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Maternity care: 'Inconsistencies' in updated hospital guidelines 'distressing'

New national guidance on the easing of restrictions at maternity hospitals allows partners to attend 12-week scans.

Image: Shutterstock/Uriel Perez

THE HSE HAS issued updated guidance on the easing of Covid-19 restrictions in maternity hospitals to allow partners to attend 12-week scans and be present during some caesarean sections.

There has been criticism in recent months of the different approaches taken by maternity hospitals, with some found not to be fully compliant with official guidance – having tighter restrictions on partner access during labour and at pre-natal appointments.

Linda Kelly, a campaigner for maternity care and a director at Fórsa, welcomed the updated guidance allowing partners to attend 12-week scans but said “other than that there’s no change for anyone”.

“If you’re going into labour soon, there’s no change around your partner being excluded from early labour,” said Kelly.

Dr Peter McKenna, HSE Clinical Director of Women and Infant Health, told Morning Ireland that hospitals have to deal with two conflicting priorities as restrictions are eased: “One is the priority to keep people safe, and the other is to keep the process of childbirth as normal as possible.”

He said partners will be able to attend c-sections depending on the type of anaesthetic used: “If for example sections were done under general anaesthetic then there’s little role for the partner to be there to support the woman, because she’s asleep…and having an additional person there is a distraction, and it’s not a support for the woman.”

He said there is no reason why partners shouldn’t be allowed to attend c-sections being done under regional anaesthetic.

Kelly told TheJournal that the updated guidance on c-sections was “really bizarre” as “last August was the last time we heard about the hospital excluding partners from the actual c-section operation and since that time partners have always attended c-sections”.

“All they’ve done is added into the guidelines what’s actually happening. There’s no change, so partners are still excluded preoperatively from being with their partner prior to the c-section operation if it’s a planned operation.”

Ahead of the updated guidance for hospitals, Chief Clinical Officer Dr Colm Henry said yesterday that he had been assured that all hospitals will be compliant with previous guidance on postnatal visits, attendance in labour wards, admittance to neonatal units, presence at 20-week anomaly scans, the early pregnancy assessment unit, attendance for high-risk pregnancies and attendance at Emergency Departments.

Dr McKenna told Morning Ireland that when it comes to guidance, hospitals need to be able to act with discretion to deal with outbreaks of Covid-19.

“If there is an outbreak in a hospital, there must be sufficient ability in the system to respond to that. Otherwise the conflicting risk of danger to other patients increases.”

Kelly said that no one is looking for “unworkable solutions” and if there’s a Coivd-19 outbreak in a maternity ward infection control measures will need to be put in place very quickly.

She said the non-compliance of some hospitals “for no reason” is what’s problematic and needs to be addressed.

Vaccination and testing

In the updated guidelines, the HSE said they envisage that they’ll be able to reduce the restrictions overtime as the vaccination rate among women attending services increases. 

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“Over the coming months it is likely that an increasing proportion of women who are attending maternity services will have been vaccinated before becoming pregnant and therefore be at a much lower risk. In that context, it is expected that restrictions on visiting will be reduced progressively.” 

Kelly said there is nothing about people who are currently attending services and vaccine status, and “they’re point blank refusing to consider any sorts of antigen testing for partners”.

“It doesn’t make sense at all because they’re asking women to undertake Covid-19 tests ahead of planned procedures. But, in a lot of cases, their partner is driving them to the test, the partner is also going to be there for the planned section, for example, and they’re not being tested at all,” said Kelly. 

If infection control is the aim of the game. Surely, the logical assumption is that partners should also be tested. It’s the inconsistency in the approach by the HSE, it’s their lack of evidence, it’s the lack of clarity from them that is causing so much confusion, and so much distress to families.

“The restrictions on partner access are still inhumane in place, apart from the seven specified areas in the guideline documents.”

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Adam Daly

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