Clinics that treat postnatal women who have experienced complications before, during or after giving birth, should be developed in all maternity units in Ireland, a new study has recommended.

The study evaluated the Poppy Clinic - a postnatal morbidity clinic, which was established in the National Maternity Hospital (NMH) in 2013. It came about after midwives, obstetricians, GPs and public health nurses found they had nowhere specific to send postnatal women who had experienced a complication during pregnancy, during childbirth or in the few days/weeks after having a baby.

Morbidity is a wide-ranging concept that refers to any physical or mental complication directly related to childbirth, which may not necessarily be life-threatening, but may have a significant impact on quality of life. The most common reason for referral is wound review. This includes women who may have developed an infection of a perineal or abdominal wound following childbirth.

The study found that between 2013 and 2018, attendance at the Poppy Clinic increased by 500%. Meanwhile in 2020, almost 700 women attended in person, with a further 60 attending virtually as a result of the COVID-19 pandemic.

The clinic was set up by midwife manager, Caroline Brophy, and consultant obstetrician, Dr Laoise O'Brien. According to Ms Brophy, who is now an advanced midwife practitioner, over a decade ago, she was "acutely aware of an ad-hoc approach to any necessary hospital follow-up for women who experienced issues postnatally".

"This gap in service was not only frustrating for mothers, but also for midwives and obstetricians, who struggled to arrange a clear pathway with identified clinicians, who would be responsible for assessing and managing their morbidity," she explained.

From this, the Poppy Clinic was born and while it started off very small, it has "grown exponentially over the past nine years", Ms Brophy noted.

She pointed out that the evaluation of healthcare services has become a worldwide priority. As a result of this, and the increasing number of women attending the Poppy Clinic, an evaluation was carried out to determine if it could be further developed or improved.

"As part of this study, a chart review was conducted to determine a profile of women attending the clinic and a survey carried out to evaluate women's experiences of attending," she said.

When asked if the healthcare professional they saw showed care and compassion, 36% answered ‘excellent', 31% answered ‘very good' and 18% answered ‘good'.

When asked if they had been made to feel at ease, 48% answered ‘excellent', 22% answered ‘very good' and 15% answered ‘good'.

However, some women were frustrated by their visits to the clinic, particularly if the healthcare professional they saw did not appear to know what the patient was there for, or if there were long waiting times.

Following the evaluation and in response to the increasing numbers of women attending, "several steps are in the planning" and some have already been implemented, to improve the quality of care available.

"The Poppy Clinic has already been expanded and as a result, appointments are now more streamlined and there are currently three clinics running per week instead of one," noted Dr O'Brien.

She emphasised that the value of this clinic for women at such a vulnerable time in their lives "cannot be underestimated".

"Prior to the clinic, these women presented to A&E, GPs or gynaecological services. We see a steady flow of postnatal patients presenting for follow-up with issues such as haemorrhages, hypertension, medical conditions and preeclampsia. Thankfully, through COVID19 we have been able to maintain all our services," she said.

The study made a number of recommendations, including:
- Postnatal morbidity clinics should be developed in all maternity units in Ireland, as they are an essential element of maternity care
- Women at high risk of developing an infection or wound breakdown, such as those who have undergone caesarean sections or those with a blood loss of over 500ml, should be given information on signs of infection and wound breakdown, and the contact details of the Poppy Clinic or other postnatal morbidity clinics, should symptoms develop
- Midwives and obstetricians should be familiar with each patient's history and reason for attendance at the Poppy Clinic prior to commencing any consultation
- Compassionate communication skills are essential for all healthcare professionals treating women with a postnatal morbidity.

A full report of the study's findings can be viewed here.