Home > The Rotunda Hospital, Dublin annual report 2021.

The Rotunda Hospital. (2022) The Rotunda Hospital, Dublin annual report 2021. Dublin: The Rotunda Hospital.

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As in 2020, the Rotunda continued to buck the trend in 2021 of falling birth-rates by successfully coping with a 10% increase in clinical volume. This included an increase of 800 women to 10,715 pregnancies registered for care in 2021 compared with 2020, leading to 821 more deliveries and 831 more babies to be cared for in 2021. 

P.65 Infectious Disease Service - This service looks after the specific needs of pregnant women who have or are at risk of blood and sexually transmitted bacterial and viral infections. This exposure may occur through drug use, unprotected sex, or any contact with infected blood or body fluid. The clinic collaborates closely with allied agencies and specialties (including addiction services and inclusion health. 

Drug liaison midwife (DLM) service - During 2021, 103 women were referred to the DLM service, including 39 women who had a history of opiate addiction and were engaged in an Opioid Substitution Treatment (OST, – primarily methadone) programme. A total of 60 women linked with the DLM delivered their babies in the Rotunda Hospital in 2021. The Drug Liaison Midwife has delivered lectures on substance misuse in pregnancy to both undergraduate and postgraduate midwifery students in TCD, as well as to students on the Masters Programme in Addiction Studies in the Dublin Business Institute and to those on the Graduate Diploma in Public Health Nursing in University College Dublin. 

P.67 Challenges 2021 - …the Infectious Disease Service and allied agencies need to adapt and respond to evolving patterns of addiction. With increasing numbers of women being prescribed buprenorphine (rather than methadone) for the Opioid Substitution Treatment programme, we need to revise inpatient prescribing and ensure adequate pharmacy supplies of buprenorphine. Furthermore, while there are excellent inpatient stabilisation services for pregnant women with opiate and benzodiazepine addiction, it is a challenge to provide similar settings for women with alcohol addiction. The HSE alcohol programmes are preparing a position paper on prevention of Fetal Alcohol Spectrum (FAS), which includes advocacy for consistent education and supports in this regard. We look forward to being sustained contributors to these solutions.

P.144 Child protection - In 2021, the medical social work team was involved in 178 child protection cases. This was a 17% increase in activity from the previous year. The main types of concerns where a referral was made or received from Tusla in 2021 are described in Table 1 of the report. 

P.145 Substance misuse - In 2021, the medical social worker attached to the DOVE (Danger of Viral Exposure) clinic provided emotional and practical support to women attending this specialist clinic. Patients attending this clinic are those who have an infectious disease diagnosis and/or substance misuse issues. The social worker liaises closely with the specialist midwives to provide a comprehensive service for women attending the DOVE clinic. As part of the role, the medical social worker helps parents to address their addiction issues, at a time where motivation to cease or reduce substance misuse can be high. A total of 48 women attending the DOVE clinic and who delivered in 2021, were referred to Tusla by the medical social worker. Referrals to Tusla regarding substance misuse also occurred when patients did not attend the DOVE clinic but drug use was identified postnatally. In 2021, Tusla held 24 Child Protection Conferences in relation to substance misusing Rotunda patients. These conferences are interagency and utilise multidisciplinary meetings where a child protection plan is formulated. Such conferences help everyone involved in the child’s life to find out what the child’s needs are and decide whether or not the child is at risk of significant harm or abuse. In 2021, there were five babies discharged to substitute care under a Court Order in this cohort of patients. The medical social worker attended Court and participated in these proceedings. It is ultimately a Judge who makes the difficult decision for the baby not to be discharged to the care of their parents. The medical social worker worked closely with colleagues in the neonatal intensive care unit. In 2021, 17 babies were admitted to the neonatal unit for the treatment of Neonatal Abstinence Syndrome (NAS). The medical social worker balances the often conflicting interests of parents struggling with addiction, a busy neonatal unit, requests from Tusla and instructions from the Courts to ensure that each baby is safely discharged. (see also P.146 Table 2: number of deliveries to substance misusing women). 

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