Professor Mary Renfrew
Co-ordinated system-wide change is urgently needed to radically improve maternity care in Northern Ireland, an independent review has found.
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.”
Professor Renfrew continued:
“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 added:
“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.
Caroline Keown, Chief Midwifery Officer DoH; Professor Mary Renfrew; Health Minister Mike Nesbitt; Maria McIlgorm, Chief Nursing Officer DoH.
In response to today’s report from an independent review of midwifery services, commissioned by the Department of Health, Health Minister Mike Nesbitt has announced that a new Maternity and Neonatal Partnership will be established to drive forward improvements in maternity care.
The Minister said:
“I am very grateful to Professor Renfrew for this comprehensive and timely report. My Department is committed to continuing a major programme of work on improving maternity and neonatal safety across Northern Ireland. The commissioning of this review has formed an important part of that work and its publication today is a significant staging post on the path to transformed services.
“I spoke with Professor Renfrew yesterday and we agreed that Northern Ireland has a genuine opportunity to be a real leader in maternity care and to deliver positive whole system reform.
“The new Maternity and Neonatal Partnership when established will be tasked with implementing a consolidated regional action plan including the overseeing of action on recommendations from Professor Renfrew. This will only be properly effective through a multi-disciplinary approach that keeps women and babies at the centre of everything we do.
“Maternity services in NI have undoubtedly been under intense pressure, not least in relation to staffing. The same, unfortunately, can be said for services right across health and social care. I want to make very clear that improving maternity and neonatal services is an immediate area of focus for my Department and for me personally.
“Professor Renfrew has found both serious weaknesses and real strengths in the current provision of midwifery and wider maternity care for mothers and their babies. We need to both build on these strengths and systematically address the weaknesses.
“This report has highlighted traumatic experiences faced by some women, which I acknowledge and deeply regret. It also underlines the pressures on midwives and wider clinical teams within maternity and neonatal services.
“There is a clear message that all of us involved in the health service must listen to women. I am listening and I agree that improvement is needed. Childbirth is a hugely significant life event for women, babies and their families and it is essential that they are provided with safe, respectful, kind, evidence-informed, multidisciplinary, individualised care across the continuum of care in all settings.”
The Minister added:
“Maternity care can make an important contribution to reducing health inequalities and improving infant development through early identification of needs and timely intervention. Its importance cannot be overstated.
“I am determined to ensure all midwifery services and care in Northern Ireland are safe, respectful, and compassionate where women and their families feel heard, valued and supported.”
The Health Minister detailed his response to Professor Renfrew’s report in a statement to the Assembly today.