Dr. Jillian Doyle:

I will pick up on a few points.

As regards well-being and mental health, when I am working with people, I often think I am initially treating their mental health. An absence of a mental health difficulty does not necessarily mean people are feeling well or are happy with their quality of life. I am always trying to think about how to work with both and help people build a life they feel is worth living that gives them joy and contentment. We need both because that helps them access their threat or "fight or flight" system in a way that helps them live their life in a way that is beneficial. We do not want to get rid of the ability to detect danger or to respond to threat, but we want people to be able to move out of it when appropriate and to access support and resources that nourish them.

It is important for people from other countries who have come to this country to be able to access supports. One of the supports we can provide therapeutically is group work. I feel a bit like Oliver Twist asking for more because we have some clinical space in the Rotunda Hospital, but not enough and none of us has access to group rooms. Groups are important for mental health. If I had a magic wand, I would make a nice baby-friendly group-room where we can get down on the floor. Babies do not like to sit on chairs. Small babies cannot sit on chairs and it can be hard for a mother to have to keep her baby in a buggy for an hour. Babies are good communicators and it can impede the mother's communication if her baby is crying.

We also do not have baby changing facilities in our fancy portacabins. That is a practical issue. A mother needs to have easy access to a toilet and baby changing facilities. We were talking about bricks and mortar. That is what we need to help people access services.

Thinking about becoming a mother, matrescence or the journey towards motherhood, happens throughout pregnancy and in the perinatal period.

We become mothers throughout the life span of our children. A woman is learning a new part of this identity of being a mother in each milestone of development. When Deputy Lahart spoke about that, I thought about teenagers, whom we highlighted in our report. It can be difficult being a teenage mum. The people in your social circle are not going through the same experience as you, so who do you have to bounce this developing identity off? It is an opportunity to bring that to the fore again, that these young women, these mothers, really need our support and our help.

When Deputy Lahart talked about turnaround speed, I thought about trauma-informed care. Some women would very much appreciate an extra few nights in hospital, but some women want to get home to their family as soon as possible. That is one of the things over which we need to give the woman control. What works best for them, what works best for their family and how do we support that? Community midwives have such an important role to play where women are maybe leaving hospital faster than would have happened historically, and of course there are the public health nurses for continuity of care.

It would be amazing to have accommodation that does not smell like a clinic or hospital and that is baby-friendly. On accommodation, we are seeing people coming into our services who are living in really difficult circumstances. In the Rotunda we have people coming from direct provision centres where a woman may have come through unspeakable trauma and is now living in a place she feels is not ideal for her and her circumstances and she does not know where she will be going next. The importance of giving people certainty cannot be overlooked when we are thinking about how to make someone feel safe. If you do not feel safe, how can you help your baby feel safe? Something I always think about when someone is referred to me is where they are living. That is the starting point. If we go back to the basic hierarchy of needs, we need to make sure someone has somewhere to live where they feel safe.

The Deputy mentioned people feeling out of control. Thinking about birth trauma, oftentimes if someone has an experience of birth trauma, they are left feeling very out of control and very disempowered. It is a very important function of all our services to give a woman back control and to educate her antenatally about what is going to happen. This involves giving education around babies and what it is like to have a baby, that women might feel depressed and overwhelmed, and where that goes from being normal to abnormal. It is also helping someone think about the fact there is a point during birth where they are out of control because the body takes over, and in our society we are so in our heads and we want to know and to be in control. This is probably the most in your body experience a person will go through. It is a case of trying to explore what it is like for them when they are out of control and how we help them to stay with themselves in that.