Why these Kerry midwives ‘love to get up and go to work in the morning’

The hubs were set up when a national maternity experience survey in 2019 revealed gaps in post-pregnancy care. Almost one in three women said they did not get mental health support after pregnancy and many also said their physical health was not checked.

On walking into the Listowel hub the words 'bright' and 'calm' spring to mind with the rooms located within the recently-renovated community hospital.

Rhowena Woodward is a staff midwife for the Kerry hubs.

“You develop relationships with women here that I think sets them up for positive parenting and a positive future,” she said.

“It just feels like you are making a difference to their lives and their babies’ lives. It’s great, you are not rushed off your feet. You are not stressed and you can be there in the moment.”

The team of four midwives see about 12 women every day, with appointments of 30 minutes or longer if needed.

“Our offices are in Centrepoint in Tralee, so we’re in Tralee two days a week,” she said.

The rest of the week is split between Listowel, Killarney, Dingle, and Cahersiveen. They have close links with the maternity unit at University Hospital Kerry.

“I think continuity of care is so important so here, every time you see the woman, you are not flicking through the notes to try and remind yourself (who she is),” she said.

You already know her, you know her history, you know if you are going to be worried about her mental health and the social situations she is in. You know the medical history and what to look out for 

She previously worked with the NHS in England where postnatal care is usually available for up to 15 days. However, the Irish hubs offer up to six weeks of support.

In Kerry, the hubs also offer antenatal care for pregnant women which is not common elsewhere.

“Personally, as a midwife, continuity of care is a really big thing for me and these hubs mean that we can provide that care — we are less likely to miss things,” she said.

“You’ve got that rapport with the woman so you’re more likely to pick up on things that might get missed in the hospital or that the woman might not trust you to disclose, if there’s domestic violence or mental health, anything like that.” 

They are also more likely to notice if infections including sepsis are developing after a caesarean section, she added.

Women can get help too with incontinence, pelvic floor problems or mental health issues, including being referred for help if necessary.

Concerns such as postnatal depression are often not apparent until weeks after pregnancy, she explained.

“So there is a need for the postnatal care and the care we have here is exceptional,” she said.

Overall she sees the hubs as “a step towards” the vision of community care set out in 2016 in the national maternity strategy.

When she first moved here from the UK, she said it was a shock to see doctors taking the lead and midwives taking a back seat.

"So it’s nice at our low-risk antenatal clinics where the midwife leads it.

“And again we go to the doctors if we need them. And there is absolutely a need for them but it’s nice for the low-risk women as well to see midwives because that’s what they need at that stage.” 

'A happy place to work'

Susan Collins is a healthcare assistant with the hub, having recently transferred from hospital work.

“It’s just a happy place to work I think,” she said. “I’ve been in the hospital since 2015 and this is the happiest I’ve been. I love getting up to go to my work in the morning.” 

She had popped in to say hello to baby Paddy Kennelly whose mother Roisin Considine was talking about her experiences in the hospital.

“There’s a real sense that they know who you were and what stage of your pregnancy you were at, it’s reassuring,” the first-time mother said.

Dr Cliona Murphy, national clinical director of the National Women and Infants Health Programme (NWHIP), said the hubs supplement existing community services.

“They are women-centred, rather than hospital-centred and that is a really important aspect of it, I think,” she said.

There are now five hub networks including also Cork, Kilkenny, Sligo, and Portiuncula. Each is connected to a local maternity hospital.

“We have a good public health system, and you don’t want to supplant that, but women felt that is focused more on the baby rather than themselves,” she said.

“So this is seen as supplemental, it is not usurping that service.” 

Research will be done to measure the impact of these hubs.

“We have received funding to expand that (hub network) out, so there’s going to be four more hubs,” she said.

“There have been expressions of interest from sites, and so the proposals will be made to NWHIP and four will be successful.”

 Those proposals will go before Angela Dunne, NWHIP lead midwife, and will be assessed by a panel.

Dr Murphy added: “Even for those who will not be successful in this round, there is potential for the future I think.” 

So why only five so far in light of their success?

Dr Murphy defended this saying planning, funding applications, and tweaking of those plans takes time.

“This was not a top-down plan from NWHIP. Principles were agreed, but at local level, there was ownership of the local teams as to what would work best for them and how best to run it,” she said.

The hubs are integrated into the wider maternity system including the peri-natal mental health service, GPs and public health nurses.

On the ground, she agreed the sense of having time with women is crucial, saying "it gives a space for a woman to ask questions” of midwives about their birth experience.

“I do see that maybe societally we have lost the village feel, and where you had your mother or grandmother around to ask those questions (we no longer do),” she said.

This is a place where in a supportive environment you can discuss what’s normal or what is not without having to queue up necessarily

She emphasised too the hubs are not necessarily only for women with low-risk pregnancies. A woman who had an emergency Caesarean-section could benefit from extra supports after leaving hospital too, she suggested.

Recruitment has not been difficult.

“The underlying ethos of being a midwife is to be 'with woman' so they are popular for people who’ve worked as midwives in hospitals and they’re moving into this space. They seem to be getting a lot of job satisfaction and positive feedback,” she said.

She added in reference to the national staffing picture: “now going forward with the limits on recruiting, there may be some challenges”.

Each hub is slightly different, she said with local midwives making choices about what will work best.

“It's really about hearing back from women as to what would work,” she said.

The mum

For Roisin Considine, the biggest difference between the Listowel postnatal maternity hub and a busy hospital was everybody knew her name and was always glad she came.

The hub, located in Listowel Community Hospital, is closely connected to the maternity unit at University Hospital Kerry. Women give birth in the hospital but are offered care afterwards here for up to six weeks.

“You get the exact same care if not better here. You are one-to-one here, whereas in the hospital you might not get that,” she said.

“There’s a lot more patients in at the one time there, but you see all the same midwives here all the time.” 

Experienced midwives see about 12 women every day with appointments of around 30 minutes although that can be flexible.

“You were really looked after, everyone is very friendly and very nice,” she said.

“Every time you come in they know you, it’s not that they are looking back through their notes to see who you are."

As she talks, her baby — six-month-old Paddy Kennelly — grins around at the midwives as if he knows they helped his parents through those months. A passing healthcare assistant pops her head in when she hears he is in the room to say hello and get a big baby smile.

Roisin describes how when she went for her booking appointment in Tralee last winter, they said antenatal care was also available in Listowel.

This came as “a relief” as it cut out a big commute from their home in Ballybunion during those cold months.

“It’s 15 minutes (to Listowel) compared to nearly 40 minutes — say about 35 to 40 minutes — to get to Tralee. It was a huge help definitely,” she said.

“It was brilliant, no waiting time or anything. You are in and out in 20 minutes — you could be nearly two hours inside in Tralee if you are going in there. So it was fantastic to have.” 

She only went to the hospital for scans and Paddy’s birth.

Listowel is one of a growing network of HSE hubs around the country, although some focus only on postnatal care.

Roisin found the easy access to antenatal care just as useful as support after birth: “Especially when you are working, you don’t have to take so much time off.”

The first-time mother added: "It was good to know there were people here closer if you had any questions. You knew who you were ringing if you had any concerns.” 

Help with breastfeeding for example is available. Even though she did face many complications as it turned out, she said it was “brilliant” to know the option was there.

“There's a real sense that they know who you were and what stage of your pregnancy you were at, it’s reassuring,” she said.

She joked the free parking was welcome as well. And with that, she had to hit the road because baby Paddy’s swimming coach was waiting for him.