A study evaluating The Poppy Clinic, a Postnatal Morbidity Service at the National Maternity Hospital has been published. Key recommendations from the study show the need for clinics of its kind to be expanded nationwide.
The Postnatal Morbidity Clinic, since renamed the Poppy Clinic, was set up in 2013 in The National Maternity Hospital by then Midwife manager, Caroline Brophy and Dr Laoise O’Brien, Consultant Obstetrician. The need for the clinic arose after the hospital identified that midwives, obstetricians, GP’s and public health nurses had nowhere specific to send postnatal women who experienced a complication during their pregnancy, during childbirth or in the few days/weeks after having their baby. Nearly 50% of all attendees require wound management and attend the clinic on multiple occasions.
The postnatal period is often referred to as the ‘Cinderella of childbirth’, compared to the care women receive during their pregnancy and birth. Morbidity is a wide-ranging concept that refers to any physical or mental complication directly related to childbirth, which may not necessarily be life-threatening but may result in significant impact on the quality of a woman’s life.
Between the years 2013 and 2018, the attendance to the clinic increased by 500%. This increase prompted the need for an evaluation of its effectiveness, to ascertain how it could be further developed and improved upon and to give users a voice. In 2020, just under 700 mothers attended the hospital with a further sixty women attending virtually as a result of COVID19.
Speaking about the Clinic, Caroline Brophy, who was appointed as the Advanced Midwife Practitioner (AMP) at The NMH last May said, “Over a decade ago, as Clinic Midwifery Manager II of a Postnatal Ward, I was acutely aware that there was an ‘ad-hoc’ approach to any necessary hospital follow up for women who experienced issues postnatally. This gap in service was not only frustrating for mothers, but also for midwives and obstetricians who struggled to arrange a clear pathway with identified clinicians who would be responsible for assessing and managing their morbidity.
The anecdotal observation noted that there was a problem with outpatient postnatal care and what is now the Poppy Clinic was born. It started off very small, but has grown exponentially over the past nine years. Evaluation in healthcare services provided has become a priority globally. As part of this study, a chart review was conducted to determine a profile of women attending the clinic and a survey carried out to evaluate women’s experiences of attending the Poppy Clinic.”
“We are delighted and welcome the findings and recommendations from the study,” said Dr Laoise O’Brien. “The Poppy Clinic has already been expanded as a result, appointments are now more streamlined and there are currently three clinics running per week instead of one.”
“The value of the service for women at such a vulnerable time in their lives cannot be underestimated. Prior to the clinic, these women presented to A&E, GPs or gynaecological services,” Dr O’Brien continued. “The clinic offers a dedicated, collaborative service through a multidisciplinary team where women can access continuous compassionate care by the same team to manage and review physical and emotional complications related to childbirth. We see a steady flow of postnatal patients presenting for follow-up with issues such as haemorrhages, hypertension, medical conditions and preeclampsia, as well as small surgical procedures and those that need to be done in theatre. Thankfully, through COVID19 we have been able to maintain all our services.”
Key Recommendations from the study:
Postnatal morbidity clinics are an essential element of maternity care and should be developed in all maternity units in Ireland.
Compassionate communication skills are essential for all clinicians treating women with a postnatal morbidity, specifically first time mothers who are at higher risk of psychological morbidity.
Waiting times should be kept to a minimum for women attending hospitals postnatally with any complication.
A national referral pathway should be available in the community (GP and PHN practices) and in all maternity units for all women displaying symptoms of a morbidity after discharge.
The study was funded by The HSE Nursing & Midwifery Planning and Development Unit, Dublin South, Kildare & Wicklow and was a joint research project between The NMH and The UCD School of Nursing, Midwifery and Health Systems. A full report of the findings has just been published and is available http://www.nmh.ie/home/joint-research-network-conference.14321.html