the long game: Interview with Dr. Rhona Mahony
Neasa Conneally UCD School of Medicine and Medical Science, University College Dublin, Belfield, Dublin 4, Ireland
Sarah Murphy UCD School of Medicine and Medical Science, University College Dublin, Belfield, Dublin 4, Ireland
Dr. Rhona Mahony, Consultant Obstetrician and the first female Master of the National Maternity Hospital, on her career, on memories of UCD and on being a prominent advocate for better maternal and infant care in Ireland.
→ Is there such thing as a typical day for you?
No, that’s the beauty of it. I am usually in the hospital by 7AM to get a feel of how things have been overnight. At 7.30 we have a handover meeting so all our NCHDs (non-consultant hospital doctors) meet, we look at what happened the night before and we try to identify the patients that we’re worried about and make sure that we have identify women with potential problems so that that nobody gets dropped on the handover.
We also use it as an opportunity to debrief a little bit; sometimes it can be traumatic for young staff who might have had a very difficult delivery. We’re very into learning from everything; we’re not into blaming or into pointing the finger. We might say, “Look, we might have done that a bit better” but in a very positive way.
At 8AM, I have to have my slice of toast and my cup of tea. I always say there’s no point asking me for something until I am fed because invariably it will be a negative answer!
After that it varies, so on a Thursday I might be scanning all day, on Wednesday I might have be operating in theatre, but very often I have a lot of business meetings as well, we are carrying out lots of renovations around the hospital just to keep it safe for the next few years while we progress with our major redevelopment plan, moving to the St Vincent’s University Hospital campus.
→ How do you find balancing your clinical practise with your duties as Master?
Lots of hours, I have to say, but I love clinical practice. People say to you “As Master, perhaps you shouldn’t do any clinical practice, you should just be the CEO”, but in terms of motivating myself and inspiring myself - seeing babies being born keeps me sane and keeps me connected. On a very important level it also keeps me very connected to the hospital so I’m not seen to be some distant figure issuing instructions. People see me at four in the morning, up to my tonsils in trouble, like everyone else! I also take part in the call rota, I think that does help when you’re trying to bring change with you, that people feel that you’re part of the team and they will come with you.
→ Do you think being a woman makes any difference to how you carry out your role?
Not at all. People say “The first female Master!” well, I’m the first female that applied to the job here so that takes care of that!
→ What do you need to be Master?
You need to be a good obstetrician. You need a good insight into complex foetal- maternal medicine problems because we might have very difficult decisions to make for patients and its really helpful having a clinical background like I have because it helps me understand, when it comes to complex decisions, what are the pitfalls, what are the difficulties and what might the outcomes be. On a strategic level, I think of my own daughters growing up and wonder how maternity and gynaecological services will be for that generation. I like to think they will be better. I think I’m very driven by that overall picture of how should it be and could be for women in Ireland
I think of my own daughters growing up and wonder how maternity and gynaecological services will be for Them
→ You really came to prominence in the public eye when you spoke at the Oireachtas hearings for the Protection of Life During Pregnancy Bill, was being an advocate for women in that role something you felt very strongly about?
I felt very much that a medical opinion should be given during the hearings because they addressed the very restrictive domain of risk to life for women and I am aware from my practice that at times there are complications of pregnancy that can result in women dying. They’re rare, they’re very infrequent, but they are there.
So I felt that if there was to be a discussion, that doctors should take part in that and give their medical experience over many years because the issue of maternal mortality very much belongs in our sphere and it was very important that any myths might be dispelled.
I didn’t appreciate the level of attention that it would bring upon me and I suppose I found that quite difficult because I wasn’t prepared for it. It’s not that I didn’t think there’d be some attention given but it was a little more than I had anticipated.
So it was a very interesting time. Would I do it again? Yes, I think it was my duty and I think I gave my honest medical opinion based on my factual experience and I think that was the right thing to do.
→ Recent events have shown that perhaps there is still some uncertainty over what the legislation actually means, would you agree with that?
I think that the law changes nothing really; it essentially legislates for the X Case. I think a lot of people thought the law was introduced in response to the Savita Halappanavar case but not at all, it was actually in response to the A, B and C v Ireland cases in the European Court.
The Supreme Court interpreted the Constitution in the X Case to permit termination of pregnancy if there was a substantial risk to a mother’s life caused by complications of pregnancy – a risk which could only be removed by terminating the pregnancy. However, there was no clear process whereby a woman could determine if she qualified termination of pregnancy on the grounds of risk to her life. So the European Court charged Ireland with providing women with such a process.
I think that a lot of people thought that the law was going to somehow revolutionise things, it never set out to do that and so it caused disappointment on both sides, because for the people that get labelled "pro-life", and I hate labels, they felt that it went too far and for the group that might get labelled "pro- choice", they felt that perhaps it didn’t go far enough but the law was never going to do anything different. Some people were unhappy that it did not deal with other aspects of complex pregnancy including rape and fatal fetal abnormality. These remain uncomfortable topics, not least for women affected, and I think the discussions and debates are far from over.
I also don’t think that any law will take away the complexity of life. The law is there to protect as much as possible, but humans are very complex, life is very complex, and reproduction has got to be one of the most complex aspects of life- glorious and fantastic, but fraught with all kinds of physical, ethical and moral challenges.
→ On the topic of fatal foetal abnormalities, do you personally feel the need for it to be legislated for and further laws to deal with the lacunas in these sorts of cases?
I think it’s really hard. It’s interesting because this is my area of practice and my experience is that some women with a fatal foetal abnormality will know this and carry their baby to term and their baby may only live for 5 minutes, 10 minutes, but those 10 minutes are the most precious moments of their life and they would never give that back. It is so important we acknowledge that and we give all the support we can to these women and their families to navigate that very tragic circumstance.
Some women, on the other hand, will find the idea of going through that pregnancy and delivering just absolutely impossible, so everyone is different and the question is how do we within our society cater for people with different opinions? I think that’s where Ireland really struggles, we like everything to be black and white and we like everyone to think the same way, but people don’t think the same way, and we have got to realise that people will approach things differently and what really matters is that we take really great care of our women and our babies.
→ When talking about increasing staffing levels, how would you improve the retention of medical graduates in Ireland?
There are a number of interesting things happening in Health at the moment. One is that we have lost some of our senior consultants because of induced voluntary retirement schemes. Approximately 70- 80% of a budget in any hospital is spent on staff; if you want to save money the big economical thing is to reduce staff.
But that can have devastating consequences. So we lost a lot of our most senior doctors and midwives; that was the first thing. The moratorium on staffing levels was a very blunt tool and resulted in gaps, which were subsequently filled by agency staff at great financial expense and at the expense of local departments stability and progress.
Then we find that we have graduates coming out of medical school who are some of the best trained in the world but 50% of them are not taking Irish registration. Some of that will be because they were never going to, they came from abroad and now are going back. But some of that is because they don’t see a future in Ireland. And when that starts to happen you have really got to wake up and smell the coffee, both as professionals and as a country.
So you have to ask Why? What could it be about working in Ireland that would put young people like you off? First thing is Ireland has got to start by providing the best teaching and training. It won’t do that unless it increases the number of Consultants. Training requires supervision and there is no point in running, as we do, our health service with lots of people in training and only a few people at the top. I think if people know that they would get the very best training then they would consider staying.
We have to address the long hours in some specialties, particularly obstetrics and surgery; you have to address those things so that people can still have a life. I wouldn’t like people coming up through the system that I came up; where we worked over 100 hours a week and I have done so pretty much ever since I was 23. I don’t think that that’s a sensible or necessary approach.
Pay is also an issue. We’ve got to take a whole new view of "How do we attract these brilliant new doctors", and not "These doctors are lucky to get a job in Ireland", which is where I think we have been. We have a reputation for being toxic employers, which we do deserve and we must now start to come away from that and start making big changes.
→ How do you balance your long working days with having a young family?
Very badly! Honestly, I’m really lucky; I have a huge amount of support from my husband. He hates me mentioning him but he is extraordinary in his ability to multitask and look after the children and do everything. He’s a total rock - he just keeps the whole house running and he works himself, I don’t know how he does it.
Your job absolutely comes first, you can't let people down, you cant just not go on call
I do give up a lot and others give up a lot on my behalf. I’m aware that I’d love to spend more time with the children. I have missed loads of things and that’s a very difficult thing about being an obstetrician, that your job absolutely comes first, you can’t let people down, you can’t just not go on call, so you have to be there all the time and it does require certain sacrifices to be made. I think it’s worth it in the long run but it is really difficult at times. I always say to my kids, “I’m not always here all of the time but I’m loving you all of the time”.
→ As a woman in a high leadership role, how would you suggest that the medical profession works with women to allow them to progress in their careers but also have families?
I think it comes back to part of providing training and flexibility. So many young doctors who are coming through now are female and that‘s fantastic, but there are going to be differences. People always say you’re being politically incorrect but actually it’s a fact and it means we might have to plan our work force a little bit differently and we might need to add in a buffer so that maternity leaves can be taken care of.
If you can support women through having their young children, then women will continue to work bringing all their skill and experience to the work place.. So you must always take a long view, but I think with the number of women coming though we will have to change how our work force planning is.
→ Speaking of having a life, what is it you like to do when you’re not working?
When I have a life! I joke that if I wrote a biography recently, it would be “I went to work and then I slept”, that’s it. It would be a short book!
No, I’m very interested in life outside of medicine; in fact one of the best things about being Master has been my exposure to all kinds of different organisations, and to things outside of medicine.
But off-duty, I go running because you can do that at any time, you just take a pair of runners and off you go. I love to run around Howth Hill because it’s so beautiful all the time. I like to read, I love theatre. I’m a geek; I love anything that will elevate me. I love eating and the odd glass of wine, if I’m honest. So I love Sunday dinner when everyone’s around the table, my mum and dad, all the family, everyone is talking at each other and no one is listening, that’s really what I love. I’m a very simple girl!
→ What was your fondest memory of your time in UCD?
Pre-med was just the best year of my life. I met such lovely people and it was so exciting. I loved the intellectual freedom in university, you were surrounded by really clever people, and yet it wasn’t like school. You had a bit of time and when you go out on Tuesday evening, you can catch up on Wednesday so you had a bit more autonomy in how you ran your life.
It was very exciting to go into the hospitals as well and be part of that, but I think it was definitely pre-med and that whole feeling of being set free and intellectual stimulation. It was just so much fun but I nearly failed my pre-med exams, I have to say!