AIMS IrelandBirthing women in Mulingar Regional Hospital only “allowed” partner support for the last 30 minutes of labour.
On the 2nd April 2020, AIMS Ireland wrote to the Minister of Health Simon Harris, the Director of Midwifery at the MRH (Ms Marie Corbett) and the Director of Nursing at the Ireland East Hospital Group Mr. Paul Gallagher with respect to the ban on partners for labour and birth at the Regional Hospital Mulingar. Here is a copy of our letter:
Dear Dr. Paul Gallagher and Ms Marie Corbett,
Following the announcement by the Midlands Regional Hospital in Mullingar on 26th March 2020 that partners will not be allowed to attend births, AIMS Ireland have unsurprisingly been inundated with emails and messages (privately and publicly) from prospective parents expressing their fears and concerns. Many have experienced previous trauma, including stillbirths, amongst an array of experiences disclosed to us. This decision is having a profound negative impact on mothers and their partners, which is not conducive to supporting pregnancy, labour and birth. We are aware that births have already taken place with this ban imposed, and we are receiving communications of the trauma this has caused and will continue to cause going forward.
Since this declaration, we have been communicating with the National Women’s and Infant Health Programme coordinators and with the Department of Health. We very much understand that Covid-19 is prevalent and that for the wellbeing and safety of everyone, stringent measures have taken place nationwide to prevent and contain further spread, across all boards.
However, the World Health Organisation (source: https://apps.who.int/iris/bitstream/handle/10665/260178/9789241550215-eng.pdf;jsessionid=6237A60A7A22BB916CEDA1191CAD745F?sequence=1) and the Health Service Executive (source: https://www.hpsc.ie/a-z/respiratory/coronavirus/novelcoronavirus/guidance/pregnancypostpartumguidance/?fbclid=IwAR0o_xvpxIZng17zYKiVt8hYlSiiaLpoTBlk1lAFuzi7tbXFBUr-kwL3aTg) have publicly published guidance stating that for a pregnant person’s emotional and psychological wellbeing, that they may have a companion of their choice to accompany them in birth even if the mother is infected with Covid-19, and so we would like to know why the RHM is not complying with the current HSE guidelines?
Specifically, we would like to see the risk assessment that was carried out which showed that the removal of a trusted birth partner posed less of a risk to a pregnant person, their family and their perinatal mental health antenatally, during birth and postnatally than the risk of them or staff being infected with covid-19 by the presence of their partner during labour and birth.
We would like to specifically see the risk assessment carried out with respect to patients with a history of previous sexual abuse, patients who experienced pervious loss, patients who are under the care of Mental Health Professionals and patients who are teenagers but over the age of consent. This list is not exhaustive of the full set of risk assessment data required for justification of hospital policy.
We would also like to know as to what other measures were considered as possible alternatives to this harsh decision?
Maternity service users are entitled to this basic information, which infringes upon their wellbeing during a most vulnerable time. We are grateful and note that the hospital apologies for any distress, but in this case an apology without an explanation is insufficient.
As Senior executives in RHM, you are both responsible for this decision at local hospital level and if you truly wish to put women at the centre of their care and all decision making please address our concern in an honest, open manner so that pregnant people and their families can understand why you are placing undue stress upon them at this particularly vulnerable time.
AIMS Ireland urges you to review this situation, especially in compliance with national guidance as issued by the HSE yesterday, and to reverse it accordingly.
Failing this, we would strongly suggest that you communicate with pregnant service users in Mullingar hospital to support them appropriately, issue reassurance, build up confidence and resilience and/or offer alternative measures to care for their needs efficiently. We would be happy to discuss such measures.
We look forward to receiving a response from you addressing these concerns with immediate effect, in order to avoid further anxiety and distress amongst pregnant people and their families.
Yours sincerely,
AIMS Ireland Committee.
On the 9th of April AIMSI Ireland received a copy of this press release from Mr. Paul Gallagher (IEHG) in response to our letter
Regional Hospital Mullingar Restrictions Lifted on Partners Attending Delivery of New Born Babies
Regional Hospital Mullingar has lifted the restriction on partners attending the delivery of their child, which was introduced last week in light of the Covid 19 crisis. However, restrictions are still in place for ante-natal, post-natal and theatre units.
Partners will be called to attend the delivery unit approximately one half hour prior to the birth of their baby. The restriction was introduced because of concern about potential patient infection and concern that infection of any members of the small staff at Mullingar could have an impact on the service provided to patients. However, we are thankful that to date, there has been a very low incidence of infection in the unit, and the Hospital therefore believes that it can relax this rule.
The Clinical Lead for Women and Midwifery Staff have worked together with the hospital’s management and with Ireland East Hospital Group including the Executive Director of Women and Children’s Health to put in place protocols which will help protect the safety of expectant mothers and their babies, the staff and partners. Announcing the move Anita Brennan, General Manager Regional Hospital Mullingar said, “At all times our priority is the provision of safe maternity services for our patients at Mullingar. A pandemic poses a particular challenge to a small unit with a
relatively low staff complement. However, it is our judgement that we can now allow partners to attend births, while monitoring carefully the level of infection. “We are constantly reviewing guidance available, and the situation at the Hospital.
However, we are very glad at this point to be able to allow partners attend births at a time when other visiting restrictions remain in place.” Restrictions will continue to be reviewed on an ongoing basis throughout the Covid 19 crisis. Regional Hospital Mullingar will communicate with all patients should it be necessary for the hospital to tighten restrictions again, but it is their sincere hope that all visitor restrictions due to Covid 19 will be lifted in the near future.”
AIMS Ireland made the following response on the 17th April 2020 to the IEHG, to the MRHM to the NWIHP, to the Department of Health and to Minister Simon Harris.
MRHM Partners permitted to attend last half an hour of birth.
- AIMS Ireland welcomes this move from the MRHM for partners who are parents, as it offers a short opportunity to for them to see their newborn baby, before an enforced separation during the postnatal hospital stay.
- AIMS Ireland expresses concern however that this move does not put pregnant people at the centre of their care and continues not to offer them the safety benefits of the presence of a trusted partner during labour. We note that the presence of a partner was cited as integral to a safe maternity experience by the WHO and by the HSE Guidance for Maternity Care during Covid 19 issued on the 1st April and also in the guidance issued by the RCOG and the IOG.
- AIMS Ireland asserts that this move by the MRHM completely misses the point of having a birthing partner.
A birthing partner is not a visitor or a spectator at the birth, intruding in at the last minute, but an integral participant in the labour and birthing process.
Many birthing people don’t always chose a second parent as a birthing partner, but they choose someone who will offer them the support physical emotional or mental that they need.
For many people their partner is their source of pain relief in labour.
The safety of the pregnant person and their newborn baby is improved, not by a visit from their partner just before they give birth, but by the continuous support of a trusted birth partner (not necessarily the biological father), who can: (i). ease the labouring person’s anxiety fears and worries, (ii), advocate for the birthing person, having been already briefed on their needs, wishes and expectations, and finally, (iii). support the birthing person through the process of labour and birth, both with physical and emotional measures.
For many labouring people this enables them to cope with labour and give birth without routine interventions. Or, should interventions become clinically necessary that they feel emotionally and physically supported in availing of them.
4. AIMS Ireland has heard from patients due at the MRHM that waiting for a support partner to be allowed into the delivery suite will add to their stress during labour. It may also result in an increase in unnecessary interventions which birthing people believe might take in the hope of speeding up when their support partner will be admitted.
5. AIMS Ireland understands from infection control protocol for maternity services in Ireland that the last half an hour of labour confers the greatest risk of transmission to the greatest number of health care professionals. Therefore, the policy adopted by MRHM appears not to be founded on the premise of infection control at all.
Taking all of the above points in consideration AIMS Ireland makes the following requests:
- AIMS Ireland would like the Midlands Regional Hospital Mullingar to make available (i) the risk assessment that indicated the presence of a birth partners was no longer a risk to mother baby and staff, (ii). the risk assessment that shows half an hour just before birth to be the length of time that offers a minimal risk to mother baby and staff for infection transmission, in comparison to a partner being present for the entire period of active labour. AIMS Ireland would like a quantified justification for not enabling partners to be present for the duration of active labour in the delivery suite.
- AIMS Ireland would like clarity on exactly how the delivery ward staff will be able to ensure the presence of the birthing partner half an hour before the moment of birth. Predicting the time of birth is notoriously difficult, especially for multiparous people. Even if the time of birth could accurately be predicted how will staff ensure that the partner can be called with enough time to arrive at the hospital, given the rural area the hospital serves? Some families live an hour’s drive away. Will the expectation of the birthing person that their partner be called and the difficultly of predicting the time of delivery not add more stress to staff in an already stressful and difficult working environment? Would it not just be easier to enable partners to be present with the birthing person from the time they first enter the delivery room?
- AIMS Ireland would like clarification on how long the partner remains in the delivery suite after delivery? Normally partners stay until the mother and baby are heading to the postnatal ward. Is this the plan in MRHM?
- AIMS Ireland would like clarification on the process for induction? What support can a labouring person expect from their partner given that induction can be a long, worrying and frightening process?
- AIMS Ireland would like clarification on the presence of the partner for both planned and unplanned c birth? Will partners still be able to attend some part of these births and offer emotional support?
Measures that are introduced which limit human rights in a time such as this need to be shown to be equitable, fair just and having the minimal adverse impact. In terms of equity, other parents-to-be in other smaller maternity units around the country are enabled to be supported by their partner throughout their labour and birth. The Midlands Regional Hospital Mullingar remains the only unit persisting in limiting the access to a birthing partner using a blanket policy without an openly accessible risk assessment to justify this measure. There is no publicly available evidence that Midlands Regional Hospital Mullingar should be any different from any other maternity unit, especially given the low rates of infection with Covid 19 in the hospital. Secondly, other patients in the Midlands Regional Hospital Mullingar, such as those with dementia are, according to the HSE website, still able to receive visitors in the normal fashion. Why are these patients being treated differently to people in labour?
For all of the above reasons AIMSI urges the Ireland East Hospital Group to reconsider its position with respect to the safety of mothers and babies giving birth there and adhere to the HSE and WHO guidance that safety of mothers and babies is improved by the presence of a trusted birth partner during labour (not just as a spectator for the birth).
If the Midlands Regional Hospital Mullingar is not able to operate a safe maternity service, then pregnant people planning to give birth there should be offered alternative safe arrangements in the Ireland East Hospital Group where they will be enabled to have a trusted partner with them as set out in the HSE guidelines, the WHO guidelines and the IOG and RCOG guidelines.
Kind regards,
The AIMS Ireland Committee.