‘We can help women stop a tragic cycle’: Meet Nicola Bailey, FSRH Member and RCN Nurse of the Year 2021

In this article adapted from RCN Nursing Standard, we share the incredible and inspiring work of FSRH Nurse Member Nicola Bailey on her journey; from defying opposition by supporting abortion services in Northern Ireland, to winning RCN Nurse of the Year 2021.

Sexual health services nurse manager Nicola Bailey set up the Rose Clinic when pandemic lockdowns meant women were unable to travel to England for a termination

Operating outside of formal commissioned services in Northern Ireland, the clinic offers an early medical abortion service, plus sexual healthcare

RCN Nursing Awards 2021 judges lauded her passion for promoting women’s health, and bravery for continuing despite protests and political resistance

A nurse who has revolutionised women’s sexual healthcare in Northern Ireland has been named RCN Nurse of the Year 2021.

Nicola Bailey, a sexual health services nurse manager at the Belfast Health and Social Care Trust, set up the Rose Clinic, an early medical abortion (EMA) service for women up to the tenth week of pregnancy.

Lockdown meant women were unable to travel to England for free NHS abortion care

For decades, abortions in Northern Ireland were only allowed if a woman’s life was at risk, or there was a risk of permanent and serious damage to her mental or physical health.

But on 31 March 2020, regulations decriminalising abortion in the country came into effect, permitting terminations in the first 12 weeks of pregnancy in any circumstance, and beyond that under certain circumstances. However, just before the change was implemented, COVID-19 hit.

‘If we did not carry on, who would care for these women? All it takes is one person to stand up to make a change, and sometimes you have to put your foot down and push on through the barriers’
Nicola Bailey, RCN Nurse of the Year 2021

At the time, no services existed in the Belfast area and lockdown rules meant women were suddenly unable to travel to England to access free NHS abortion care, as they had previously been able to do. In 2019 alone, 1,014 women from Northern Ireland travelled to England or Wales for a termination.

Within days of the change in regulations, Ms Bailey set up the Rose Clinic. Working within the trust's sexual health service, she rearranged services and used some of the existing budget to make time and space for EMA care.

‘Already, before this change, travelling to England for an abortion was often only an option for some women,’ says Ms Bailey. ‘It wasn’t an option for the most vulnerable, the poorest, the youngest, the ones in controlling relationships and those who could not just leave their children to go to England for a termination.

‘The pandemic limited women’s options even further because of the difficulty in travelling. We had to get a local service in place straight away.’

Rapid clinic set-up during lockdown

In the days that followed, Ms Bailey got to work developing clinic protocols and standard operating procedures with her colleague, associate specialist Siobhan Kirk. Drug cupboards were acquired, legal paperwork organised and online consultation forms and patient information leaflets designed.

‘Medication had to be ordered from pharmacy and Nicola to make several trips to collect supplies herself,’ Dr Kirk recalls. She also forged links with the Northern Ireland sexual and reproductive health charity Informing Choices, which agreed to act as a central access point for EMA self-referral.

EMA is a two-stage treatment process in which a woman is given a mifepristone pill within a clinical setting and a misoprostol pill to be taken at home 1-2 days later.

‘We have women coming in who have had numerous children removed from their care. Now if they come in to see me with an unwanted pregnancy I can help them stop that cycle’
Ms Bailey

Setting up a new service in lockdown was a challenge, but the sensitivities surrounding abortion in Northern Ireland made it even more so. Ms Bailey says one of the most significant challenges was and still is the regular presence of protestors outside the clinic.

Legal challenge mounted by anti-abortion campaigners

‘Often the women coming to my clinics are vulnerable and it is hard for them to walk past the protestors stuffing leaflets in their bags,’ she says. ‘I go out to wherever my patients are and walk them in.’

Despite the regulation change, no formal abortion services have been commissioned in Northern Ireland because of disagreement between the main political parties.

In July 2021, the UK government introduced new powers enabling secretary of state for Northern Ireland Brandon Lewis to direct Stormont to set up full abortion services throughout the country by March 2022.

But in October 2021 a second legal challenge was mounted by anti-abortion campaigners opposing the move. Dealing with the political opposition and the protests is not easy, Ms Bailey says, and is sometimes exhausting.

‘But if we did not carry on, who would care for these women? All it takes is one person to stand up to make a change, and sometimes you have to put your foot down and push on through the barriers.’

Extending services and improving sexual health education

As well as setting up the Rose Clinic, Ms Bailey has maintained existing sexual health services and developed others during the pandemic. This has included overseeing a new contraceptive telemedicine service and a patient helpline that she operates single-handedly, alongside her other duties.

Ms Bailey has also completed training enabling her to fit subdermal contraceptive implants, and provides two implant clinics a week, as well as offering immediate implant insertion to EMA patients.

She is an active member of the Northern Ireland Abortion and Contraception Taskgroup, which campaigns for formally commissioned services. ‘It is so important to press for commissioned services for our women,’ says Ms Bailey. ‘Without this, clinics offering EMAs are liable to fold.’

‘You never know how your kindness can turn someone else’s life around, especially when people are at their most vulnerable’
Ms Bailey

She is proud of the holistic care her clinics deliver. ‘We have women coming in who have had numerous children removed from their care, which is a tragedy for them and the children. Now if they come in to see me with an unwanted pregnancy I can help them stop that cycle.

‘In Northern Ireland the sexual health and contraceptive services are on their knees and sex education in schools is poor. Some teenagers I see have no sexual health knowledge at all and it is no wonder we have so many unwanted pregnancies. I am able to talk to them about contraception and cervical smears and build trust, which helps them look after themselves.’

RCN general secretary Pat Cullen applauded Ms Bailey’s tenacity and perseverance. ‘Nicola Bailey identified an area where she could use her knowledge and skills to improve access to care and treatment and moved swiftly to create an excellent person-centred service within her trust,’ she said.

‘As nurses we often work in challenging environments and we work to challenge barriers and develop solutions to problems – Nicola is no exception and as a result of her tenacity, she has overcome every obstacle in her way to ensure women and girls get the support they need.’

Campaign to improve care and combat misinformation

Keen to keep moving care forward, Ms Bailey is putting together a proposal to extend abortion services at the Rose Clinic for women who are 10-12 weeks’ pregnant.

She also wants a public health campaign to signpost to regulated abortion services, to deter women from buying tablets for termination on the internet, and to raise awareness of services that appear to be offering full choices to women but are actually run by anti-abortion groups.

And while the political stalemate doesn’t look like being resolved in the near future, the number of women attending her clinic is rising. ‘These women and the impact our services have on their lives keep me going,’ says Ms Bailey. ‘You never know how your kindness can turn someone else’s life around, especially when people are at their most vulnerable.’

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This news item was adapted from an article "‘We can help women stop a tragic cycle’: meet our RCN Nurse of the Year 2021" written by Elaine Cole, RCNi special projects editor of the Nursing Standard.

View the original article.