Baby Mary is lying sleeping in her cot in the Coombe Women's Hospital in Dublin, a Bible by her tiny head, opened at Psalm 23, The Lord is My Shepherd. Her mother, Olayinka Ujimakinwa, a Nigerian asylum-seeker who arrived in the State last April, is recovering well. She praises her medical treatment and, tutting and shaking her head, says that she definitely does not want to return to Nigeria.
Olayinka is one of five women in the 36-bed Our Lady's Ward today who are non-Irish nationals. They also include Angel Kabongo from Zaire who has been granted refugee status, entitling her to live in Ireland permanently, and who is expecting her third Irish-born child.
The number of non-Irish nationals attending the maternity hospital has increased in line with the generally upward trend in asylum applications in the past year, and now accounts for 10 per cent of its 7,000 patients annually. This picture is reflected in the capital's two other main maternity hospitals, the National Maternity Hospital at Holles Street and the Rotunda Hospital on Parnell Square, close to the area known as Little Africa due to the proliferation of African-owned shops.
Dr Peter McKenna, the master of the Rotunda, estimates the hospital will deliver babies for about 700 non-Irish nationals this year, out of some 6,000 births. Neither the Coombe nor the Rotunda categorises mothers on the basis of their status as asylum-seekers or refugees. However, Holles Street hospital does, and a spokeswoman said that about 10 per cent of its 6,500 annual births are to non-Irish nationals, with half of these to asylum-seekers or refugees.
In his office two floors below Our Lady's Ward, the Coombe's Master, Dr Sean Daly, says he's not interested in what brings asylum-seekers and other immigrants to Ireland, or whether they should or should not be here. What interests him is the medical care of such women, who often arrive at the hospital very late in pregnancy, having had little or no previous medical attention.
"The issue is that this hospital provides care for everybody," he says. "We are now seeing a range of medical disorders in pregnancy that are being presented to us so late that we are trying to catch up. And on the one hand it's challenging, but on the other it's time consuming and needs additional resources."
The medical disorders include hepatitis, HIV and sickle cell disease - a blood disorder prevalent among Africans and associated with severe bone pain and pre-term delivery. Dr Daly recently saw a woman with sickle cell disease have a psychotic episode on the labour ward. He also recently treated his first two cases of expectant mothers with malaria.
"When I worked in the US, I had dealt with sickle cell disease, but I had never seen malaria," he says. "Now we investigate for malaria, but before we wouldn't have considered it in the differential diagnosis. The complexity of the pregnancies is much greater than we've been used to dealing with." In the case of HIV infection, early treatment can reduce the blood's "viral load" to almost zero, which means the risk of infection of the baby through vaginal delivery is minimal. However, if the viral load is not virtually zero, then consideration for Caesarean section is appropriate as this drastically cuts the risk of transmission of the AIDS virus.
If an HIV-positive patient arrives in the State already heavily pregnant, she will invariably have to have a Caesarean section, says Dr Daly. This means a slower recovery time for the patient and increased staff workload. Prompted by concerns for the welfare of heavily pregnant patients with medical complications, the hospital has set up a fast-track referral system for asylum-seekers. Dr Daly stresses that such patients are managed well and there is no risk to other patients. "The staff are becoming more familiar with the diseases, but we could certainly do with more expertise in dealing with the complexity of cases," he says.
This complexity goes well beyond just the women's medical needs. There are obvious issues such as language barriers, gender sensitivities, cultural nuances and dietary needs. And then there are less obvious matters, such as taking into account the trauma or distress the women may have recently fled.
"You might ask someone `is your husband going to come?' and they say: `Well he doesn't know where I am and I have no way of contacting him'," says Rosemary Grant, the hospital's head medical social worker.
Grant says her staff have learned when dealing with immigrants to suspend the normal assumptions they make when dealing with Irish nationals.
"What does it mean to have a Down's syndrome baby if you are from another country?" she asks. "You can't take for granted that the ways we think here are going to fit. You have to learn about what would be the norm in the woman's country."
Staff are constantly learning about the sensitivities involved in dealing with such patients, she adds. For example, staff formerly used family members or friends to interpret for women who did not speak English, "but then we realised that the women might not want to talk about intimate issues in front of people they know, so we changed that".
For the women too, Irish practices may take some getting used to. For example, in some African states, women might bring their children to stay in the hospital with them when they are having their new baby. "So the idea of having to organise someone to look after them is difficult for the women and the husband who is used to sending them all off to hospital together," says Grant.
The system of direct provision for asylum-seekers - where they are placed in full-board accommodation and paid £15 per week comfort money per adult and £7.50 per child - places additional stresses on new mothers, says Grant. While grants for clothing, cots and prams are available to asylum-seekers on the same basis as Irish nationals, asylum-seekers usually have fewer family members or friends to rely on to supplement State benefits.
"Irish people would have someone they could borrow a carry cot from, or hand-me-down clothes, whereas most of the asylum-seekers wouldn't, and they could go home from hospital without anything to put the baby in and no one to ask `could you lend me that for the week?'," Grant explains.
Dr Daly has written to the Minister for Justice, John O'Donoghue, telling him it is difficult for staff to maintain the current level of service in the face of such challenges. He says he is not publicising these issues "as a stick to beat the Government with. People are concerned in this hospital that the numbers coming through are going to increase and our ability to deliver quality care could be compromised ultimately."
In his letter, Dr Daly advises the Minister that asylum-seekers with complicated pregnancies should remain in Dublin rather than being sent to towns and villages around the State under the mandatory dispersal programme.
"We deliver more than 7,000 babies per year, we have a lot of consultations and therefore it's easier for us to deal with complicated pregnancies than a two or three-doctor unit down the country which is not used to dealing with them. I think we should look after those women but I think we should get extra funding to do it," he says.
Dr Daly returns to the guiding philosophy behind the hospital, set up by a philanthrophist, Margaret Boyle, in 1826. "Margaret Boyle set up the hospital 175 years ago next year because two pregnant women died in the snow trying to get to the Rotunda," he says. "This hospital has always offered care to women who wanted it or needed it and what brings them to the door is not something of concern to us. We should care for people if they need it. Other issues are superfluous to us."