Maternity - Inpatient

Coombe Women & Infants University Hospital Annual Report 2020

Infant feeding statistics in the CWIUH from 2014 to 2020 are presented in Table 1.11.1. The percentage of babies in whom breastfeeding was initiated increased from 61.3% in 2014 to a peak of 66.6% in 2019. The decrease to 65.5% in 2020 may have been due to the COVID-19 pandemic because it goes against the upward trend seen since 2014. The percentage of babies breastfeeding exclusively at the time of discharge from the CWIUH fell from a peak of 38.9% in 2016 to a trough of 32.5% in 2020. The COVID-19 pandemic may have contributed to the 3.2% decrease seen between 2019 and 2020. In contrast, the percentage of babies breastfeeding non-exclusively at the time of discharge from the CWIUH has increased steadily from 19.0% in 2014 to 33.5% in 2020.

Women who may experience breastfeeding difficulties are identified through the use of an antenatal discussion checklist and an antenatal lactation self-assessment tool. These women receive individualised preparation, planning and follow up. Up until March 2020, the team were able to facilitate lactation clinics to assist women who may experience breastfeeding difficulties. All antenatal breastfeeding classes also stopped at this time. In order to continue breastfeeding education, the team commenced daily distribution of information about breastfeeding with relevant contact details, in all outpatient areas. One on one postnatal consultations for inpatients and outpatients continued during the COVID-19 pandemic. The volume and duration of phone support that the team provided to women in the community increased during the pandemic. The team prepared updated information about breastfeeding, with relevant video links, for uploading to the CWIUH website.

The team developed an Information Leaflet on the harvesting of colostrum in 2020. Following the distribution of this, there was an increase in the demand for harvesting colostrum from women with potential breastfeeding challenges. The team distributed packs for the antenatal harvesting of colostrum and documented this in women’s medical records.

The team revised the CWIUH Infant Feeding Information Leaflet and collaborated in the updating of the HSE booklet entitled ‘Breastfeeding and expressing for your premature or sick baby’. The team supported and facilitated a lactation support nurse to facilitate the provision of breast milk to premature babies in NICU within two hours of birth. At three months, there were improvements in; time to women receiving assistance, time colostrum received in NICU as well as increased maternal milk supplies. The data suggest that there was an increase in both the supply of expressed breast milk and maternal satisfaction.

In 2020, there was an increase in the number of babies referred for assessment and division of ankyloglossia within the CWIUH. This may have been due to the development in 2019 of a formalised pathway. The team worked in collaboration with the Department of Paediatrics and Newborn Medicine to cope with this increase in demand. The team continued to follow up babies after frenotomy and to promote and support exclusive breastfeeding.

Midwives in the CWIUH continued to collaborate with the Community Midwifery Service in the provision of the Early Transfer Home (ETH) service for women and families residing in the Community Midwifery Service’s catchment areas. The rotation of a newly qualified midwifery group, which recommenced in January and February 2020, brought great benefits to all departments. The rotation incorporated antenatal, intranatal and postnatal components.

The CWIUH commenced the process of facilitating midwives moving from Nigeria, Ghana, and Zimbabwe to Ireland to complete a midwifery adaptation programme in collaboration with the Nursing and Midwifery Board of Ireland. The role of the Clinical Skills Facilitators was paramount in supporting, mentoring and advising these midwives as well as other midwifery staff that joined the CWIUH in 2020. A new orientation booklet was developed to assist all new midwifery staff.

The relaunch of the five-year midwifery and nursing vision took place in January. Leadership, integrity, belief and dedication to delivering the highest quality of care to mothers and babies are the foundations of this five-year vision. The primary drivers of this vision are workforce, education and research, leadership and management, and innovation. All CMM3s and CNM3s presented to staff in order to showcase the work of their individual departments.