Midwives and doctors working in the maternity services are facing an 'extraordinarily punitive environment', according to the Master of the National Maternity Hospital, Dr Rhona Mahony.

Dr Mahony, writing in the hospital's latest annual report, says our current culture is one of 'blame, litigation and punishment'.

She said at a time when maternity outcomes at Holles Street have never been better, litigation is spiralling.

"Patient expectation is high and yet public confidence is consistently undermined."

Dr Mahony said doctors and midwives, over-exposed to volume and case complexity, find themselves in 'an extraordinarily punitive environment of High Court, Medical Council, Coroners Court, An Bord Altranais and increasingly commonly, media'.

She said hospital staff are used to exhaustion, frustration and stress, 'but the fear is new, and fear is a dangerous emotion'.

"It paralyses and diminishes, it does not make patients safer."