Legislative Council, Wednesday 16 November 2022

Ms FORREST question to LEADER of the GOVERNMENT in the LEGISLATIVE COUNCIL, Mrs HISCUTT

1 Are antenatal classes being offered face to face;

1.1 If so, in which hospitals/facilities;

2 What is the schedule of routine care provided by the Child Health and Parenting Services (CHAPs) nurses listed by:

2.1 Frequency;

2.2 Location (i.e. in home, in clinic, other);

2.3 Are parenting groups being encouraged for new families; and

3 How are parents of babies born during the period of COVID related restrictions related to antenatal care, education, labour and birth care, and home visits by CHAPs nurses being specifically supported during the postnatal period?

4 What dedicated support is currently available to parents who have experienced birthing trauma and ongoing trauma related impacts to assist them?

Answers:

1 All public hospital antenatal classes are now offered face to face. At Mersey Community Hospitals and North West Regional Hospital, these are currently delivered as one on one sessions with midwives. Full classes are recommencing in January 2023.

2 Child Health and Parenting Service (CHaPS) schedule of routine care includes the following:

a. The Child Health and Parenting Service delivery model includes provision of a routine schedule of voluntary Child Health Assessments to Tasmanian families with children 0-5 years of age. This includes 2 wk., 4wk, 8wk, 6mth, 12mth, 2yr and 4 yr. developmental assessments, along with some appointments for families in relation to parenting support, breastfeeding, perinatal mental health, sleeping and settling etc.

b. 2-week appointments can be offered as a home visit, along with some other appointments based on client need/circumstances. Other developmental assessments and appointments are routinely scheduled in clinics or may be offered using Telehealth.

c. new parent groups are offered by CHaPS (scheduled to match available staffing and client numbers regionally). These groups have traditionally been scheduled face to face but were offered through online format during the COVID escalation period. A range of other groups are also offered to families for broader parenting or perinatal mental health needs across the state.

3 There are currently limited restrictions in place in relation to antenatal care, education, labour, birth and home visits in Tasmanian public hospitals.
• Partners were always able to attend birth; including where the mother or partner were COVID-19, in which case they were encouraged to room in together to mitigate spread throughout the ward.
• In the North, routine antenatal classes continue to be delivered to women and their primary support person face to face and in small groups.
• In the North and North West, extended midwifery with home visits continue to be provided in the initial week following birth and were for the duration of COVID-19 restrictions.
• COVID-19 restrictions have impacted hospital visiting hours. Many patients have indicated this has been positive, as it provides more time for rest and an opportunity for staff support for breast feeding and other in hospital parenting education.
The Child Health and Parenting Service continued to offer services to all families throughout the COVID period from 2020 through until now. The service was required to be nimble and responsive at times modifying some service delivery to include telehealth and telephone options combined with shorter clinic appointments. It continued to offer home visits to clients with new babies as appropriate, along with providing a level of continuous face to face clinic-based service delivery options to families through the entire period.

4 At the Royal Hobart Hospital, women who disclose previous trauma around birth have their views and requests formulated in a plan, for example, a request for an elective lower caesarean section following a perineal trauma of forceps delivery.

Women are offered perinatal mental health services to support them both antenatally and postnatally.

There is also the ability to admit to two beds in the private mental health facility if required and available.

Following birth midwives on the postnatal pathway guideline routinely check in with women on how they found their birth experience and if a more structured debrief is identified as being necessary there can be a medical consult to answer questions and provide explanation. Social work staff are also engaged to provide support. A postnatal review clinic has also been established to provide ongoing review and follow up.

At the Launceston General Hospital, women who have more complicated births (for example an unexpected caesarean section, assisted delivery, emergency delivery, baby unwell after delivery or other complications) are offered a debrief prior to discharge. Follow up may be arranged in the early postnatal period depending on needs. Referral may be made to support services; social work, perinatal mental health etc as needed. GPs are notified of more complicated births for follow up. For pregnancies following complicated births, a consistent midwife and individualised birth plan is offered. Social work and perinatal mental health supports are also organised as required.

The North West Integrated Maternity Service formulate plans with women who disclose previous trauma around birth to support them with their pregnancy to birth journey, with further review through postnatal clinics.