IAANMP: Updates from advanced practice across Ireland

Postnatal hub service at Sligo University Hospital

Sligo University Hospital is one of five national pilot sites for the implementation of a Postnatal Hub Service, funded by the National Women and Infants Health Programme (NWIHP). The service officially commenced in Sligo at the end of December 2023.

Postnatal care has long been recognised as the least satisfying component of the childbirth continuum, often referred to as the ‘Cinderella’ of maternity services. However, this phase presents a vital window of opportunity for delivering care that can significantly influence the health and wellbeing of mothers, infants, and families.

The postnatal hubs are designed to enhance structured support for women and their babies in the weeks following birth, facilitating earlier intervention, where necessary, across a range of physical, emotional, and social health needs. They also improve access to specialised maternity health services tailored to the unique requirements of the postnatal period.

Currently, the Postnatal Hub Service in the Sligo region operates across four key locations: Sligo Town, Carrick-on-Shannon, Ballyshannon, and Ballymote.

All women, regardless of their care pathway or mode of delivery, are routinely offered a postnatal appointment, typically scheduled between two and four weeks postpartum. This appointment is designed to be flexible and woman-centred, ensuring individual needs and preferences are prioritised.

Earlier or later appointments may be arranged if clinically indicated, based on assessments made by the discharging maternity staff in collaboration with the Postnatal Hub team. Appointments are usually scheduled upon discharge from the maternity ward.Prior to the appointment, women are contacted to confirm their availability, discuss any emerging concerns, and ensure the appointment time is appropriate. This proactive engagement helps enhance continuity of care and early postnatal contact.

Public Health Nurses (PHNs) also have the option to refer women for an earlier appointment if clinically necessary. Each appointment is scheduled for one hour, with follow-up appointments offered as needed. During the consultation, a full postnatal assessment of both mother and baby is carried out.

The visit may also include birth reflection, breastfeeding and lactation support, and onward referral to specialist services, such as perinatal mental health or other relevant support. A dedicated postnatal consultation pro forma has been developed to guide comprehensive care delivery.

Women are provided with the contact number for the postnatal hotline upon discharge from the ward. This number allows them to reach the Postnatal Hub team for clinical advice or to reschedule their appointments as required.

• Since the end of November 2023, over 1,700 women and their babies have been seen through the Hub.
• Approximately 15 per cent of these were referred to additional or specialist services based on identified needs.
• The average ‘did not attend’ or ‘could not attend’ rate is 12 per cent; all women in this group are offered a rescheduled appointment to ensure continuity of care.

Developments since the establishment of the Postnatal Hubs include:

• Full establishment of all Postnatal Hubs and implementation of monthly key performance indicators.
• Strengthened communication and collaboration with healthcare professionals, including weekly referrals from PHNs and GPs.
• Direct referral pathways established to services such as the Mirena clinic and gynaecology outpatient department.
• Streamlined process for complaints management, including access to formal debriefing sessions when required.
• Provision of birth reflection and emotional support for postnatal women.
• Enhanced utilisation of ongoing community-based supports, such as family resource centres, breastfeeding support groups, and Lifestart.
• Clear escalation pathways developed for involvement of hospital services including the postnatal ward, emergency department, and paediatrics.
• Introduction of student placements within the Hubs to support professional education and workforce development.
• Structured discussions on future modes of delivery, including vaginal birth after caesarean counselling.
• Funding secured for dedicated physiotherapy services within the Postnatal Hub model.
• Standard operating procedure created for women who delivered in other hospitals but require local postnatal care.
• Establishment of a postnatal anaesthetic clinic to address specific postpartum concerns.
• Active participation in the Infant Mental Health Forum, supporting integrated maternal-infant wellbeing initiatives.

Research currently being conducted by Trinity College on the experiences of both the women who attended the service and staff who work within it has revealed the following insights:

• Women described the Postnatal Hub service as both beneficial and essential to their postnatal journey and recovery.
• They particularly valued the personalised, woman-centred care received from supportive and reassuring healthcare providers.
• For staff working in the Hubs, the research findings show that staff feel empowered to utilise the full range of their professional skills. They report a strong sense of autonomy in practice and the work environment was described as highly supportive, contributing to job satisfaction and quality care delivery.