You are very welcome to the 25th edition of the Rotunda GP-Connect E-zine. In this issue Dr. Richard Duffy who is our consultant Perinatal Psychiatrist gives a detail review of the Perinatal Mental Health Services here in the Rotunda. He includes the criteria, the pathway and the referral content and we are very happy that we are able to offer care to woman from booking until a year after they have had their baby. There are a range of issues that can result in women requiring Perinatal Mental Health Services. There is a comprehensive list of services that are commonly used by the Perinatal Mental Health Team and these are given at the end of Dr. Duffy’s review.
On a related topic Ms. Nicole Maiorano who works with the Trinity Centre for Global Health has an informative piece on trauma informed care. The Rotunda Hospital has provided money to get a research programme started in the hospital in conjunction with the Trinity College Centre for Global Health. This research will include the analysis of various data sources such as hospital policies, organization wide surveys with service users and interviews with focus groups. We hope that this will benefit the Rotunda Hospital in terms of moving forward with trauma informed care for all our couples.
General Practitioners within our catchment area are already aware of the planned Centralization of Benign Gynaecology Referrals across North Dublin. We have partnered with Connolly and Beaumont Hospital and will initiate a centralized referrals office in September. The idea centralizing referrals is to try and ensure that the patient pathway is streamlined and that right woman sees the right doctor the first time. There are lots of detail in the article and we believe that this new system will result in a more timely service for women across North Dublin.
Our Senior Clinical Psychologist in Perinatal Health, Ms. Jillian Doyle has a very informative article about the impact of modern technology and the consequences of an online world to young children and parents. She makes the point that not all screen time is equal and that high quality interactive content can support learning whilst on the other hand a prolonged exposure to various screening platforms is possibly harmful. There is a specific role and that limiting screen time particularly to children is very important.
Dr. Aine Dempsey who is working between Connolly Hospital and the Rotunda Hospital is a Consultant Obstetrician and Gynaecologist with a particular interest in complications of early pregnancy. Aine has done a lot of work on this and has a very informative article about bleeding in early pregnancy the risk of an ectopic pregnancy. The clinical features of ectopic pregnancy and then the very common problem of nausea and vomiting particularly in early pregnancy when it can affect up to 80% of women. The second part of her article focuses on Gestational Trophoblastic Disease (GTD) which obviously is a rare pregnancy related condition in which the developing placenta functions like a cancer which can spread outside of the uterus. There is now a national GTD registry which is under the leadership of Professor John Coulter in Cork University Maternity Hospital and Aine outlines the recommendation for pregnancy interval after GTD and the issues around future fertility.
Ms. Carol Rock who is the Clinical Midwifery Specialist in Bereavement has written about the most common complication of pregnancy, that of early pregnancy loss. She details how the Rotunda try and manage early pregnancy loss and support couples through this. I believe a patient centered care approach to managing these complications is critical and the Rotunda Hospital has always prioritized such an approach. As part of that Ann Charlton who is our Chaplin has a detailed article about the chaplaincy services available in the Rotunda and the specific role of bereavement care for parents who have tragically lost a baby.
There are two other things to note, the consultant led semi private care which is available in the hospital for all couples as well as early pregnancy ultrasound, antenatal classes and breast feeding workshops.
Finally just to let you know that on Saturday 17th January next year we will be holding a symposium on fertility and endometriosis; a guide diagnosis and management. Both these areas are extremely important in terms managing women and I do believe that this symposium will prove very popular. If you want to email Ms. Eleanor Power on [email protected] you can reserve your place. With best wishes.
Professor Sean Daly,
Master/CEO, Rotunda Hospital.
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Under the Children First Act, the Rotunda Hospital has a statutory obligation to prepare and publish a Children First Safeguarding Statement:
This is a written statement that specifies the service being provided and the principles and procedures to be observed in order to ensure, as far as practicable, that a child availing of the service is safe from harm.
The Child Safeguarding Statement provides an overview of the measures that the Hospital has in place to ensure that children are protected from harm.
You can view our Child Safeguarding Statement Here.
You are very welcome to the 24th edition of the Rotunda GP-Connect E-zine. Aileen Fleming, our Candidate AMP in Diabetes has written a very informative article about managing diabetes in pregnancy. The postpartum follow up is very important and as Aileen said we have decided that this is best done within General Practice. The decision to allow a fasting glucose and HbA1c is consistent with the NICE guidelines and should be checked 3 months after the delivery. It is now part of the annual screening for chronic disease prevention and allows women, especially those who are breastfeeding, to be effectively screened by a General Practitioner.
Over the last 4 months of 2024 and from January to February of this year, we implemented a very effective programme to offer immunisation to all newborn babies against RSV respiratory infection. As you know the disease burden of this infection can be considerable and many babies and young children end up being admitted to hospital and some of them are extremely ill. We managed to implement the programme and Emer Croke was the coordinator for what turned out to be a very successful RSV Pathfinder programme. Ultimately over 82% of the babies who met the criteria were immunised with Nirsevimab; by using our electronic health care medical record and with the help of Leon O’Hagan, who was the Senior Pharmacist and Informatics person, we were able to look specifically at the women who declined immunisation and will work with these women to try and improve uptake later this year when the programme will be repeated. Leon has a very detailed report which gives you an in-depth look at the results.
The journey initiative, which has made a huge difference to those couples who came through our Fetal Medicine Unit and are faced with a difficult diagnosis, forms the final report in this month’s Rotunda GP-Connect. As you can see there are multiple aspects to this journey project and I would like to complement our Fetal Medicine Midwives who have taken on this initiative and have brought it forward.
Professor Sean Daly,
Master/CEO, Rotunda Hospital.
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You are very welcome to the February edition of the Rotunda GP-Connect. We had a historic opening of our new facility in Hampson House in January were the Tánaiste as he was at that time and Taoiseach as he is today Mr. Micheál Martin enthusiastically opened what we believe is a wonderful addition to the campus of the Rotunda Hospital. We have a new and expanded Paediatric Outpatient Department, two new Maternity Outpatients floors, a modern Colposcopy Suite and additional areas for Perinatal Health and other Allied Health Services such as Social Work, Radiology and Dietetics. This is the first part of a plan to develop significant additional facilities on the Rotunda Hospital Campus which will provide modern Neonatal High Dependency and Special Care Baby Units, an expanded Labour Ward and significant Post Natal accommodation.
The Community Midwifery Service which cares for over 2,000 pregnant woman annually has a detailed piece in this E-zine. The Rotunda is very proud of the fact that this service operates in the community and brings care to the women and families that we serve in locations located across North Dublin from Balbriggan to Finglas and Cabra. We have several midwifery specialists who work within the Community Midwifery Service and deliver the highest quality of care to women both antenally and postnatally. Dr. Fiona Keogh has a very informative chapter on “The Management of Pelvic Organ Prolapse in the Community”. Some of you may know we held an Educational Event here last month were Fiona and her colleagues outlined the management of pelvic organ prolapse and gave instruction in the use of the wide range of pessaries that are now available.
The final part of this E-Zine is on informative list of resources for the Management of Common Feeding problems in Primary care. I hope you will find these useful and there is a QR Code for more information on introducing family meals and weaning new born infants.
Professor Sean Daly,
Master/CEO, Rotunda Hospital.
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The site of the Rotunda’s First Lying-In Hospital at 60 South Great Georges Street, now home to Decwells Hardware, was memorialised by a Dublin City Council commemorative plaque today, Friday, 1st November 2024.
The first iteration of the Rotunda Hospital was founded over 200 years ago by Dr Bartholomew Mosse in an effort to mitigate the poor health care service often experienced by expectant mothers in Dublin City. A three story house on South Great George’s street was converted into a Maternity Hospital; opening its doors on March 15th 1745 and delivering its first infant on March 20th 1745. It operated from these premises from 1745 to 1757.
Speaking at the plaque unveiling, The Lord Mayor of Dublin James Geoghegan said “The 1740s was a particularly bad time to be a child. Infant mortality rates, high to start with, had doubled over the previous 100 years. Bartholomew Mosse decided to take women out of the slums. His lying-in hospital meant just that. Expectant mothers would lie-in, in advance of childbirth and be tended to by trained staff. His specialist premises provided shelter, warmth, food, and medical care for mothers.”
The Lord Mayor continued, “Our maternity service today is staffed by 4,250 midwives and delivers 60,000 babies a year. Most of these are delivered by midwives and 98 percent are seen in their own home within 72 hours of discharge by a public health nurse. Our rates of childhood mortality are among the lowest in the world and lower than our peers. Bartholomew would be proud.”
Professor Seán Daly, Master of the Rotunda commented that: “it is remarkable to think that a humble maternity hospital which opened at South Great Georges Street over 200 years ago supported the birth of over 4,000 children and the safe care of their mothers during its twelve years of operation. It is equally of note at the location was also the site of the first midwifery training hospital in both Ireland and Great Britain.”
Professor Daly continued, “In many ways, this first “lying-in hospital” was a victim of its own success; so in demand were their services that the building quickly became too small to cater for all the expectant mothers who needed to avail of their services, and so eventually the hospital was relocated to the site of the current Rotunda. The current Rotunda Hospital is the oldest maternity hospital in the world and will deliver its one- millionth baby in 2027. However, I am delighted that DCC have decided to mark the site of the first Rotunda “Lying-In Hospital”, and pay homage to all those who availed of its services. Since that day the Rotunda has been part of the heart of Dublin city and intends to remain so.”
It is my pleasure to welcome you to the 22nd edition of the Rotunda GPConnect E-zine. Our online educational study evening will take place on Thursday, 10th October 2024. There is a zoom webinar code which can be obtained by scanning the QR code on the front of this publication. There were four talks at the virtual GP evening, which are identical to the “in-person” event which took place earlier this year and concentrate on our emergency room, common feeding problems, the management of urinary incontinence and a perinatal mental health update from our Perinatal Mental Health team.
In this E-zine we have a very informative article by our newly appointed consultant colleague, Dr. Fiona Reidy, on endometriosis. This chronic and difficult to manage condition has a variety of hormonal management options as well as surgical options, but the importance of treating symptoms and supporting women from a psychological point-of-view cannot be overstated. The Rotunda endometriosis hub is led by Dr. Niamh Daly and Ms. Shelby José as the clinical nurse specialist. Shelby has a very helpful article about the Rotunda Endometriosis Hub which can provide multi-disciplinary care to women with this debilitating diagnosis.
The Rotunda Menopause Clinic, which is led by Dr. Caoimhe Hartley, is a clinic designed for women with complex menopause problems. The GP referral pathway is outlined within this E-zine and gives valuable information on what the referral criteria for the clinic are as well as a link to the Rotunda Menopause clinic.
Ms Anne O’Byrne, who is our head librarian and has a wealth of knowledge on the history of the Rotunda Hospital, has a very informative article on the Rotunda. This Baroque-style chapel in the middle of the original hospital building is a testament to Dr Bartholomew Mosse who built the Rotunda to care for the poor people of Dublin. The chapel was first open in 1762, was a huge benefit to the hospital in terms of religious services, which were conducted weekly and remains available for services today. The Chapel is also a respite for women from the busy postnatal ward in which it is located. This year the chapel is part of the Dublin Culture Night which takes place on Friday, 20th September 2024.
Post pandemic parenting is a very informative article written by Ms. Amanda Scott and Ms. Gillian Doyle and outlines some of the research that is ongoing in this area after what was a very unusual two years in all our lives. The effect on society, and in particular children, forms the basis for this article and raises multiple potential issues which to be honest I had never considered.
Finally, the Rotunda is one of six publicly funded fertility hubs and the contact details of this new service are available on the final page of this E-zine. Many thanks for your ongoing support of the Rotunda and I would like to finish by acknowledging and thanking Ms. Eleanor Power, who is our very effective GP Liaison person.
Professor Sean Daly,
Master/CEO, Rotunda Hospital.
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It is my pleasure to write an introduction for the 21st edition of the Rotunda GP-Connect E-zine in which we have four very informative articles covering fertility, the sexual assault treatment unit, management of post bariatric surgery patients during pregnancy and our Emergency Assessment Unit.
Glenda Sanbenero and Chloe Kelly our two Clinical Fertility Midwife Specialists are part of a multidisciplinary team providing care to couples experiencing difficulty achieving a pregnancy. There is now accepted criteria for referring to the National Fertility Hub and the referrals are triaged by one of our consultants and a questionnaire is sent to the couple. Once the questionnaire has been completed an appointment will be organised with a member of the team and initial fertility investigations are performed. The article is very informative in terms of what these initial investigations would be and details the services that are available to couples within the Rotunda Fertility Hub.
Dr. Dan Kane who is a Specialist Registrar and a forensic examiner within the Rotunda Sexual Assault Treatment Unit has a very informative article about the care provided within this unit. This Unit, was the first Sexual Assault Treatment Unit in Europe, offers care to people of all genders who are over 14 years of age. It operates 24/7 and there are essentially three options; a forensic examination with a member of the Garda Síochána, a health check and a forensic examination without An Garda Síochána involvement. The pathway is detailed with a description of what is involved in each of these options and the referral pathways.
The third article in this particular E-zine refers to the management of patients post bariatric surgery during pregnancy. The numbers being referred to the Rotunda are increasing year on year and we cared for 84 women post bariatric surgery in 2023. This article is particularly detailed and I certainly believe it will be very useful and it is almost counter intuitive that this group could suffer from malnutrition with a subsequent increase risk of adverse maternal and fetal outcomes. There is a recommendation now that women should wait 12- 18 months post-surgery as this may further increase the risk of maternal complications.
The final article is written by one of our Advance Midwife Pactioneers in our Emergency Assessment Unit Ms. Debra England. Debra outlines areas were referrals may not be useful and also gives some details about our Day Assessment Unit which is open 7 days a week. Debra and her colleagues run a 24/7 day service. The article highlights the increase pressures on Emergency Departments and in particular ours in the Rotunda with referrals that could be better managed within the community
Professor Sean Daly,
Master/CEO, Rotunda Hospital.
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There will be traffic restrictions in place on Saturday, 16th and Sunday, 17th March in Dublin City Centre, around Parnell Square.
As always, Garda Siochana have assured the Hospital that patients will be provided access to the hospital as in the past.
Staff and visitors will be able to get to the hospital by being aware of the road closures and the routes to circumvent them.
Below is a map of the parade route, and info from St. Patrick’s Festival about the specific road closures.
St. Patrick’s Festival intends to close the following roads to facilitate the St. Patricks Festival Events, during the periods listed
Location A:
Western Way (Dominick St Upr to Mountjoy St) from 19.00hrs on Saturday 16th March 2024 to 15.00hrs on Sunday 17th March 2024.
Location B:
Mountjoy St, Mountjoy St Middle, Palmerstown Place, Wellington St, St Mary’s Place North, Granby Row, Parnell Sq North, Parnell Sq East, Cavendish Row, O’Connell St Upr & Lwr, O’Connell Bridge from 04.00hrs to 15.00hrs on Sunday 17th March 2024.
Location
Westmoreland St, College Green, Dame St, Lord Edward St, Christchurch Place, High St, Nicholas St, Patrick St from 04.00hrs to 17.00hrs on Sunday 17th March 2024.
Location
New Street South, Clanbrassil St, Kevin Street Upper, Kevin Street Lower, Cuffe Street, Stephens Green South, Earlsfort Terrace from 04.00hrs to 18.30hrs on Sunday 17th March 2024.
Location
Liffey Street West (Benburb Street to Wolfe Tone Quay) Dublin 7 from 11.00hrs to 23.30hrs, Saturday, 16th March 2024.
Location
Custom House Quay (Beresford Place to Memorial Road) from 19.00hrs to 06.00hrs Friday, 15th March 2024 to Tuesday, 19th March 2024.
Traffic Management Plan
This year promises to be a very exciting time for the Rotunda Hospital as it develops its campus within the Northside of Dublin City. While the Earl Building will provide state of the art facilities for our paediatric and hospital based pregnancy care, the purchase of Dominick Street Lower by the H.S.E. will enable us to transform our gynaecology services.
Key to this service provision is our colleagues in primary healthcare and in this edition of the E-zine we outline the basis for this new service. Essentially this service is predicated upon primary healthcare doctors, who know their patients better than anyone, to indicate to us the sub-specialty area within gynaecology which would best serve the individual women who they are caring for. To that end we would ask that you would identify the specific problem that your patient is presenting to you with and we will then ensure that an appropriate care pathway is generated for that woman.
The aim of this service is to ensure that the right woman sees the right doctor the first time they are seen within secondary care. Your co-operation and help with this is absolutely essential to providing this service. Professor Dorothy Ryan and Dr. Brian Harnedy have written a very informative article on evaluating dyspnoea in pregnancy. This is a common presentation among pregnant women and their insights are extremely important in terms of identifying those women who need extra care.
Our Physiotherapy department have written a very helpful article on pregnancy related pelvic girdle pain. This pain, which can affect up to two thirds of pregnant women, can cause significant disability. Interestingly exercise may actually prevent or reduce the incidents of pelvic girdle pain.
Over many years now, and in particular since 2019, the Perinatal Mental Health service has developed within the Rotunda. Ursula Nagle, who is an Advanced Midwife Practitioner, has helped to establish the Perinatal Trauma Clinic. Unfortunately, some women do experience a traumatic birth and require additional care following this. Ursula and her team have written a very informative article about birth trauma and the service.
With every good wish for 2024.
Professor Sean Daly,
Master/CEO, Rotunda Hospital.
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The Earl Building will provide services to over 100,000 appointments annually.
Dublin, 17th November 2023: Minister for Health Stephen Donnelly T.D. has today visited the site of the new outpatient and ambulatory services for the Rotunda Hospital, which will be situated in the Earl Building in the newly revamped Clery’s Quarter. The site was procured by the HSE for the Rotunda and will cater for over 100,000 outpatient and ambulatory patients annually
Once commissioned, the new site will be the primary location for clinics which will provide a range of outpatient services for over 100,000 patients. The following services will be provided from the Earl Building:
- Maternity Outpatients
- Paediatric Outpatients
- Colposcopy
- Perinatal Mental Health
- Allied Health- Social Work/Dietetics
The relocation of outpatient services to the Earl Building is a key enabler in progressing the development of a critical care wing for the Rotunda Hospital on its Parnell Square campus. A Critical Care Wing build will provide a new and expanded neonatal intensive care unit and special baby care unit, expanded Delivery suite & operating theatre capacity, increased single occupancy Post-natal beds and other clinical supports such as Central Services Supplies Department (Decontamination).
Minister for Health Stephen Donnelly TD said: “I welcome the HSE’s purchase of the new Earl building to support the delivery of outpatient services for the Rotunda. Promoting Women’s Health is a priority within the Programme for Government and a top priority for me as Minister. The quality of care delivered at the Rotunda is of the highest standard and this new building, once commissioned in 2024, will enable that care to continue to be delivered in facilities more befitting of a 21st century health system.”
Professor Sean Daly, Master of the Rotunda Hospital said: “On behalf of the Board, management and staff at the Rotunda Hospital, I am delighted to welcome the Minister for Health Stephen Donnelly TD to the site of the new outpatient services for the Rotunda Hospital in the Earl Building. I would like to thank colleagues within the HSE, Department of Health and RCSI Hospitals Group, as in parallel we continue to work collaboratively in progressing plans and designs to develop a critical care wing on the Rotunda campus. The Procurement of the Earl building will be a key enabler in any planned or future proposed development of the Rotunda Campus and will facilitate the decant of all OPD and other ambulatory services into a current and modern healthcare facility
The Rotunda are greatly enthused about this project and are hugely motivated with our colleagues in the HSE in progressing with the new site over the coming months to enhance the service offering for mothers and babies.”
The Rotunda Hospital is the oldest continuously operating maternity hospital in the world, founded in 1745 and has been operating out of its current buildings since 1757. Approximately one in six of all babies born in Ireland are born in the Rotunda Hospital.