Irish inquiry reports on pregnancy loss services: what recommendations on staffing and training?

Irish inquiry reports on pregnancy loss services: what recommendations on staffing and training?

Änne Helps (1,2,3), Sara Leitao (2), Laura O’Byrne (1), Richard Greene (2), Keelin O’Donoghue (1,3)

1) Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Ireland, 2) National Perinatal Epidemiology Centre (NPEC), University College Cork, Ireland, 3) The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Ireland

Background
External inquiries are carried out following specific adverse maternal events and aim to identify issues in the maternity care provided to pregnant women and make recommendations to improve standards of care. The current work examines the recommendations made in these reports on the topics of staffing and training, and their link with the care provided to bereaved parents.

Methods
From the national inquiries into the Irish maternity services, 10 publically-available health-service-commissioned inquiry reports relating to pregnancy loss services (published between 2005-2018) were analysed. Qualitative data was collected by 2 clinicians, separately, using a specifically designed review tool. Thematic analysis of the findings and recommendations was carried out.

Results
The reports focused on maternity services in relation to pregnancy loss and/or clinical care provided around the time of the loss. The recommendations included: appointment of a bereavement officer in each maternity unit to liaise with families and multidisciplinary teams, and staff training in bereavement care to provide appropriate support to families. Insufficient workforce training (e.g. intrapartum monitoring, incident review) was highlighted and reflected in the recommendations. Recommendations to increase specialist services (e.g. perinatal mental health), as well as consultant obstetrician/midwifery staffing numbers to internationally accepted levels (including one-to-one ratio of midwife to woman in labour) were made.

Conclusions
These reports highlight the importance for an experienced, single point of contact and support for bereaved parents. Timely and well-executed adverse incident reviews provide essential learning to the hospital and key information for bereaved parents. An adequately trained and staffed workforce is essential to provide safe maternity care, and ensuring the reduction of risk of adverse outcomes.

Ethics statement:
Only publicly-available reports were analysed, therefore no ethics approval was required.

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