for the health services and for society.

“Investing in improvement will contribute to better physical and mental health for women, better health, well-being and development for babies, better attachment and family relationships, better population health and reduced inequalities, better health and well-being for staff with improved staff retention, and better use of health service resources.”

The report was commissioned by the Department of Health following a coroner’s court hearing into the tragic death of a baby during birth. To learn lessons and prevent such distressing outcomes in the future, the review sought to understand underlying causes and develop effective evidence-based solutions.

Professor Renfrew continued: “Many women and their partners who engaged with the review described a range of unacceptable experiences during their maternity journey which contributed to physical and emotional harm, sometimes causing long-lasting distress.

“Many midwives and interdisciplinary colleagues described working in circumstances where they could not give the quality of care that they knew was needed.

“The voices of the women and families and of the staff who spoke so openly, often at the cost of re-experiencing their trauma and harm, must result in the outcome they all hope for - a better experience for women, babies, and families in the future.”

“Many women also described examples of good quality care and services and many staff are committed to providing quality care and are open to change: there are strengths to learn from and to build on with the right support and investment.”

Professor Renfrew’s report details 32 evidence-informed recommendations for action.

In summary, the report advocates for the following changes:

* A shared strategic vision for safe, quality midwifery and wider maternal and newborn services in Northern Ireland with a regional framework for action.

* A reconfigured relationship with women, families and communities, ensuring respectful personalised care for all and a genuine voice in shaping services.

* A consistent, region-wide, evidence-informed approach to planning, funding, standards, provision, monitoring, and review of maternity and neonatal services.

* Improving clinical, psychological, and cultural safety and equity for women, babies and families across the whole continuum of care and in all settings.

* Changing the prevailing work culture to implement an enabling environment for all staff and managers, including ensuring midwives are represented at senior management levels, tackling silo working, and developing an open learning culture at every level of the system.

* Supporting midwives to provide quality midwifery care and services across the whole continuum of maternal and newborn care, with investment in community as well as hospital services, and increasing midwives’ influence over the safety and quality of care and services.

* Better oversight through improved accountability, monitoring, evaluation, and research.

* A unified approach to education and training of all staff, including leadership development - especially for midwives - and capacity building for the future.

The full report can be read here -Enabling Safe Quality Midwifery Services and Care in Northern Ireland.

Notes to editors:

1. Professor Emerita Mary Renfrew OBE RGN RM PhD FMedSci FRSE has had a distinguished career as a researcher and educator in midwifery and maternal and newborn health in the UK and internationally. She has advised evidence-based policy for governments and global organisations; she led the work for the regulator, the Nursing and Midwifery Council, to develop the new midwifery standards for midwives in the UK; she was principal investigator for the ground-breaking Lancet Series on Midwifery; and she has worked as consultant and adviser to the World Health Organisation for many years. She is the first midwife or nurse to be elected as Fellow of the Royal Society of Edinburgh, and the first midwife to be elected as Fellow of the Academy of Medical Sciences.

2. For media enquiries please contact the DoH Press Office by emailpressoffice@health-ni.gov.uk.

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‘Radical system-wide change needed in maternity services’ (2024)
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