Postnatal Care

How many public, semi-private and private postnatal beds/wards are there in my local maternity unit?

All maternity units have public beds/wards. Only four maternity units (MRH Mullingar, MRH Portlaoise, University Hospital Kerry and Wexford General Hospital) don't have semi-private beds/wards. All units have private rooms for those availing of private care.

Women attending the two midwifery-led units in Cavan and Drogheda have their own en-suite rooms where partners and children are welcome to stay (this is a public service).

I'm going public. Can I pay for a semi-private or private room on the postnatal ward?

Not all units answered this question, but the majority said no. Two units indicated that it is possible (Letterkenny University Hospital and the National Maternity Hospital).

Can my partner stay with me overnight on the postnatal ward?

Partners are generally welcome to stay with mothers all day but not overnight – except in the two midwifery-led units (MLUs) in Cavan and Drogheda. In special circumstances, a woman can be given a private room where her partner can stay overnight to support her.

What is the ratio of midwives to women in the postnatal ward in my maternity unit?

This varies from unit to unit and doesn't appear to depend on whether your care is public, semi-private or 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.

I am rhesus negative; when after my baby's birth is Anti-D available?

This varies from 12 hours to 72 hours but not more. (Most, but not all units also offer Anti-D during pregnancy at 28 weeks.)

What are the options in my local maternity unit for vitamin K for newborn babies?

If you want your baby to receive vitamin K, it is usually given by intramuscular injection in the labour ward (or sometimes the postnatal ward) with your consent. All but one of the units (CUMH) offer an option for oral vitamin K

What routine newborn baby checks and tests are offered in the postnatal ward?

Typically offered are full head-to-toe examinations, hip checks and newborn hearing screening. Metabolic screening is sometimes offered in the maternity unit and sometimes offered in the community. Additional tests are available for jaundice, blood sugars, and others, if required.

Units stated that they generally avoid waking mothers and babies for checks and tests unless medically required.

Who looks after me in the postnatal ward?

For the most part, women in public, semi-private and private care are cared for by midwives on the postnatal ward who the women have not met before. For semi-private and private care, you may also be seen by a doctor/consultant during your stay.

Women attending either of the midwifery-led units in Cavan or Drogheda receive their postnatal care from a small team of midwives that they would have met during pregnancy.

Women using community midwife services/DOMINO services who give birth in hospital typically spend a short time on the postnatal ward. They often opt to go home early, where the midwives who looked after them during pregnancy will continue their care.

What sleeping arrangements are available for me and my baby in the postnatal ward?

All maternity units practice rooming-in (this is where your baby stays with you at all times and sleeps in a cot beside your bed). Exceptions to this are usually if a baby is in the special care unit or if the mother is unwell or temporarily unable to look after her baby. Generally, co-sleeping (baby sleeping in the same bed as the mother) is not encouraged in maternity units, but breastfeeding in bed and time for skin-to-skin contact is encouraged.

I've heard about the benefits of skin-to-skin. How does my unit encourage it?

Skin-to-skin contact with the mother or father is extremely beneficial for all babies in the days and weeks after birth. It is the norm for all mammals; experts often refer to the mother's body as the baby's natural habitat. As well as being great for bonding and calming for your baby, it helps to regulate a baby's temperature, heart rate, breathing and oxygen levels. In particular, skin-to-skin can help prevent or resolve issues such as jaundice or low blood sugars. It is also very helpful in establishing breastfeeding and is recommended in the 2015 HSE National Infant Feeding Policy.

All units promote skin-to-skin contact immediately after birth and also during the mother's stay on the postnatal ward. Some hospitals specifically stated that partners are encouraged to do skin-to-skin in situations where the mother is unable.

Is baby-led feeding practised in my local maternity unit?

Baby-led feeding is where the mother feeds her baby when the baby shows signs of being hungry (such as 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 unless medically indicated. Some units mentioned jaundiced or sleepy babies, and risk of low blood sugars as reasons for mothers to wake their babies for 3-hourly feeds if their babies are not showing feeding cues sooner.

If I am breastfeeding my baby, under what circumstances might it be recommended that my baby be given extra feeds?

The 2015 HSE National Infant Feeding Policy states that newborn infants should not be given any food or drink other than breast milk, unless medically indicated. It recommends to first assess how effective breastfeeding is and to correct any issues before resorting to supplementing. If supplementing is medically indicated, then the mother's own expressed milk is the optimal choice, followed by donor milk. Artificial formula should be given only if the mother's own milk or donor milk are not available.

Low blood sugar in the baby, jaundice and where the baby's weight drops more than 10% are common reasons for recommending additional feeds. Another reason might be where a mother is expressing milk for her baby in special care and a greater volume is required. In addition, some units listed situations where breastfeeding is contraindicated, e.g. HIV positive mother or galactosaemia.

All units stated they "always" seek consent from parents for these additional feeds. The majority of units mentioned cup feeding for giving these extra feeds and other methods are spoon, syringe, bottle or tube.

Due to the risk of nipple confusion in a breastfed baby, best practice is to use methods such as cup, spoon or syringe feeding.

What if my baby has jaundice?

Generally in Irish hospitals, frequent feeding is advised (3 hourly typically) for jaundiced babies, but only two units stated that they encourage skin-to-skin contact, even though it is known to help reduce jaundice. If required, light therapy and extra feeds (of expressed breast milk or formula) would be recommended. In more persistent or higher levels your baby might be offered special care.

What if my baby has low blood sugars?

Generally, units reported that if a baby is suspected of having low blood sugars, a blood sample is taken a short while after a feed. If levels are low, mothers are advised to feed more frequently and/or to supplement with expressed breast milk or formula with follow-up testing. Only two units mentioned skin-to-skin contact to help raise blood sugar levels, even though it has been well established as a helpful practice to raise levels.

What if my baby loses weight?

It is normal for babies to lose weight after birth. The vast majority of babies will regain their birth weight within 10 days to 2 weeks if feeding is going well. Note that IV fluids during labour are known to cause the baby's birth weight to be higher than what it would normally be without the fluids; however, this factor is not usually taken into account when weight loss/gain is assessed.

Most units mentioned that if a baby's weight drops 10% below birth weight, they will make sure feeding is effective and request a paediatric review if necessary. If breastfeeding, mothers are often recommended to give their babies extra feeds after each breastfeed. These feeds are preferably expressed breast milk but can be formula milk. Weights can be reviewed after 24 hours and again as necessary.

The 2015 HSE National Infant Feeding Policy states that newborn infants should not be given any food or drink other than breast milk, unless medically indicated. It recommends to first assess how effective breastfeeding is and to correct any issues before resorting to supplementing.

If there is a delay in my mature breast milk coming in (following a Caesarean birth or for any another reason), what is my local unit's policy?

Most units encourage frequent feeding and expression to increase milk production while the mother's milk changes from the first milk called "colostrum", which is rich in carbohydrates, protein and antibodies, to mature milk (usually around day 3 or 4). Only five units stated that they recommend skin-to-skin contact, even though it is known to be helpful in establishing breastfeeding.

If I experience postnatal pain, how would I be helped to care for and feed my baby?

Just over half the units mentioned offering mothers medication to help manage the pain, and most units stated that there would be extra assistance from midwives, health care assistants or nursery nurses for caring for babies in this situation. Three units specified assistance with correct positioning for breastfeeding.

If I had antibiotics before, during or after birth, how can I help prevent thrush?

A few units specified using probiotics (e.g. probiotic yoghurt), reducing sugar intake and good hygiene as ways to prevent thrush in a mother or baby. Most observe both mother and baby and only treat if necessary. Others inform mothers of the signs of thrush.

Will I be shown how to care for my baby while I'm staying in the postnatal ward?

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. Several units recommend only cleaning when necessary or during bath time, keeping the nappy below the level of the cord and keeping the cord dry. Three units recommend cleaning at every nappy change. Most units recommend only cotton wool and water to clean the cord when necessary. One unit recommends surgical spirits.

All units either show or instruct mothers how to bath their newborn baby. Some units suggest daily bathing, others once a week, others two to three times per week and others suggest only when necessary. Five units recommend daily "topping and tailing", which means cleaning your baby's eyes (as below), around his/her mouth and nose, then face, ears and 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, (in all but one unit) 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 eyes are sticky. 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 c hange their baby's nappy (e.g. cleaning girls from front to back and using cotton wool and water). What the units recommend ranges from changing the nappy when necessary to structured timing of nappy changing, either before or after a feed, or sometimes both. Only one unit recommends a barrier cream such as Vaseline.

Only five units show/tell parents how to swaddle (wrapping in a cloth or blanket) their baby. Seven units do not recommend swaddling. Not all units answered the question.

How to put the baby safely down to sleep is also either shown to you or 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), parents are recommended to put babies lying on their backs to sleep with their feet at the foot end of the cot with no pillows, stuffed toys, cot bumpers and so on. The mattress should be firm with a tightly fitted sheet. Layers on a baby include each layer of clothing and each layer of cellular blankets. It is important that a baby does not become overheated by too many layers. Only two units stated that they give guidance on safe bed sharing for exclusively breastfed babies. Professor James J. McKenna is recognized as the world's leading authority on mother-infant co-sleeping in relationship to breastfeeding and SIDS. Here is a link to his recommendations for safe co-sleeping.

How would I express breast milk if I needed to?

You could express breast milk by hand, and you will be shown how to do this in all units, or you could use breast pumps which are available to use in all units during your postnatal stay. Most hospitals stated that they have free disposable breast pump kits for mothers to use.

If I am formula feeding my baby, will I be shown how to safely make up feeds for my baby?

In almost all units you will be shown how to prepare formula feeds safely, including how to sterilise bottles and teats. Sometimes this is done 1:1 or in small groups of mothers. In some units this is only offered to those who choose to bottle feed and in other units it is available to all mothers. Where there is no demonstration or instruction, mothers receive leaflets. Two units suggest making a feed just before it is required, whereas two units mention storing feeds.

If demonstration or instruction is available, your partner might like to request to attend too.

Safe preparation of artificial milk (formula feeds)

If I choose to formula feed my baby, is formula provided in the postnatal ward?

We asked all maternity units whether formula is distributed to individual mothers at each feed, or if mothers are given enough for the day, or if mothers get it themselves from storage. The responses were quite varied. Each maternity unit has a different practice in this regard, but ALL units provide formula to those who want it. These artificial feeds are usually pre-packaged and ready to use. If a special formula is required, a member of staff prepares the feed in a clean environment.

Whilst on the postnatal ward, if I am hungry in the evening what can I have to eat?

Generally, only drinks and sandwiches/snacks are available during this period. If you want to, you can bring in your own snacks. We asked about whether there are microwave ovens on the wards to prepare food and most units said no. Most of those who said yes also said that they could only be used by staff.

Who can visit me on the postnatal ward and when?

In most units partners are welcome from early morning to late evening, but in some units the visiting time is restricted to ensure quiet rest periods for mothers. If you have other children, they are welcome to visit in all but one unit with your partner, but they are generally limited to particular visiting times. Generally, other family members are also welcome to visit at one or two specified visiting times. Some units operate a card system to restrict the number of visitors to a maximum of two. Children other than the baby's siblings are sometimes welcome to visit.

If I am a smoker, is there a place where I can smoke?

There has been a big change since our last survey of the hospitals when the majority of maternity units had a designated external smoking area. Now only three hospitals report that they have smoking facilities, although it is unclear if all of these are within the hospital grounds as the HSE has a policy of smoke-free hospital campuses.

This is my FIRST baby, how long do I stay on the postnatal ward?

First-time mothers in Irish maternity units stay between 1 and 4 days in hospital after the birth of their baby if they have had a vaginal birth. In most units the typical length of stay is 2-3 days, but others stated 1-2 days or 3-4 days. Only four units specified that the stay was typically longer if the woman were in private/semi-private care, with all other units indicating that the stay was the same for women availing of public, semi-private or private care. If you've had a Caesarean birth, stays of 3-5 days are typical, with up to 6 days mentioned in one unit.

This is NOT my first baby, how long do I stay on the postnatal ward?

If this is your second or subsequent baby, your postnatal stay might be shorter than for your first baby. Stays of only 1 or 2 nights are common after a vaginal birth, but range up to 5 nights after a Caesarean birth. Only four 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 or private care.

What if I want to leave earlier than that?

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 after the birth). These are Wexford DOMINO scheme, University Hospital Galway (within a 3-mile radius of hospital), NMH (Holles Street) (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.

How are postnatal ward staff trained to help me breastfeed?

All units reported a high percentage of midwives that have breastfeeding training. Most units did not report the percentage of doctors who had training, with only four units able to do so. Two units reported that no doctors were trained. Very few units provided information about how other staff are trained to support breastfeeding, but those that did specified health care assistants and nursery nurses.

Are there staff that specialise in supporting breastfeeding in my local unit?

All units except Kerry UH reported having International Board Certified Lactation Consultants (IBCLCs) and/or Clinic Nurse/Midwife Specialists (CMSs) in Lactation in their unit. Some of these staff provide breastfeeding support full-time and others on a part-time basis.

Some units reported that specialised breastfeeding support from a lactation consultant or CMS lactation ranges from 14 hours per week to normal daytime working hours, Monday to Friday. Generally, there seems to be little or no weekend or evening specialised support. In some units, their specially trained staff are not always available to provide breastfeeding support due to other workloads.

What are the breastfeeding rates like in my local maternity unit?

Eight units did not provide figures. Of those that did, initiation rates (that is, breastfeeding soon after birth) ranged from 51% to 76%. Rates of mothers who were exclusively breastfeeding upon leaving the hospitals (on discharge) fell to between 33% and 66% (with one unit reporting rates between 10% and 15%, which might be calculated on a different basis.)

If I would like extra breastfeeding support from voluntary breastfeeding supporters or private lactation consultants, are they welcome to visit me on the postnatal ward?

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

Fewer units reported that they facilitate private lactation consultants visiting mothers.

If I would like my doula to visit me, is she welcome on the postnatal ward?

Eleven units answered this question, with answers ranging from a mother's doula is welcome at any time during the day, to during visiting hours only to by special arrangement.

How might I be screened for risk of postnatal depression?

All units provide supports for women at risk of postnatal depression, and assessment often takes place antenatally. Previous history of postnatal depression is a risk factor and is noted. Midwives observe mothers and can offer referrals to psychiatric liaison nurses or psychiatrists. Units inform public health nurses and GPs. Other units use screening tools to detect mothers at risk.

Whilst still on the postnatal ward, if I wish to discuss my labour, birth and postnatal experiences, what opportunities are available to me?

Only two units did not answer this question. All other units reported providing opportunities to debrief, but some proactively encourage it. Mothers can debrief with the caregivers who attended them or with managers.

How does my unit support women who have had a traumatic birth?

Support is mostly provided in the form of debriefing and sometimes with counselling. Mothers can debrief with the caregivers who attended them or with managers. Some units offer the services of bereavement midwives or mental health midwives. Some units mentioned referrals to the gynaecology clinic if required.

If the postnatal ward was full, where would I be accommodated?

Hospitals are generally able to manage the number of postnatal beds and the number of mothers who are staying or going home. Units have a back-up plan if there is a bed shortage. Women sometimes stay on the labour ward, antenatal ward or other wards until a bed in the postnatal ward becomes available. In other cases, extra beds can be brought in to the postnatal ward.