The journey
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General Information and Developments

Mid Pregnancy

I plan to breastfeed my baby. How will I be encouraged and informed?

Breastfeeding is widely encouraged, and information is generally provided through discussion at antenatal visits. The benefits of breastfeeding are either explained by a midwife or through leaflets. Sometimes dedicated breastfeeding classes are available. Promoting breastfeeding throughout pregnancy was a key part of the Baby Friendly Health Initiative (BFHI), which all the maternity hospitals participated in (some units had met all the criteria, while others were striving to meet the criteria). Note that after the hospitals reported to us, the HSE withdrew funding for the scheme in 2017; at the time of writing this guide, no alternative has been put in place.

How are mothers informed about, encouraged and supported to breastfeed?:

What if I'm unsure about which way I want to feed my baby?

All units encourage and promote breastfeeding as the biologically normal way to feed babies. However, parents' decisions will be respected in all cases. Some units provide specific help and encouragement for mothers who are unsure in the antenatal period. Not all units answered this question.

Support provided:

What dietary support is available in my maternity unit?

Not all units answered this question. Those that did respond said generally that they encourage healthy eating, at their antenatal clinics, through leaflets and through their antenatal classes. In a few units, women can ask to be referred to a dietician; but in most units, referrals are usually only made for very under- or overweight women or those with diabetes.

Support provided:

Does my maternity unit offer any exercise classes or promote physical activity?

Only about half the units answered this question. Those that did respond said generally that they promote healthy levels of physical activity, at their antenatal clinics, through leaflets and through their antenatal classes. Some mentioned that physiotherapists are involved in antenatal classes, and one unit mentioned referrals to physiotherapists for pelvic girdle pain and other such issues. None mentioned that they provided exercise classes during pregnancy. Only one unit mentioned a postnatal class. Another unit currently has no physiotherapy services for pregnant women due to staff shortages.

Support provided around physical activity:

What tests and checks are routine and which others are available?

There are a wide range of tests that are done routinely in antenatal clinics, and other tests than can be done if required. In general, the units are fairly consistent in which tests are routine and which are offered only when necessary. Notable exceptions to this follow: the glucose tolerance test (GTT) in one unit is offered to all women regardless of need; group B strep (GBS) is tested in one unit at the booking visit, which can have implications for the management of labour; and routine anatomy/anomaly scans are only available in 9 units (see here for more information)

Tests available:

Full blood count (routine):
Iron level (routine):
Blood group (routine):
Antibodies (routine):
Rubella (routine):
Varicella (routine in 10 units):
Hepatitis B (routine):
Syphilis (routine):
Hepatitis C (routine in 10 units):
HIV:
Sickle cell (routine in 3 units but usually only offered based on country of origin/ethnicity):
Thalassaemia (routine in 1 unit but usually only offered based on country of origin/ethnicity):
Glucose tolerance test (non-routine in all units - offered based on history or clinical indications - except one where it is offered to all women):
Additional comment:
Thyroid Function (routine in 2 units but usually only if required):
Liver function (routine in 1 unit but usually only if required):
Urine – dipstick (routine):
Urine – MSSU (midstream specimen of urine) (sometimes tested at booking visit, and if required later in pregnancy):
Additional comment:
Group B strep (non-routine in all units - offered based on history or clinical indications - except one where the booking MSSU is tested for all women):
Additional comment:
Palpation (routine):
Additional comment:
EFM (Electronic Fetal Monitoring) (non-routine):
Additional comment:
Fetal heart rate (other methods) (routine using Pinard stethoscopes or hand-held Doppler monitors):
Anatomy/anomaly scans (routine in only 9 units):
Additional comment:
Triple test (non-routine - referral to larger hospitals if required):
Amniocentesis (generally non-routine, available at maternal request in 2 units - referral to larger hospitals if required):
Chorionic villus sampling (non-routine - referral to larger hospitals if required):

What immunisations are routinely offered to pregnant women and who administers them?

Generally, flu and whooping cough vaccinations are recommended during pregnancy and are administered by your GP.

I'm Rhesus negative. Is any routine treatment necessary?

According to the 2012 Irish national clinical guideline for the use of Anti-D, best practice is to offer Anti-D at 28 weeks of pregnancy to all Rhesus negative mothers to protect this baby and future babies. At the time that the units responded to our survey, 15 units did, 4 units did not and 2 units didn't answer.

Prophylactic Anti-D offered:

If I have additional medical or clinical requirements, what services and supports are available?

Not all units answered for each additional requirement. The majority of units provide specialised clinics or additional supports for the following issues:

Multiple pregnancy (answers included more frequent antenatal appointments at special clinic or high risk clinic, or attend consultant obstetrician; additional scanning; and some units offer specialised antenatal classes):
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Previous Caesarean/VBAC (vaginal birth after caesarean) (answers included information and support, leaflets, some special clinics, some specified consultant care):
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Hypertension/previous PE (pre-eclampsia) (answers included consultant care or high risk clinic, additional testing):
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Assisted conception pregnancy (answers varied from routine care to services in the early pregnancy assessment unit to consultant care):
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Older mothers (answers included consultant care or high risk clinic; one unit offers additional DNA testing and another specified the glucose tolerance test):
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Obese mothers (answers varied from consultant care or high risk clinic, referral to dietician or anaesthetist, glucose tolerance test):
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Diabetes/Gestational Diabetes (most units have special clinics for women with diabetes/gestational diabetes with endocrinologists or specially trained midwives; some units specified the involvement of dietitians):
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Hyperemesis (answers varied from no special support to dietary support to admission for fluids):
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IUGR (intrauterine growth retardation) (answers ranged from consultant care to additional scanning to health and dietary advice):
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Preterm birth risk (answers ranged from additional visits to consultant care to specialised clinics to referral to tertiary units to administration of steroids):
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Stillbirth (answers included bereavement support and/or counselling and consultant care):
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Known fetal anomalies (answers included bereavement support and/or counselling, consultant care, perinatal specialists and neonatal care):
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Other medical conditions (answers included special clinics/high risk clinics, consultant care, referral to tertiary hospitals if necessary and multi-disciplinary teams):
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How does my unit support a woman's mental well-being? What if I have mental health problems antenatally?

Not all units answered these questions. Some units have specialist teams including mental health midwives and/or psychiatrists, others can refer to mental health services, and still others enquire about mental well-being at antenatal visits and can provide additional support if required. Some can offer counselling services; others mentioned listening and giving time to women.

Supports for mental well-being:
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Supports for women experiencing mental health problems:
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If I have social or other additional requirements, what services and supports are available?

Not all units answered for each additional requirement. The majority of units provide specialised clinics or additional supports for the following issues:

Intellectual disabilities (several units specified one-to-one care and/or antenatal classes, others mentioned social worker support, others said they assess each case individually):
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Teenage pregnancy (some units provide special clinics and/or antenatal classes for teenage mothers, others mentioned Tusla, Barnardos or social worker support, others one-to-one care):
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Homelessness / other social issues, including domestic violence (almost all units offer social worker involvement or outside agencies like Tusla to provide support):
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Drug or alcohol abuse (most units offer social worker involvement and some provide specialised care):
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STDs (sexually transmitted diseases) (most units can refer the woman to sexually transmitted infections units, others offer high risk care and agree plans for birth):
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Other special needs (visual / hearing impairment, mobility issues) (generally, needs are assessed on an individual basis;, some units offer one-to-one care, some units have sign language interpreters available):
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Mental health issues or psychiatric disorders (psychiatric services often available either in-house or externally; some units offer social worker involvement or the services of a mental health team):
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Non-English-speaking or English as a 2nd language (most units can access the services of interpreters; some also have information in several languages):
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LGBT parents (very few units answered; no specific supports provided):
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What if I want a second opinion regarding my care?

Most units answered this question indicating that a second opinion would be arranged, although in one instance a written request was required from the woman or her GP.

Second opinion:
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