Declan Devane, Professor of Midwifery at NUI Galway

Recently appointed as Ireland’s first ever Professor of Midwifery at NUI Galway, Declan Devane believes that more of a focus needs to be put on midwife care as Ireland’s maternity units continue to struggle with over 76,000 births annually.

Originally from Hollymount in Mayo, Declan trained in nursing at University Hospital Galway (UHG) or the Regional Hospital, as it was then known, before moving to the UK, where he specialised in midwifery at Bristol and Gloucester.

Three years ago, he returned to Galway to teach at NUI Galway’s School of Nursing and Midwifery and was appointed Ireland’s first ever professor dedicated solely to midwifery last November. “It was a competitive post and I was glad to get it,” he says.

His 22-year career has been very successful and Declan has gained a reputation as a leading researcher and scholar in areas including the implementation and evaluation of models of maternity care and on methods of assessment of foetal wellbeing.

However despite his many successes, he admits that nursing and midwifery was originally not a career path he had long dreamed about taking.

“But once I started it I found I had an aptitude for it and it is something that has stuck with me since. I think we are very privileged to be involved with what is for many women and families a major life event,” he says.

In view of the fact that Ireland now has the highest birth rate in Europe, Declan says that one of the biggest problems facing modern maternity care is the continuing centralisation of services.

“For example of the 76,000 infants that are born in Ireland every year, almost a third of those will be born in three hospitals in Dublin. There is a hospital in Dublin pushing 10,000 births per year. The facilities were never made to cope with that number of births,” he says.

He adds that existing midwifery services need more funding to be able to support the clinical side of maternity care, which he says is at “breaking point” in some hospitals.

“There are lots of models of midwifery care and there are some really good examples of midwifery care being provided in the West of Ireland and throughout the rest of the country and what we need to do is to develop those further and support those further,” he says.

Along with a current maternity infrastructure that is struggling to cope, Declan says the country also faces a challenge in providing alternative models of childbirth such as midwifery units and homebirths alongside the traditional consultant-led care models, which are the ones under most pressure at the moment.

And he says that more midwifery care in Ireland would be of great benefit to the country’s women, both medically and financially.

“We have high quality evidence to say that midwifery models of care are at least as safe as consultant-led models of care. They are cost effective and women who use them are highly satisfied so there is a strong clinical, economic and social argument to be made to use these midwifery services,” says Declan.

While he feels that more of a focus is needed on midwifery care, Declan insists that it should always be done in conjunction with the other arms of maternity care such as obstetrics.

“Not for a moment do I think that there isn’t a role for mainstream obstetric care. There absolutely is. Many women have much better outcomes for having received high quality obstetric care and that needs to continue but we have many women accessing obstetric care who don’t need that level of service and may not benefit from that level of service.

“I have always argued, and it is an important point to make, that midwives, obstetricians and GPs each have their place and their role in collaborative maternity care. Of all the models, no one model of care, of caregiver or of a birth setting should be advocated for or will suit every woman but every woman should receive the best care from the most appropriate person,” he says.

He adds that there are a number of advantages to midwifery care for many women, especially those who are low risk and not likely to need extensive hospital care.

“The advantages are that there is less clinical intervention, there is less need for chemical intervention during childbirth, we know that for a fact, and that reduction in intervention doesn’t result in any worse outcome for the baby so despite low rates of intervention, the outcomes for mothers and their baby are at least as good as the outcome for similar women who are cared for in mainstream obstetric services,” says Declan.