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Galway midwives set the standard

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The midwives of University Hospital Galway believe they know how to improve maternity services for women of this county and beyond.

And they are awaiting the outcome of the new National Maternity Strategy currently being finalised in the hope that it will back them up.

“We are really hoping midwifery-led care will become the norm for all low-risk pregnancies,” explains Jennifer Duggan, clinical midwife manager at UHG. Last year 38% of women who delivered at the Galway unit came through the midwives’ clinics – staffed by just six women, one of them working part-time.

If there was a change of focus, there would need to be a change of resources to expand services run by the midwives.

The Minister for Health Leo Varadkar announced last April the appointment of a steering group to prepare a new National Maternity Strategy that will “put the needs of mothers, babies and their families at its centre”.

Maternity services have been under the spotlight like never before.

Horrific stories have served to undermine the confidence of pregnant women, some of them all too close to home.

The death of Savita Halappanavar at University Hospital Galway in 2009 sparked an international outcry and an avalanche of reports. The deaths of a number of babies at Portiuncla Hospital – with others left seriously deprived of oxygen – is currently the subject of an independent investigation. Publication of the report into “twelve adverse perinatal events” between 2008 and November 2014 at the Ballinasloe facility has been delayed until the end of the year at the earliest.

There are currently five antenatal clinics being run outside of the city, in Tuam, Oughterard, Doughiska, Gort and since last month Athenry.

While the two scans for public patients – one at twelve weeks to give an accurate due date and between 18 and 22 weeks to detect anomalies – are still carried out at UHG, all other checks can be carried out in the community.

In 2014, 499 women had their antenatal care in the community, reducing stress levels of pregnant mums trying to beat traffic and find scarce parking in a jammed packed city campus.

They also get the opportunity to see the same midwife all through term, at an allotted time and in the more relaxed atmosphere of a country clinic. They often feel more able to discuss pressing concerns around their new arrival and become educated about what to expect, reveals Jennifer.

It has the added advantage of taking the pressure off the unit at UHG and frees up consultants to see women with complications.

The early transfer home service allows women who have had a problem-free birth to be discharged within hours of the baby being born and getting all postnatal care in the comfort of their homes.

So instead of being crammed in a six-bedded ward with screaming babies and exhausted mums, they get to sleep in their own beds, eat home-cooked food while a pair of midwives visit them at home for up to five days after birth, giving advice, support, feeding tips and all the usual tests carried out in the maternity ward.

The scheme when it first started off in 2009 had around 9% of eligible women taking part. Last year 398 women were cared for at home – out of 2,900 deliveries.

It still only operates in the city and parts of Oranmore and Claregalway.

Extensive research backs up the case for midwifery-led care.

Trials on more than 16,000 women found that women who receive continuous care from midwives throughout pregnancy and birth fare better than women cared for by a combination of obstetricians, GPs and midwives.

The study carried out by NUI Galway and three British universities and published in the Cochrane Library in 2013 found that those cared for by a small group of midwives throughout pregnancy were less likely to give birth pre-term and required fewer interventions during labour and birth than those whose care was shared.

Women under midwife-led support were found to be happier with the care they received, had fewer epidurals, fewer assisted births and fewer episiotomies. They were “no more likely” to have a Caesarean birth, but were in labour for about half an hour longer on average. Women at low risk and high risk of complications participated in the study.

Ireland differs from countries such as Britain and Australia where midwives are the main providers of care to pregnant women. Here 95% are booked directly into the care of a consultant obstetrician.

“Hospital care in Ireland is obstetric-led in practice and policy and includes many routine interventions which increase distress to babies in labour and increase the risk of adverse effects on women, for example higher rates of induction, amniotomy (breaking the waters), epidural analgesia and use of oxytocin,” according to Jene Kelly from the Association for Improvements in Maternity Services (AIMS Ireland).

“Some practices may not be routine for every woman, but are frequently in use despite risks. For example recent research by the American College of Gynaecologists has shown the use of oxytocin – for induction of labour or to ‘speed-up’ labour – poses an independent risk to babies and increases neonatal intensive care admissions.”

Minister Varadkar acknowledged there was a clear need to provide reassurance in terms of safety, quality and choice.

There was a 22 per cent rise in the number of maternal deaths in 2010-2012 – making it higher than in the UK, according to the Confidential Maternal Death Enquiry.

In the same period, the birth rate here has also increased dramatically – by approximately 30% from 2000 to 2012, with the greatest number of births recorded in 2009. In Galway the peak birth rate was in 2008 when 3,600 babies were born.

According to a recent opinion piece by consultant obstetrician and gynaecologist at the National Maternity Hospital Dr Peter Boylan, the recommended midwife to patient ratio is 1:30, the recommended consultant to patient ratio is 1:350.

Consultant numbers would have to almost double to achieve the recommended level, while an estimated 600 additional midwifery posts are needed to achieve the ratio.

CITY TRIBUNE

Councillors back bid to ban city centre parking in Galway

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From this week’s Galway City Tribune – Councillors have unanimously agreed to ask Transport Minister Eamon Ryan to limit parking to residents only in the city centre.

Pedestrians in the city are being treated like second-class citizens, according to the Mayor, who said cars continued to get the priority on Galway’s streets.

At a meeting of the City Council this week, Mayor Colette Connolly (Ind) said the city had come to a standstill in car traffic, and pedestrians and cyclists were suffering the consequences.

“At junctions, why am I a second-class citizen in my own city as a pedestrian? It rains in Galway for 300 days of the year, but I am a second-class citizen when priority is given to motorists.

“It’s always the pedestrian that waits,” she said, hitting out at the length it took to get a green light to cross at pedestrian crossings.

One way to reduce the number of cars in the city centre would be to limit parking to residents only in the city centre, said the Mayor.

In a motion she proposed, seconded by Cllr Mike Cubbard (Ind), councillors unanimously agreed to write to the Minister for Transport to demand he pass the necessary legislation to enable the Council to do this.

The Mayor said residents were “sick, sore and tired” of people parking where they wanted when they visited the city and said despite a desire to introduce this measure going back almost 20 years, the Council was hamstrung by national legislation that prevented them from proceeding.

This is a shortened preview version of this article. To read the rest of the story, see this week’s Galway City Tribune. You can buy a digital edition HERE.

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CITY TRIBUNE

Planners approve homes for ‘cuckoo fund’ investor

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From this week’s Galway City Tribune – The green light has been given for the construction of 345 apartments at the Crown Square site in Mervue – the majority of which will be put on the rental market and operated by a ‘cuckoo fund’ for a minimum of fifteen years.

Crown Square Developments, which is owned by developer Padraic Rhatigan, has secured permission from An Bord Pleanála for the ‘Build to Rent’ development, with four blocks ranging ranging from four to nine storeys in height.

There will also be a neighbourhood facility with a gym, a primary care medical centre with pharmacy, a ‘working from home’ lounge, six shops, a games room and a creche.

There will be 240 two-bed apartments, 86 one-beds and 19 three-beds, all of which will be specifically for the rental market and not available to purchase.

A breakdown of the apartments shows there will be 240 two-beds; 86 one-beds and 19 three-beds.

To meet social housing requirements, the developer plans to transfer 35 of the apartments (20 two-bed, 10 one-bed and 5 three-bed) to Galway City Council.

A total of 138 car-parking spaces have been allocated on the lower basement levels of Crown Square for residents, along with shared access to another 109 spaces and another 13 for use by a ‘car club’. There will be 796 secure bicycle parking spaces to serve the apartments.

The Board has ordered that the apartments can only be used as long-term rentals, and none can be used for short-term lettings.

Under ‘Build to Rent’ guidelines, the development must be owned and operated by an institutional entity for a minimum period of 15 years and “where no individual residential units shall be sold separately for that period”. The 15-year period starts from the date of occupation of the first residential unit.

This is a shortened preview version of this article. To read the rest of the story, see this week’s Galway City Tribune. You can buy a digital edition HERE.

 

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CITY TRIBUNE

Councillors divided over vote on Salthill Prom cycleway

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From this week’s Galway City Tribune – A proposal to install a temporary two-way cycle lane along Salthill Promenade hangs in the balance, with city councillors split ahead of a vote next week.

On Monday night, the 18 city councillors will discuss Mayor Colette Connolly’s motion that the lane be installed on the coastal side of the road from Blackrock to a point opposite Galway Business School.

A poll of the councillors carried out by the Galway City Tribune yesterday found nine in favour of the proposal, with one indicating they will abstain. A simple majority is required and if there is a 9-9 split, the Mayor holds a ‘casting’ vote, effectively a second vote.

There has been a flurry of lobbying by cycling campaigners urging councillors to vote in favour, as well as some complaints from residents worried it will again impinge on their parking as visitors to Salthill seek somewhere to park up while they swim or walk along the most utilised resource the city has.

During lockdown, Gardaí removed parking on the Prom to deter people from gathering in a public space. This resulted in motorists blocking driveways and entering private estates, leading one estate off Threadneedle Road to hire a private clamping company.

Mayor Colette Connolly (Ind) believes there are a maximum of 250 spaces that would be lost to the project on one side of the road as currently proposed, including seven disabled spaces, which could be reassigned close by.

This is a shortened preview version of this article. To read extensive coverage of the issue and to see how each councillor intends to vote, see this week’s Galway City Tribune. You can buy a digital edition HERE.

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