My Care During Pregnancy and Beyond

All maternity units except one (Mount Carmel) have public beds/wards. 3 maternity units (MRH Mullingar, Kerry GH, Wexford GH) don't have semi-private beds/wards. The two midwifery-led units have birthing suites (complete with birthing pool and ensuite facilities) which double up as postnatal accommodation where women stay after the birth of their baby until they are ready to go home (this is a public service). All others have public, semi-private and private postnatal beds/wards.

This varies from unit to unit and doesn't appear to depend on being public, semi-private and private. The ratio varies from 1:4 to 1:13 in the general postnatal wards and from 1:2 to 2:1 in the midwifery-led units. Units also reported that there are typically more midwives on duty in the early part of the day.

This varies from 4 hours to 72 hours but not more. One unit also offers it during pregnancy at 28 weeks.

With your consent vitamin K is given to newborn babies either by an injection into a muscle or orally. In some units it's given in the birthing room and others in the postnatal ward.

The BCG vaccine (against tuberculosis (TB)) is available in just under half of the maternity units. In some instances the resources have been diverted to other vaccination programmes.

All babies are typically weighed and measured and have a full top to toe examination at least once in the postnatal stay. In most units babies are checked by a paediatrician before discharge.

Women attending either of the midwifery led units in Cavan or Drogheda or community midwife services/DOMINO services where available, will typically have their care from a small team of midwives that they met antenatally.

The vast majority of postnatal care for women in public, semi-private and private care is given by midwives on the postnatal ward that they may not have met before. For semi-private and private care you may be seen by a doctor/consultant at least once before discharge.

All maternity units practice rooming in (this is where your baby stays with you at all times and sleeps in a cot beside/attached to the bed, except in certain medical circumstances). Generally co-sleeping (baby sleeping in same bed as mother) is not encouraged in maternity units but feeding in bed and allowing time for skin-to-skin contact is encouraged.

Less than half the units have a room where babies can be cared for in exceptional circumstances. In most cases this room is used for bathing and demonstrating/teaching baby skills to parents.

Baby-led feeding is where the mother feeds the baby when the baby shows signs of being hungry (hands up to mouth, lip smacking, rooting, and eventually crying). This is also called feeding on demand and applies to both breastfeeding and formula feeding. All units practice baby-led feeding except in certain medical circumstances.

Low blood sugar in the baby, jaundice and where the baby's weight drops more than 10% are common reasons for recommending additional feeds. One unit stated they 'mostly' seek consent from parents for these additional feeds, with all other units stating that they 'always' seek consent.

These feeds can be given by cup, spoon, syringe, bottle or tube. Mothers may be advised that bottle feeding a breastfed baby can make the baby confused about how to feed from the breast.

Most units encourage skin-to-skin contact, frequent feeding and expression to increase milk production.

You would be offered pain relief to help manage the pain and most units stated that there would be extra assistance for caring for babies in this situation.

Frequent feeding is advised (3 hourly typically). If required, light therapy and extra feeds (of expressed milk or formula) would be recommended. In more persistent or higher levels your baby would be offered special care.

Most units highlight the importance of hand washing before and after cleaning your baby.

You'll have the option to be shown, or told how to, look after your baby's umbilical cord whilst on the postnatal ward. Most units recommend cleaning the cord with water and cotton wool (with one unit recommending surgical spirits). A couple of units recommend only cleaning when necessary or during bath time. Some units specified keeping the nappy below the level of the cord.

All units either show or instruct mothers how to bath their newborn baby however some units suggest 'daily' bathing whereas other units are 'once a week' or 'when necessary'. Some units recommend daily 'topping and tailing' which means cleaning your baby’s eyes (as below), around his/her mouth and nose, then face, ears & neck (paying attention to the neck creases where milk and fluff can get trapped using cotton wool balls and cooled boiled water. Then wash the hands and feet and finally ‘tail’ your baby by taking off the nappy and washing his/her bottom.

In addition to bathing your baby you'll be shown how to clean your baby's eyes. The maternity units vary in recommendations on baby eye care from daily cleaning to no cleaning unless necessary. The methods also vary, but the most frequent is to use cooled boiled water and clean cotton wool for each eye and to clean from the bridge of the nose to the outer eye.

Parents are also shown/told how to change their baby's nappy (cleaning girls from front to back). What the units recommended varied from changing the nappy when necessary to structured timing of nappy changing either before or after a feed or sometimes both.

How to put the baby safely down to sleep is also either shown to you, described or you'll be given a leaflet. In order to reduce the risk of SIDS (Sudden Infant Death Syndrome – commonly known as cot death) all babies are put lying on their backs to sleep with their feet at the foot end of the cot and overheating should be avoided.

In most units you will be shown/told how to prepare formula feeds safely including sterilisation of bottles and teats. Sometimes this is done in small groups of mothers who choose to bottle feed. In other instances, leaflets or guides are given.

You could express breast milk by hand and you will be shown how to do this or you could use breast pumps which are available to use in all units.

We asked all maternity units whether formula was distributed to individual mothers at each feed, or enough for the day, or mothers get it themselves from storage. The responses were varied. Each maternity unit has a different practice in this regard but ALL units provide formula to those that want it.

Generally only drinks and sandwiches/snacks are available during this period. If you care to you can bring in your own snacks.

In most units partners are welcome from early morning to late evening but in some units the visiting time is restricted. If you have other children in some cases they are welcome to visit with your partner but they are generally limited to particular visiting times. In the case of other family members generally they are also welcome at one or two specified visiting times. Some units operate a card system to restrict the number of visitors and in other units it's partners and grandparents only.

The majority of maternity units have a smoking area outside the hospital but about a quarter report having no smoking facilities.

First time mothers can opt to stay from 1-4 days. Only 3 units specified that the stay was typically longer if you were in private/semi-private care, with all other units indicating that the stay was the same for women availing of public, semi-private and private care. If you've had a caesarean birth stays of 3-5 days are typical with up to six days mentioned in one unit.

If this is your second (third, fourth, etc.) baby your postnatal stay might be shorter than for your first baby. Only 3 units specified that the stay was typically longer if you were in private/semi-private care, with all other units indicating that the stay was the same for women availing of public, semi-private and private care.

Some units provide Early Transfer Home Schemes (where you are cared for at home with daily visits by hospital midwives, usually up to day 5). These are Wexford DOMINO scheme, University Hospital Galway (within 3 mile radius of hospital), NMH (Holles St) (within catchment area), the midwifery-led units at Cavan and OLOL, the Coombe (WIUH) (within catchment area), the Rotunda (within catchment area, Dublin north of the Liffey), Limerick & Waterford IHCMS.

Other units will request early public health nurse visits for women who want to discharge themselves early.

All units reported a high percentage of midwives that have breastfeeding training. Most units did not report the percentage of doctors who had training. 4 units reported that no doctors were trained and only 3 units reported their percentage.

All units except 2 (Sligo and Letterkenny) reported having either or both Certified Lactation Consultants (IBCLC) or Clinic Nurse/Midwife Specialists in Lactation in their unit.

Responses range from 8 hours per week specialised breastfeeding support to normal working hours Monday to Friday.

Two thirds of the units reported that voluntary breastfeeding supporters are welcome.

Fewer units facilitate private lactation consultants visiting mothers

Maternity units have a backup plan for these situations.

All units provide supports for women at risk and assessment often takes place antenatally. Other units use EPDS (Edinburgh Postnatal Depression Screening) to help them screen for mothers at risk of postnatal depression. (The Edinburgh Postnatal Depression Scale uses a short questionnaire which women fill in themselves. The questions are about how they have felt in the past 7 days. The answers are scored by a health professional who can prompt further investigation & support if necessary.)

All units reported providing opportunities to debrief.

Support is mostly provided in the form of debriefing and sometimes with counselling.