UCC SONM 25 Year Book

UCC / School of Nursing and Midwifery

Midwifery Practice and changing Health Services

As has been seen, the gradual move from home to hospital happened and by the 1950’s many births took place in hospitals. The Health Act (1953) introduced the Mother and Infant Scheme which provided free maternity care to women. This service provided women with antenatal and postnatal care by their general practitioner (GP) and a hospital service under the care of an obstetrician. Midwives were not mentioned. When first proposed, the Scheme was controversial, but it led to the development of hospital services and more obstetricians were appointed. Home births were still possible, but the number of home births declined and by 1990, there were just 177 home births. Until the 1970s, home births were a feature of midwifery practice and education in the Erinville and St. Finbarr’s.

Dr. Rhona O’Connell pictured with participants at S/SWHG Midwifery Conference 2017

Simulation in midwifery practice.

While doctors determined the practices of midwives in hospital settings, midwives had considerable autonomy in providing care to mothers and babies. Practices were based on routine and tradition and midwifery textbooks relied on obstetric sources of information. By the 1980s, Active Management of Labour became the norm and increasingly technology became a feature of maternity care with obstetric ultrasound and CTGs replacing the clinical skills of midwives and obstetricians. In more recent decades, epidural analgesia has become a feature of maternity care. Towards the end of this period, the increasing intervention in childbirth led to the call for evidence in health care and also calls from women for normalising birth. This is an ongoing issue in contemporary maternity care. The National Maternity Strategy (DoH 2016), is the current driver of maternity care. Midwifery continuity of care and home births are now recommended as options for women with straightforward low risk pregnancies. Homebirths are provided under a national home birth scheme and many maternity units now offer midwifery led antenatal care and Domino services for women. In addition, there are many midwives in specialist roles including bereavement specialist, lactation specialists and in perinatal mental health. The development of advanced practice in midwifery posts are the next area of practice ready for development within the Irish maternity services.

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