My Care During Pregnancy and Beyond

A little over 50% of units stated you can contact them directly yourself when you're pregnant. However all units accept a G.P. Referral letter. Other less frequent methods of referral are via the following services e.g. gynaecology clinics, infertility clinics, early pregnancy units and referral from other hospitals.

Most units have an early pregnancy unit/clinic but not all are 24 hours - they typically operate Monday-Friday daytime hours. If you phone your unit they will advise you on your next step which might be an appointment with the early pregnancy unit/clinic.

Depending on where you live you may have more or fewer options available to you about where you have your antenatal care, where you choose to have your baby and who foots the bill! These options include Midwifery-Led Units, Domino Midwives, Community Midwives including a homebirth service, combined antenatal care (G.P. & hospital), public care, semi-private care, private care and Self Employed Community Midwives.

Midwifery-Led Care

Midwifery-Led Units

A Midwifery-Led Unit offers you the chance to birth your baby in a homely environment with a midwife you have come to know during your antenatal care. These units provide healthy women (with no risk factors for pregnancy and labour), a safe and satisfying choice in how they access free maternity care. A team of experienced midwives provides the care. Mothers can give birth in a uniquely designed birthing room where they will be cared for by a midwife they have already met and where they can avail of facilities such as music, a water pool and supportive aids (gym ball, bean bags etc.). Pain relief (Entonox (also known as 'Gas & Air') and Pethidine) is available if required. Mothers are enabled to have an early discharge home i.e. within 6-48 hours where one of the team of midwives will visit them on a daily basis at home up to the 7th postnatal day, when the care of the mother and baby will be transferred to the public health nurse.

At any point where a problem is detected or anticipated, formal contact will be established with the obstetric/paediatric team on call or if applicable, the general practitioner.

There are currently only 2 Midwifery-Led Units (MLU) in the Republic of Ireland –

Community & Domino Midwives Schemes

Designed for women who are classified as being at 'low risk of complications', these Domino/Community Midwives Schemes allow you to see a team of midwives for your antenatal care free-of-charge. With the Community Midwives scheme a mother has the option of giving birth either at home or in the hospital and with the Domino Scheme the mother gives birth in hospital. (DOMINO stands for DOMiciliary IN and Out. (Domiciliary means taking place in the home.)) Antenatal visits take place either in the Community/Domino Midwives' Clinic or in a local health centre. Some antenatal visits may take place in the home.

At approximately 18-22 weeks into your pregnancy a routine scan and a complete physical examination will be offered to assess your suitability for the scheme for the remainder of your pregnancy. As part of the programme you are entitled to an early hospital discharge and home visits from a midwife for up to a week after your baby is born.

There are 4 of these schemes in the Republic of Ireland –

Obstetric led care

Public Care

Every woman is entitled to free maternity care. This is irrespective of whether or not you have a medical card, Private Health Insurance (e.g. VHI, Hibernian Aviva, Quinn Healthcare) or are a member of a Health Care Cash Plan (e.g. Hospital Saturday Fund).

Public care includes all antenatal care, all care during labour and childbirth, and all postnatal care. It covers all hospital accommodation costs for you and your baby. You are not guaranteed to see the same doctor/midwife at each visit to the public antenatal clinic.

Several hospitals offer public patients the choice of attending the Midwives' Clinic. These clinics are staffed by experienced midwives. The clinics are for women with uncomplicated pregnancies, offering continuity of carer where possible for antenatal care. Each hospital sets its own criteria for those women who can attend the Midwives' Clinic, so check with the hospital if you are interested in this option.

During labour and usually during birth the hospital midwives will care for you. You may not need to see a doctor at all. If you need an instrumental birth or caesarean birth, the doctor on duty will attend you. You may not have met any of these midwives or doctors before.

After your baby's birth you will stay in a public ward.

Semi-private Care

Semi-private care appears to mean different things in different hospitals. Sometimes it means that you see a consultant privately when you are pregnant but the birth of your baby will be attended by whichever doctor is on duty. Another system is where you attend a 'Semi-private Clinic' run by a consultant and senior members of his team. Someone from the team is generally available to check in on you during your labour and for the birth of your baby.

After birth you usually stay in a semi-private ward if there is availability, which may mean sharing with up to five other mothers.

Private Care

If you have private antenatal care, you will see a consultant at each antenatal visit either in the hospital or in the consultant’s private rooms. The private option means that you see the same person at each visit.

During a labour with no complications consultant obstetricians check in on women who have opted for private care. They are also likely to be present as the baby is being born. He/she will usually make alternative arrangements for cover with a consultant colleague if he/she anticipates being away for your due date.

After the birth there should be a degree of privacy as you will usually stay in a private room. However you may have to spend some/all of your stay in a public or semi-private ward if a single room is not immediately available.

Midwifery-led services available:

Obstetric-led services available:

This is where your GP provides about half of your antenatal care and you only visit the hospital early in pregnancy and for a reduced number of visits after that. Virtually all GPs participate in the Maternity and Infant Care Scheme but double-check with your GP first. Those GPs that participate are reimbursed by the HSE so you do not need to pay for any of your visits to your GP for antenatal care - not even the first one to confirm your pregnancy.

Combined Care is an option for women who are availing of public, semi-private and private care or midwifery-led services. Some private obstetricians are happy for their clients to make antenatal visits to their GP and may reduce the fee accordingly.

Hospital only care is available for some clinics but combined care tends to be encouraged

Combined care with G.P.

Hospital only care

All units have antenatal clinics at the unit's main location. Some units provide outlying antenatal clinics in their catchment area. In a few instances private care is provided off-site in consultants’ rooms.

This ranges from 12-18 weeks depending on the unit and the particular service you choose.

Typical timing for first antenatal visit

In addition to noting your medical history there is a range of tests that are typically done at a booking visit.

Routinely tested at booking visit

Just under half of the units routinely offer this option.

Feedback from women shows that continuity of carer (seeing same person or small team of people) can make a big difference to their level of satisfaction with their care.

Continuity of carer

If you choose a midwife-led service, where it's available, you will be given approximately 30 minutes per visit. If you choose an obstetric-led service you will be given from 5-20 minutes per visit - this varies from clinic to clinic. Usually a booking visit lasts at least 30 minutes for all clinics.

Approximate length of consultation with carer

Average waiting times and facilities at each clinic:

Other information provided:

Two thirds of the units responded that they 'always' ask mothers how they intend to feed their babies.

Units typically have a range of leaflets available.

Leaflets available

The majority of maternity units offer this but there is a small percentage that don't.

All maternity units provide supports ranging from Early Pregnancy Units to pastoral support to bereavement counselling.

The majority, but not all, units offer a booking scan/first trimester scan from 12-18 weeks of pregnancy. In some units an anomaly scan is offered in the 2nd trimester (18-24 weeks). In others it is available if required. Some, but very few, units routinely scan in the 3rd trimester (28-40 weeks).

The policies on this vary from unit to unit with some units estimating the due date based on the scan and in other units it's determined by the consultant. In others the EDD is only changed if there's more than a 7 or 10 day discrepancy.