‘Childbirth can’t be postponed’ – how Holles Street is coping

Ireland is one of the safest places in the world to have a baby, and according to staff in our maternity hospitals, that's not about to change because of Covid-19.

At the National Maternity Hospital (NMH) on Holles Street in Dublin, the 900 staff – from the front desk and throughout the hospital – have been working to keep women and babies safe, and to ensure they receive the same level of healthcare, regardless of what's going on outside. As Prof Shane Higgins, Master of the NMH says, while other hospitals can cancel procedures, "childbirth can't be postponed".

So, what has the hospital done to respond? "We've built a hospital within a hospital," Prof Higgins says. "Now, patients with symptoms or who have tested positive [for Covid-19] can be cared for in the appropriate setting, and the rest of the hospital can continue to function normally." One half of an entire floor of Holles Street has been converted into an isolation unit, complete with obstetric theatre, a ward and single rooms with "negative pressure ventilation" – meaning the air is changed every five minutes so harmful particles cannot remain. "The designated unit has allowed us the opportunity to look after women in a safer environment, so midwives and nurses can stay with patients, and so that women won't be alone," explains Mary Brosnan, director of midwifery. A few weeks ago, the ward didn't exist – now it's up and running.

The biggest change for patients is that partners are only permitted into the hospital for the actual birth. For all other appointments, such as ultrasounds , women come by themselves. They are met at the door by porters, queues are staggered, and appointments are arranged to make sure everyone can maintain physical distance and still be comfortable. These measures, Prof Higgins acknowledges, “might seem draconian, but patients have got in touch with us to say they find them reassuring”.

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In cases where it’s not advised that patients visit the hospital, the hospital – virtually – goes to them. The team at Holles Street have put together a series of videos and other online material about maternal health, from dietary advice to virus protocols. These resources help midwives and neonatal nurses to reach their patients, despite the new physical distancing rules, which is important not only for physical wellbeing but to help women deal with mental health challenges too. “I’ve been stressing,” said one patient, “but it seems a lot more manageable now.”

Maintaining contact with patients is also important for the hospital’s counsellors, who are continuing their work with vulnerable patients who have experienced pregnancy loss, or who have mental health difficulties, and who particularly need support during this period of social distancing.

While partners are allowed in for the birth, they can’t stay. “It’s heartbreaking,” says Brosnan, “seeing partners say goodbye to their child before they leave.” But, when all is well, it’s not for long. Prof Higgins points out that where a woman is fit and healthy, she can be discharged within 12 hours through the early-transfer-home service. Community midwives play a major role in helping women and families to adjust, and their role is now more vital than ever. And, while parents are obviously delighted to be reunited once mother and baby are discharged, there are also some unforeseen benefits to the current system.

Without the interruptions of visitors, Brosnan says that the wards are much quieter places: “Women are getting a real rest.”

‘Mask, goggles, gown and gloves’

How do staff feel in all this? Even if you don't work on the frontline, you can experience stress around the pandemic. So the hospital has been actively training staff in the correct procedures for using personal protective equipment (PPE), both in person and through online videos. The recurring questions in the media about whether hospitals will have enough PPE are, however, also on people's minds. General manager Ronan Gavin says, "There's certainly enough at the moment in the hospital, and we're beginning to see more arriving".

And though staff are taking safety extremely seriously, they're also determined to keep morale up, with Prof Grainne Flannelly re-inventing the nursery rhyme "Heads, shoulders, knees and toes" for staff, with new lyrics: "Mask, goggles, gown and gloves."

Keeping staff safe and healthy is paramount, so they can stay well and continue to care for their patients. Rosters have changed so that everyone now works in separate teams, thereby reducing overlap and any risk of infection. Staff also wear “Keep a Safe Distance” badges, while the hospital sends out newsletters three times a week, to make sure everyone has the facts on how to treat affected patients and how to keep themselves safe. Everyone I speak to talks about their sense of purpose and camaraderie. “It’s incredible,” agrees Brosnan, while other staff members say that the hospital has always felt like a family, “but now, more than ever, we are standing together”.

Standing together

Solidarity for staff and patients has been a redeeming feature of the pandemic so far. Local businesses have been supportive, from a local beauty salon donating 1,500 face masks, to the restaurants and takeaways delivering meals through the “Feed the Heroes” initiative. Moments of recognition are important, such as the applause for healthcare workers on the evening of March 26th, which left many at the hospital with tears in their eyes.

No one can pretend that it’s not an anxious time – having a baby is always going to be daunting – but as Mary Brosnan puts it: “We’re ready to mind them and to get them through this.”

In some ways, Covid-19 has changed everything. But, in other ways, major life events like becoming a parent will always transcend a crisis. As one new dad of a baby girl posted on social media, “We have many reasons to be anxious right now, so it’s more important than ever to remember the positives … We can tell her that she was born at a time when social solidarity was at its highest.” And how are the family doing now? “Happy to report that baby and parents are doing splendidly.”

Covid-19: Advice for pregnant women

What to do if you’re expecting and you develop symptoms or get a diagnosis of Covid-19?

If you’re an expectant mother with symptoms or a diagnosis of Covid-19 it’s important to get in touch with the hospital to let them know about your condition. The hospital can advise you and give you all the information you need about how this affects you.

NMH Covid-19 advice for pregant women

1 If you have symptoms or a diagnosis, when you go into labour you are asked to phone the hospital in advance to let them know you're on your way. We know it can be hard to remember an extra step when you're in labour, but this will really help us to prepare for your arrival.

2 Please don't take public transport to the hospital.

3 You or your partner are asked to phone the hospital again just before you actually arrive – a quick call to the hospital helpline means they can get a team member to the door in time to meet you and get you to your labour ward in the safest way.

4 When we meet you, we will give you a mask and ask you to wash your hands or use an alcohol gel. Your medical team will be also wearing protective gear, as that's the best way for us to take care of you safely and so that we can stay with you.

For anyone concerned they may have contracted the virus or who have pregnancy-related concerns, the hospital has a dedicated helpline available every day from 8am-8pm: (01) 637 3511. And please remember, the most important thing we can do to support medical staff is to stay at home, so that they can go to work more safely.

Emilie Pine is writer in residence at the National Maternity Hospital.