A week in my . . . medical social work practice

There are six social workers in the Rotunda Hospital. We provide a confidential information, support and counselling service to all women who attend the hospital. Each social worker has a different area of responsibility such as in the foetal-assessment unit, where babies can be diagnosed with a health problem, or the clinic that deals solely with teenage mothers, or the clinic that supports women who have addiction issues. There’s also a dedicated bereavement social worker who offers counselling support to parents who have experienced pregnancy loss. I’m the social worker attached to the neonatal intensive care unit and the paediatrics outpatients department. We meet patients in our own offices and we also see parents on the wards.

Our patient catchment area is the Dublin North East region, but any woman can choose to come to the Rotunda Hospital to have her baby.

In the neonatal intensive care unit, there is a parents’ room close to where the babies are, which means that I can meet and talk to parents in private. I also support parents who have multiple births, or a baby with a disability. I put them in touch with organisations such as the Irish Premature Babies organisation, the Irish Multiple Births Association or groups such as Down Syndrome Ireland.

They might also need help organising home help or accessing their entitlements.

Women from all backgrounds

I meet women from all socioeconomic and cultural backgrounds. We are keen to meet women as early as possible in their pregnancy. Sometimes, women come to see me because the pregnancy is unplanned and they need support to come to terms with their changed life circumstances. There are still women who conceal their pregnancies and we support them. We also work with women who are considering placing their baby for adoption.

Sometimes, there are financial difficulties, housing difficulties or relationship issues. We help parents who need information about social welfare and other entitlements such as rent supplement. People are facing a range of uncertainties since the recession including unemployment, personal debts and a housing shortage in the rental sector. We encounter families who are sharing houses and sharing bedrooms, and living in circumstances that are far from desirable.

We see quite a number of women who have suffered domestic violence. It’s such a prevalent problem that, in 2013, the Rotunda Hospital introduced a routine inquiry about domestic violence at antenatal appointments. We ask women whether they have ever been afraid of anyone close to them. Domestic violence can start or increase during a pregnancy and we are mindful to reach out and offer support in these situations.

Domestic violence is a very complex issue and women can get great benefit from discussing personal issues like this with someone outside their network of family and friends. We can discuss options such as having a safety plan if things become difficult, or finding alternative accommodation, or linking with a support worker in the community if they have a controlling or oppressive partner.

Children’s safety

In the public mind, social workers are associated with child protection work and we do work with Tusla, the child and family agency, to ensure there is a safe level of care for babies. We also liaise with Tusla social workers to make sure parents who need support have it in place before their babies are born.

We advocate on behalf of women who need other forms of community support. On any given day, I write five or six letters for people to community welfare officers or other agencies. For example, sometimes women from outside the EU may need family members to come to Ireland to help mind other children when they are in hospital having a baby.

We meet undocumented women and women who live in direct provision services. We have regular contact with the staff at the Balseskin Reception Centre and its medical centre. We also see women who have come here as students and become pregnant. There can be a huge stigma around being a single parent in some countries, and some of these women have no money to support themselves.

We have a lot of contact with public health nurses, who are a great source of information about services in the community. Parents also face substantial costs if their baby is transferred to the neonatal intensive care unit from a regional hospital. There is no accommodation for parents attached to the hospital, which is very regrettable. It would make a tremendous difference to parents if there was subsidised accommodation nearby. We can sometimes get assistance with travel costs for low-income families in these situations.

I regularly meet parents whose babies are admitted to the neonatal unit – due either to health problems or to prematurity. It’s a profoundly difficult experience. No one expects to see their baby in an incubator. Parents describe it as an emotional rollercoaster. As the social worker attached to the neonatal intensive care unit, I offer emotional support as well as practical assistance with things such as maternity benefit and breast pumps. I also offer bereavement support to parents whose baby dies on the unit. You never forget a baby who dies. It is one of the worst imaginable tragedies.

When a baby is born prematurely, the woman’s maternity leave starts then and there is no facility to have paid maternity leave extended, so the baby is often only three months old when she is due back at work. This can cause considerable stress for parents as you can’t leave a premature baby in a creche or with a childminder because the baby is more vulnerable to infection and may have special needs. We have a good rapport with the medical card office for babies who need discretionary medical cards due to special medical needs.

Follow-up

In the paediatric outpatients department, we follow up on babies for up to two years, once they are discharged and go home. I meet parents there to see how they are doing. Parents tend to be immensely grateful and continue their links with the hospital, bringing back their children on birthdays or when they start school.

I feel so fortunate to see these children, who had a difficult start in life, go on to do so well. We have a photo-montage on the corridor showing them as newborns, on discharge and then as they grow older. We often show these photographs to parents with babies in incubators to give them hope.

Having a baby is a unique time in people’s lives and it’s such a privilege to play a small role, to help them cope with any difficulties they face.

There is a great sense of community in the Rotunda Hospital. There is a caring ethos and a strong awareness among staff that people’s emotional wellbeing and social circumstances can have an impact on their overall health while they are in our care.