Ongoing Restrictions in Maternity Services

Wed, Apr 26, 2023

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While pandemic-era restrictions have been removed, there are still restrictions with our Maternity Services that exclude partners from antenatal appointments and assessment units, and a ban on the visit of older siblings. Neasa urged the Government to ensure that every maternity unit in the country publishes a risk assessments so people accessing services can understand why they are still not allowed to receive supports from their partners.


Neasa Hourigan TD: I have one very clear and concise request for the Department tonight. It is that every maternity unit in the country publish its risk assessments each month or whenever a new assessment is completed so that people accessing the services can understand why they are still not allowed to receive supports from their partners in some hospitals. During the pandemic, partners were banned from appointments in order to curtail the spread of Covid-19 in clinical settings. We all understood that but the reality is that even now, those restrictions are still in place. In some units, visitors are restricted to one designated support partner. In some cases, partners are not even allowed into particular appointments. Time and again I have outlined in this House the negative consequences for partners, women and families and, more importantly, for infants when people are not supported during childbirth. The ongoing exclusion of partners from antenatal appointments and assessment units is being implemented by individual hospitals. We all know that but ultimately it is the Department and the Minister who have a responsibility to address the ongoing constraints that are contrary to the best care and best practice for people giving birth.

During the pandemic, at least the restrictions were part of national guidance and were developed in collaboration with stakeholders, patients and senior HSE executives, but this model of decision-making seems very regional in its approach and highly specific. What I am asking for is not necessarily to override those decisions but simply to make them legible to the people they are affecting.

From Wednesday last week, mask-wearing is no longer mandatory in hospitals, except in certain circumstances. That is the last vestige of Covid leaving our system. We are all happy to see that but it makes the continued existence of some of those restrictions in maternity units even more baffling and really hard to understand for the families affected.

To put it mildly, although it might be a significant understatement, we do not have a positive legacy in this country of listening to women in terms of their healthcare and what they need. It is frustrating that Deputies still have to come into this Chamber to talk about maternity restrictions and ask the Government to provide guidance to maternity units. It is now more than three years since partner restrictions were implemented in maternity units across the country. Thousands of people have laboured alone, have given birth on their own without their partner, the support who knows them best, but also the person who is often the other parent of the child in question. People have suffered unbearable losses in maternity units, on their own, without support, while others have had to cope with sick infants and deal with the impact of that on their own. Their partners have to sit in carparks or at home wondering how their very much loved family is coping without them, knowing for certain that they might not be coping and are still on their own.

In August 2021, the Minister for Health, Deputy Stephen Donnelly, confirmed that the nationwide restrictions were no longer in place and that partners could once again be present to support during maternity care. We were all hoping that would mean they could come to everything in its entirety. I truly do not understand why we are still here talking about this issue and I am still getting emails and phone calls from distressed people on it. We know it is affecting people who do not have English as a first language or who may be from a particularly vulnerable cohort. They may not have the agency to challenge decisions. It is really important that when specific decisions are being made, they are made legible and people are informed of the risk assessment and the reason the decision was made. That information must be available and public.

Minister of State, Mary Butler: I thank the Deputy for raising this very important issue. I know it has been an issue of concern for women and their families. I fully appreciate that limitations on partners accessing maternity services have been very difficult for everyone over the course of the Covid-19 pandemic. That is why I was surprised earlier when I read the topic to which I was to respond this evening. I was not aware that partner restrictions were still in place. I do not believe they are in every maternity hospital but obviously they are still in some. Deputy Hourigan, like me, is a mother and we have plenty of dads here in the Dáil Chamber. People need support at many times in their lives and this is one important time in life when people need to have support.

The objective throughout Covid had always been to keep maternity services as safe as possible, support the woman on her pregnancy journey and facilitate access for the nominated support partner. Maternity services have remained focused on maximising access and, in effect, all restrictions that were introduced during the pandemic have now been removed, including for routine scanning, labour, delivery and time spent on antenatal and postnatal wards.

However, the clinical advice has always been focused on the potential for infection to spread in maternity services, and the highest priority is protecting the health and safety of the women and babies in our care. Variations exist across our maternity services and hospitals which include case load, complexity and infrastructure. This all feeds into decisions made in relation to infection prevention and control risks in our maternity services.

The HSE has advised the Department that Health Protection Surveillance Centre, HPSC, guidance and restrictions that were in place regarding access to maternity services in the context of Covid-19 are no longer applicable. That is why I was surprised to find I was responding to this matter. There are limited exceptions introduced at times, based on local infection control and health and safety measures. Everyone appreciates that there are times when local infection takes over but limitations on access for nominated support partners should always be the minimum required to manage this risk. They must be clearly explained and should be applied with consideration for individual circumstances and needs. In all circumstances a person-centred approach should be adopted to recognise the context in which the presence of a support person is required.

Each maternity service assesses its ability to accommodate access for partners in the context of local facilities and infection control requirements. For example, in light of the recent fire at Wexford hospital, while support partners can attend all antenatal appointments, they are requested to wait outside until their pregnant partner is called for her appointment.

The HSE recognises that a nominated support partner plays a central part in supporting a person using maternity services. The support person also has a right to be present and to participate in the care process to the greatest practical degree.

Regarding children visiting at maternity services, as in all other hospital settings, in circumstances where a woman has a long length of stay, the hospital should provide reasonable access for her children to visit her.

I assure the Deputy that any access limitations individual hospitals may implement from time to time are necessary for infection prevention and control. A decision to limit access is taken locally by clinicians and hospital management who know their own circumstances intimately. The HSE has assured the Department that every effort continues to be made to maximise access for partners and their loved ones during their maternity care. It is obvious, however, that this is not the case in all hospitals, as Deputy Hourigan outlined.

Neasa Hourigan TD: I thank the Minister of State. I know she fully understands the issue. I am sure she also hears constituents or people around the country raise it every so often. This issue only seems to be raising its head in some maternity units. It does not apply in all hospitals. To be honest, part of the problem may be that it is not a nationwide standard. I fully accept that every unit is different. We are very aware that the infrastructure in the health service is not always what we want it to be. We are dealing with older buildings. Capital spending on the upgrade of maternity hospitals has been a particular focus of the Government and we are doing good work. I want to focus tonight not on querying whether there would ever be restrictions but on querying the fact that we do not make readily available the thinking and reasoning behind it.

In preparing for this discussion, I had a look at what is happening in other countries. I reviewed ten NHS trusts with maternity units. Eight of those trusts have been providing risk assessments for at least 18 months and of the remaining two, one was two years old and the other was three and a half years old. I know the risk assessments are being done.

The people who operate maternity units are well used to evidence-based decision-making and make risk assessments based on what they have to hand. I hope and assume it is not something they are doing without due consideration. The request is to make the consideration publicly available. All our hospitals and hospital groups, from what I can see, have fairly well operating websites and a platform whereby they can communicate with the public. It would be incredibly helpful to people, particularly those in more vulnerable cohorts who do not feel they can speak up and those who do not feel they understand the minimum requirement to manage risk, if the thinking, outline and risk could be made available to them.

Minister of State, Mary Butler: I acknowledge how important the support of partners is to women throughout their pregnancy journey. It is also important that the partners be present as much as possible. The Deputy might have hit the nail on the head when she talked about some of the older buildings and some of the risk assessments. It is really important that we have evidence-based decision-making regarding restrictions. It is difficult for families at a joyful time if there are restrictions.

We have 19 maternity hospitals. Perinatal mental health supports are available in every single one of them. If a person presents with mental illness or mental health challenges before, during or after giving birth, there are supports. In some cases, it might just involve the anxiety of being a first-time mother and the associated difficulties. One of the success stories of our mental health service is that we have supports rolled out to every single maternity unit in Ireland. Last year, I was delighted to visit the Rotunda. Of the 1,000 mothers who presented last year, 20% used the perinatal mental health supports. I am aware that I digress a little but it is sometimes important to put out the message, especially to mothers who might be feeling vulnerable and who might not have access to the language supports they need, that there are supports being provided in their hospital.

The Deputy made a valid point about the risk assessments and having information available. I will certainly relay it to the HSE on her behalf. I thank her again for raising this matter. I did not believe I would be answering a question like this at this stage of Covid but I understand that infection prevention and control measures are really important. They are always taken to support mothers and their babies, especially in the neonatal units.