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THE PUBLIC HEALTH Nurse (PHN) tends to hold a special place in the hearts of Irish society. Many will know them best from their work at the coalface of the community, looking after young and old.
Most mums, however, tend to associate them with post maternity care and developmental checks, and those memories aren’t always so rosy.
Like a lot of mums, I had a bit of a love/hate relationship with PHN, especially on my first baby. While these specialised community nurses are often overstretched and underfunded, and forced do to a lot with a little, for many first-time mums, the PHN can be a divisive figure and one who doesn’t always leave them feeling happier or more confident about their skills as a mother.
For some, the mere mention of the words ‘percentiles’, ‘clicky hips’ or ‘tummy time’ is likely to give them the shivers. One of the most common irks I hear from mums about their experience with the Public Health Nurse is around not being listened to, feeling talked down to, too much box ticking, too much focus on children’s weight, and even leaving appointments in tears.
Being told by the PHN that “Your baby has a huge head or a tiny head, or those sound like clicky hips to me,” and being sent off for what often turns out to be an unnecessary check with a specialist, seems to be a common experience. While early interventions are of course essential, unnecessary referrals do nothing but pile on pointless anxiety.
It doesn’t help that on those first couple of PHN visits, most first-time mums feel vulnerable and unsure. Add in a busy, overworked community nurse who may not have had a break all day, and it’s not hard to see how encounters can get rocky.
For all those who have had bad experiences, you’ll also find mums who have glowing praise for their PHN and have found them a solid listening ear. I’ve heard mums describe their PHN as “angels” and “their rocks”, and it would be amazing if all new mums had care like that.
For those of us who have had patchier encounters or still get triggered at the thought of those pesky charts and percentiles, we tend to wear them like a badge of honour, and in true Irish style, often process it all by lovingly sending it up with some good old-fashioned dark humour.
Comedians like Laura O’Connell have this down to a tee, giving traumatised mums a safe space to talk and laugh about their common PHN or midwife experiences. One brilliant skit I came across online recently, from fellow Irish comedian Laura O’Mahony, captures the PHN experience of many first time mums perfectly, “At your baby’s age we’d expect babies head to be the size of a small goat, but it’s actually off the charts and it’s the size of a large goat, so I’ll have to send him to a head specialist in Maynooth,” she says in full PHN character.
I’ve never felt more seen.
The sharp-witted skit brought me right back to my own first visit from the very busy and very matter-of-fact Public Health Nurse, three days after I got home from the hospital after giving birth to my first child.
My overriding memory of it all, apart from the necessary, but horrific heel prick test on my son, was of her patronisingly calling me ‘mum’ the whole time instead of Niamh. It was, “Now mum, you’re feeling tired? Well, that’s to be expected.” “Okay, mum, that’s a hungry cry from baby.”
“How are the stitches, mum? No, I won’t need to look at them, mum.” “How’s dad doing, mum? Is he getting enough sleep too?”
“Here’s a leaflet on baby blues for you, mum,” and so on in that vein until she left, not before underlining the importance of tummy time several times and not to have the room too warm.
It was a complete whirlwind of never-ending leaflets and the oddity of her never using any of our first names. All of her edicts were technically correct, but it felt like she came from a different era entirely, one that was laced with condescension.
Nine and a half years on, I look back on that first visit from the PHN and, like most mums, just laugh about it. I’m sure she was overworked and hugely busy, but part of me can’t ignore that she failed to spot that I was struggling, both mentally and physically.
I was perched on the side of the couch for the whole visit, not because it was comfier, but because I was unable to sit down. She didn’t check my stitches, and since I was not feeling like myself, I didn’t recognise that the pain from those stitches was not normal, but instead due to a serious infection I later had to get antibiotics for.
And while I understand it was much harder to spot, she also missed that I was on the verge of tears for the whole visit. I didn’t fully understand this myself at the time, but as a trained professional, you’d imagine she might have. It was only a few months later that I realised it was due to feelings of post-natal depression, or what she fleetingly referred to at the visit as “baby blues,” as she handed me a leaflet about it and probed no further or made any other enquiries about my mental health.
We know that midwifery and public health nursing are vital cogs in the healthcare system, but they are massively under-resourced, and the sector faces a constant recruitment struggle. And it’s not hard to see why. Many are feeling burnt out, some face physical and verbal abuse daily, and the better working conditions offered abroad are a huge drain on our nursing numbers.
All of this has very real consequences for parents and babies. In the last number of years, parents raised concerns that “vital” developmental checks were not being carried out on newborns due to a lack of public health nurses. PHN checks and developmental visits are supposed to happen at three days, three months, 9-11 months, 21-24 months and 46-48 months, but we know that doesn’t always happen. For many, it can be down to a location lottery and how well-staffed or how busy your local health centre is.
On my second baby, the final three checks were cancelled outright due to Covid. When they did see us on what was supposed to be his final check, way after the 48-month mark, the nurse opened his chart to plot his progress on the graph (those all-important percentiles you see), only to find that his chart was empty and there was nothing to plot.
Earlier this year, the Irish Midwife Organisation (IMO) also reported on “unsafe staffing levels” in maternity care, noting “despite a rising demand and increasing clinical complexity, the number of whole-time equivalent midwives employed in the public system has declined since 2019.” They went on to add that “a large proportion of midwives report considering leaving the profession due to workload, stress and lack of support.”
Even more worrying is that, according to the ESRI’s most recent reporting, Ireland will need more than 2,000 additional public health and community nurses by 2040.
Nursing is a calling and a bloody tough job. I admire anyone who goes into the profession, and looking back, I can see the public health nurses who visited me were all well-intentioned, caring people who were most likely overstretched or working off outdated practices, but those gaps in care had negative consequences for me.
I know that there are lots of mothers who have had terrific encounters with their PHN’s and have been able to call them with any issues or concerns. But when you hear similar negative stories from many first-time mums, it’s hard to ignore the pattern.
I’m not trying to do down the PHN for funsies, but I do believe those times when care was lacking, or new parents left visits feeling small or upset, shouldn’t be brushed off or dismissed out of hand.
People deserve to be heard. An acknowledgement that there are sometimes real issues here is required. Issues with the system behind the PHN service and staffing levels.
Issues around gaps in care. Issues around updated training and guidelines, plus a boost in resources, if we want this much-needed community healthcare service to improve and continue to do what it does best.
Niamh O’Reilly is a freelance journalist and parenting columnist for TheJournal.ie.
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