Nurses rejected a motion to require only midwives to carry out postnatal assessments at the union’s conference at Croke Park on Thursday.
After an unusually protracted debate marked by stark divisions of opinion, delegates to the conference voted against the motion which called on the union to lobby the Department of Health to ensure detailed assessment of postnatal women routinely carried out by public health nurses (PHNs) are in future required to be carried out by staff with a midwifery qualification.
The motion was proposed by the union’s midwifery section and those backing it cited research that found more than half of maternal deaths, generally related to issues such as haemorrhage, hypertension, sepsis and thrombosis, occurred at the postnatal stage and that a greater focus on prevention was required.
The maternity-related training of PHNs does not, it was suggested, provide the required experience and expertise to nurses to carry out and act on the assessments, it was argued.
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There was considerable pushback, though, by members who were PHNs, a number of whom said they were themselves qualified midwives.
A midwifery qualification was previously required to become a public health nurse but the regulations were changed more than a decade ago because of the shortage of eligible candidates to become PHNs. That would be likely to remain an issue if the requirements were changed now but after the debate Lynda Moore, chair of the union’s midwifery section, said PHN training that included six weeks of practical maternity experience as an observer was not enough and the issue still needed to be looked at despite the strength of feeling among public health nurses.
During the exchanges on the conference floor Maeve Gaynor from the Drogheda branch said she had spent four years training to become a direct-entry midwife and “we didn’t have a postnatal care module or a six-week placement in postnatal care ... it was a hugely integral part of our training”.
“This isn’t about taking from the PHN role,” she said. “This is about ensuring proper safe care for the women in this country, who unfortunately have tended to suffer when it has come to HSE services over the years.
“I think we need to put our women first by providing them with the best-qualified people; people with the most experience who have been exposed to all aspects of postnatal care, not just a fraction of it or what they have seen in a book.”
Among those arguing against the motion was an assistant director of public health nursing based in Kilkenny, Aine Ward, who is also a registered midwife.
“I have to admit I did have concerns when midwifery was withdrawn as a requirement for the public health nurse course,” she said, “because of the impact that might have on maternal and postnatal care. But I have seen first-hand that my colleagues without midwifery are more than competent to meet the maternal postnatal care of women out there in the community.”
Other speakers against the motion said the training currently provided to candidates who were already qualified nurses was entirely appropriate and the proposed restriction could negatively impact on new mothers in more remote areas.
After by far the longest debate of the conference so far, the motion was ultimately defeated but Ms Moore said she didn’t believe that would be the end of it.
She said PHNs were particularly good on issues such as postnatal depression and providing other supports but “the study I quoted spoke about a need for more focused postnatal care because that’s when 53 per cent of deaths occur, that’s when most of the infections, the clots, all of the dangerous things happen. And ‘more focused postnatal care’ – that for me means more expertise in the area.”
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