bump2babe - The Consumer Guide to Maternity Services in Ireland

In March 2016, bump2babe sent a comprehensive survey to the 19 maternity hospitals/units and 2 midwifery-led units in Ireland. Responses were returned between March 2016 and May 2017. Here bump2babe provides you with the opportunity to read the complete survey responses. In some instances, minor modifications were made to the responses (e.g. replacing clinical terms with more user-friendly wording).

The information provided in this Guide is as was provided to us by the maternity hospitals and units but please check with your caregiver to see if there have been any recent changes to services, polices or practices.

Blank spaces indicate no information was provided by the maternity unit.

Unit: Cavan Midwifery Led Unit, Module: Care During Labour & Birth Print Version

Question	Sub Question	Answer
Is there a 24-hour drop in support service or emergency phone number available for women in late pregnancy?	Yes/No	Yes
	Please provide details	Women can access the MLU midwives on 24 hour telephone and bleep system.
Is there a labour assessment or triage room available?	Yes/No	No
	Please provide details including if birth partners/supporters are welcome to stay with mother during assessment	Women are reviewed in MLU. Partner/support person welcome to stay
Please describe the unit procedure for induction of labour		N/A. Women are transferred for consultant review by a consultant for plan of induction before term + 12
Please describe the routine admission procedure (specifically include the routine practice of vaginal examination, ARM and admission trace etc.)		Full Antenatal check. Auscultation of Fetal Heart using hand held doppler or pinards. Women are offered a vaginal examination within 2 hours of admission with regular contractions. No routine ARM.
What happens when a mother declines any or all of the above admissions procedures?		Full discussion to explain the rational of all the procedures preformed
If an admission trace is still part of the unit admission procedure, what plans are there to phase it out?		No admission trace
What happens if a woman presents with contractions, but is assessed as only effacing or in very early labour?		Women who are in the latent phases of labour are offered the opportunity to go home. Alternatively they can stay in the MLU for up to 12 hours. Then if not in active stage of labour are given the option to go home to await events or transfer to Consultant led care
Unit policy/guideline on SROM (spontaneous rupture of membranes) at term with contractions. Please include what women are advised to do.		Women are offered expectant management (wait and see) in hospital or at home or transfer to the consultant led unit. Women are offered IV antibiotics at 18 hours post SROM (spontaneous rupture of membranes) if in established labour. At 24 hours post SROM care is transferred to the CLU due to the recommended need for continuous fetal monitoring.
What is the unit policy/guideline on SROM (spontaneous rupture of membranes) at term with no contractions? Please include what women are advised to do.		Women are offered expectant management (wait and see) in hospital or at home or transfer to the consultant-led Unit for review regarding induction of labour. Women are given an information/advice leaflet regarding monitoring of colour of vaginal loss, fetal movements and thermometer to record 4 hourly temperatures
What are the options for women with no contractions who decline induction of labour for SROM at term?		Women are transferred to Consultant-led care at 08.00 in the morning following 24 hours.
What are the implications for labour management (including induction of labour) for:	Multiples (twins, triplets etc.)	N/a Not booked in MLU
	Women planning a VBAC	N/a Not booked in MLU
	Diabetes/gestational diabetes	N/a Not booked in MLU
	Women who tested positive for Group B Strep during this pregnancy	N/a transferred to Consultant led care
	Women who tested positive for Group B Strep during a previous pregnancy	Not booked in MLU
	Assisted conception pregnancy	Not booked in MLU
	Older mother	Not booked in MLU
	Obese mother	Not booked in MLU
	Baby diagnosed as small	Transferred to Consultant led care
	Baby diagnosed as big	Transferred to Consultant led care
	Breech baby	Transferred to Consultant led care
	OP baby
	Known fetal anomalies	Transferred to Consultant led care
	Pre-eclampsia	Transferred to Consultant led care
	Preterm birth	Transferred to Consultant led care
	Stillbirth	Transferred to Consultant led care
Under what circumstances would a woman's care be transferred to a tertiary centre in late pregnancy or in labour?
Describe the accommodation in early labour (please include the number of each type of room/ward in the description, whether toilets/showers/bath are en-suite and whether birth partners/supporters are welcome to stay with mothers 24/7)	Home from home rooms	2 birthing rooms with en-suite shower rooms for labour, birth and postnatal stay
	Early labour single rooms	As above, 2 birthing rooms with en-suite shower rooms for labour, birth and postnatal stay
	Early labour twin rooms	0
	Early labour 3-4 bed rooms	0
	Communal labour ward, specify no of beds per ward	0
	Other, please specify
Policy/guideline on eating and drinking in early labour (please enter Yes for all that apply)	Mother's choice	Yes
	Light diet	Yes
	Fluids only	Yes
	Ice	Not available
	Nil by Mouth	No
	IV fluids for hydration	No
	Criteria/comments
Midwife:women ratio	In early labour	1:1
	In established labour	1:1
	At birth	2:1
	Please indicate differences that might occur at weekends or on nights.	No difference
Unit policy/guideline on the number of birth partners/supporters for each woman	In early labour	Woman's choice
	In established labour	Woman's choice
	At birth	Woman's choice
Unit procedure on maternal request for more birth partners/supporters than the unit policy/guideline states		Woman's choice
Unit procedure on maternal request for different birth partners/supporters at different times		Woman's choice
Unit policy/guideline on birth plans		Actively encouraged. Women are asked at antenatal appointments about birth preferences.
Criteria used when allocating birthing rooms to mothers		Both birthing rooms are identical. Occasionally a problem may arise whereby rooms are occupied and a woman comes in labour. In this case priority would be given to the labouring woman and the postnatal woman would be given a bed in the public ward if required and not wishing to go home.
Is a midwife or student midwife assigned to each woman in established labour to give one to one care?	Yes/No	Yes
	Additional comment	Not always a student in the MLU but women will be asked to consent for student to be involved in their care if a student midwife is on duty.
Continuity of carer in the midwifery-led unit (alongside)	N/A
	Mothers are attended by the same person they saw antenatally
	Mothers are attended by one of team (8 people or less) that they saw antenatally	Yes
	Mothers are attended by a midwife they may not have met before
	Additional comment
Continuity of carer with community midwives - antenatal and postnatal care provided in woman’s home or at outreach clinic with option for home birth or birth in hospital attended by a Community Midwife.	N/A
	Mothers are attended by the same person they saw antenatally
	Mothers are attended by one of team (8 people or less) that they saw antenatally
	Mothers are attended by a midwife they may not have met before
	Additional comment
Continuity of carer with DOMINO midwives - antenatal and postnatal care provided in woman’s home or at outreach clinic with birth in unit not necessarily attended by DOMINO team midwife.	N/A
	Mothers are attended by the same person they saw antenatally
	Mothers are attended by one of team (8 people or less) that they saw antenatally
	Mothers are attended by a midwife they may not have met before
	Additional comment
Continuity of carer with mothers who attended the public midwives clinic - antenatal care provided by midwives only	N/A
	Mothers are attended by the same person they saw antenatally
	Mothers are attended by one of team (8 people or less) that they saw antenatally
	Mothers are attended by a midwife they may not have met before
	Additional comment
Continuity of carer in other midwifery-led services specified by you in the Questionnaire: Module 2 - Antenatal Care	N/A
	Mothers are attended by the same person they saw antenatally
	Mothers are attended by one of team (8 people or less) that they saw antenatally
	Mothers are attended by a midwife they may not have met before
	Additional comment
Continuity of carer for mothers who attended the public clinic	N/A
	Mothers are attended by the same person they saw antenatally
	Mothers are attended by one of team (8 people or less) that they saw antenatally
	Mothers are attended by a midwife they may not have met before
	Additional comment
Continuity of carer for mothers who attended the semi-private clinic	N/A
	Mothers are attended by the same person they saw antenatally
	Mothers are attended by one of team (8 people or less) that they saw antenatally
	Mothers are attended by a midwife they may not have met before
	Additional comment
Continuity of carer for women who attended the private clinic	N/A
	Mothers are attended by the same person they saw antenatally
	Mothers are attended by one of team (8 people or less) that they saw antenatally
	Mothers are attended by a midwife they may not have met before
	Additional comment
Continuity of carer in other obstetric-led services specified by you in the Questionnaire: Module 2 - Antenatal Care	N/A
	Mothers are attended by the same person they saw antenatally
	Mothers are attended by one of team (8 people or less) that they saw antenatally
	Mothers are attended by a midwife they may not have met before
	Additional comment
Policy/guideline on eating and drinking in established labour (please enter Yes for all that apply)	Mother's choice	Yes
	Light diet	Yes
	Fluids	Yes
	Ice
	Nil by Mouth
	IV fluids for hydration
	Criteria/comments	If had pethidine encouraged not to eat.
Number of labour/birthing rooms in the unit		2
How many of the birthing rooms in the unit have en-suite facilities?	Toilet only
	Shower only
	Bath only
	Toilet and shower/bath	2
	No en suite facilities
	Other
For the rooms without en suites, how accessible are the facilities (proximity/how many)?	Toilet
	Shower
	Bath
Are birthing pools available to women?	Yes, for labouring	Yes
	Yes, for giving birth	No
	No
	If no, are women facilitated to bring their own
Birthing aids available
Bath	Yes/No	Yes. Pool
	Additional comment	Pool
Shower	Yes/No	Yes
	Additional comment
Chairs to straddle	Yes/No	Yes
	Additional comment
Chairs for rocking/reclining	Yes/No	No
	Additional comment
Birth ball	Yes/No	Yes
	Additional comment
Floor mats	Yes/No	Yes
	Additional comment
Beanbags	Yes/No	Yes
	Additional comment
Pillows	Yes/No	Yes
	Additional comment
Peanut ball	Yes/No	No
	Additional comment
Birthing stool	Yes/No	Yes
	Additional comment
Adjustable lighting	Yes/No	Yes
	Additional comment
Privacy (doors closed, knock & wait before entering)	Yes/No	Yes
	Additional comment
Music system	Yes/No	Yes. CDs available or couple can bring their own.
	Additional comment	CDs available or couple can bring their own.
Aromatherapy vaporiser	Yes/No	No
	Additional comment
Other birthing aids, please specify		Pole
Facilitation of non-pharmacological pain relief or coping methods (please add comments where necessary)
TENS	Yes/No	Yes
	Additional comment
Doula as the main birth supporter or as second birth supporter	Yes/No	Yes
	Additional comment	Woman's choice if she wants to bring a Doula.
Acupuncture/Acupressure	Yes/No	Yes
	Additional comment	Midwife cannot get involved as untrained.
Hypnobirthing or Gentlebirthing	Yes/No	Yes
	Additional comment	2 midwives undergoing training
Psychoprophylaxsis (breathing and relaxation)	Yes/No	Yes
	Additional comment
Homoeopathy	Yes/No	Yes
	Additional comment	Midwife cannot get involved as untrained.
Aromatherapy	Yes/No	Yes
	Additional comment	Midwife cannot get involved as untrained.
Hot or cold packs	Yes/No	Yes
	Additional comment	Not provided
Hot towels	Yes/No	Yes
	Additional comment
Massage	Yes/No	Yes
	Additional comment
Other non-pharmacological coping methods - please specify
For non-pharmacological strategies that require a practitioner, does the unit facilitate the practitioner to be present in addition to birth partners/supporters?	Yes/No	Yes
	Additional comment	Woman's choice
Is there a comfortable chair or bed for birth partners/supporters to rest in?		Pull-out sofa bed
Location of toilets for birth partners/supporters (please enter Yes for all that apply)	En-suite	yes
	Toilet on labour ward
	Public toilets off labour ward
	Additional comment
Availability of pharmacological pain relief methods or anaesthesia at various stages of labour and birth (please enter Yes to all that apply)
Nitrous Oxide and Oxygen (Entonox)	Early labour
	1st stage	Yes
	2nd stage	Yes
	3rd stage	Yes
	After birth	Yes
	Additional information
	Indications for use
Mobile epidural	Early labour
	1st stage
	2nd stage
	3rd stage
	After birth
	Additional information including any differences for first-time mothers versus 2nd- and subsequent-time mothers, use of continuous infusion versus single dose plus top ups, OR plans to introduce a mobile epidural	Not available in MLU
	Indications for use
Epidural	Early labour
	1st stage
	2nd stage
	3rd stage
	After birth
	Additional information including any differences for first-time mothers versus 2nd- and subsequent-time mothers, and use of continuous infusion versus single dose plus top ups	Not available in MLU
	Indications for use
Spinal	Early labour
	1st stage
	2nd stage
	3rd stage
	After birth
	Additional information	Not available in MLU
	Indications for use in labour
Combined spinal/epidural	Early labour
	1st stage
	2nd stage
	3rd stage
	After birth
	Additional information including any differences for first-time mothers versus 2nd- and subsequent-time mothers, and use of continuous infusion versus single dose plus top ups	Not available in MLU
	Indications for use
Pethidine	Early labour	Yes
	1st stage	Yes
	2nd stage
	3rd stage
	After birth
	Additional information including any precautions	Cannot use pool for 2 hours post administration
	Indications for use
Diamorphine	Early labour
	1st stage
	2nd stage
	3rd stage
	After birth
	Additional information including any precautions	Not used
	Indications for use
Other pharmacological pain relief available (please specify type and stage administered)
Positions facilitated during labour (please enter Yes to all that apply)
Recumbent	During 1st stage
	During 2nd stage
	Other, please specify
Semi-recumbent	During 1st stage	Yes
	During 2nd stage	Yes
	Other, please specify	Woman' s choice
Left/right lateral	During 1st stage	Yes
	During 2nd stage	Yes
	Other, please specify	Woman' s choice
Upright: all fours - on bed	During 1st stage	Yes
	During 2nd stage	Yes
	Other, please specify	Woman's choice
Upright: all fours - off bed	During 1st stage	Yes
	During 2nd stage	Yes
	Other, please specify	Woman' s choice
Upright: kneeling leaning forward - on bed	During 1st stage	Yes
	During 2nd stage	Yes
	Other, please specify	Woman' s choice
Upright: kneeling leaning forward - off bed	During 1st stage	Yes
	During 2nd stage	Yes
	Other, please specify
Walking	During 1st stage	Yes
	During 2nd stage	Yes
	Other, please specify	Woman' s choice
Standing	During 1st stage	Yes
	During 2nd stage	Yes
	Other, please specify	Woman' s choice
Sitting upright on stool or chair	During 1st stage	Yes
	During 2nd stage	Yes
	Other, please specify	Woman' s choice
High squat	During 1st stage	Yes
	During 2nd stage	Yes
	Other, please specify	Woman' s choice
Supported squat	During 1st stage	Yes
	During 2nd stage	Yes
	Other, please specify	Woman' s choice
Low squat	During 1st stage	Yes
	During 2nd stage	Yes
	Other, please specify	Woman' s choice
Knee - chest	During 1st stage	Yes
	During 2nd stage	Yes
	Other, please specify	Woman' s choice
Pelvic rocking	During 1st stage	Yes
	During 2nd stage	Yes
	Other, please specify	Woman' s choice
Other positions facilitated (please describe)
Are positions used in 1st and 2nd stage of labour documented in the woman's notes?		Yes
What supports are given to a labouring woman who is hoping to avoid using an epidural?		One to on support in labour. Support person present. Well informed about other choices available
What is the unit practice to ensure that the mother and birth partners/supporters receive evidence-based information on the benefits, risks and alternatives (including expectant care or 'watch & wait' approach) of routine and non-routine procedures, in order to obtain informed consent/refusal?		Informed choice always facilitated.
When discussing routine and non-routine procedures with mother and birth partners/supporters, is the likelihood of possible further interventions made clear?	Always	Always
	Mostly
	Sometimes
	Never
	Additional comment
Unit policy/procedure if a mother requests a second opinion during labour		Care can be transferred to the consultant led unit at any time.
Monitoring of fetal well-being
Pinard stethoscope	Used with low-risk women (yes/no)	YES
	Indication for use (low-risk women)
	Used with high-risk women (yes/no)
	Indication for use (high-risk women)
Hand-held Doppler	Used with low-risk women (yes/no)	Yes
	Indication for use (low-risk women)
	Used with high-risk women (yes/no)
	Indication for use (high-risk women)
Cardiotocograph (CTG)	Used with low-risk women (yes/no)	Not in use in MLU
	Indication for use (low-risk women)
	Used with high-risk women (yes/no)
	Indication for use (high-risk women)
Wireless CTG	Used with low-risk women (yes/no)	Not in use in MLU
	Indication for use (low-risk women)
	Used with high-risk women (yes/no)
	Indication for use (high-risk women)
Fetal scalp electrode	Used with low-risk women (yes/no)	Not in use in MLU
	Indication for use (low-risk women)
	Used with high-risk women (yes/no)
	Indication for use (high-risk women)
Fetal blood sampling	Available in the unit? Yes/No	Not in use in MLU
	Used with low-risk women (yes/no)
	Indication for use (low-risk women)
	Used with high-risk women (yes/no)
	Indication for use (high-risk women)
Are the increased risks of instrumental or surgical birth with continuous electronic fetal monitoring explained?	Yes, to low risk women
	Yes, to high risk women
	Only when asked
	No
	Additional comment	Not used in MLU
Assessment of progress in labour
Policy/guideline on frequency of abdominal palpation	First-time mothers	On admission and prior to vaginal examination
	2nd- & subsequent-time mothers	On admission and prior to vaginal examination
Policy/guideline on frequency of vaginal examination	First-time mothers	Within 2 hours of admission to Midwifery Led unit with obvious signs of labour. Re-examine vaginally 4 hours later in the absence of signs of full dilatation. In the absence of strong uterine activity, re- examine 2 hours later
	2nd- & subsequent-time mothers	Within 2 hours of admission to Midwifery Led unit with obvious signs of labour. Re-examine vaginally 4 hours later in the absence of signs of full dilatation. In the absence of strong uterine activity, re- examine 2 hours later and offered 4 hourly
How is progress assessed using maternal indicators? (Please list as many as possible including emotional, physical, psychological and behavioural indicators.)	First-time mothers
	2nd- & subsequent-time mothers
Unit policy/guideline (if any) on length of first stage of labour. (Please give details of when (established) labour is deemed to have started, use of partogram and action lines etc. )		Evidence based guidelines. Where from diagnosis of onset of active labour to full dilatation of the cervix is greater than 12 hours for a first time mum and greater than 7 hours for 2nd and subsequent referral to consultant led care should be made.
Indications for use of antibiotics in labour		Spontaneous rupture of membranes greater 18 hours
Indications for artificial rupture of membranes	First-time mothers	Progress of less than 2cm in 4 hours
	2nd- & subsequent-time mothers	Progress of less than 4cm in 4 hours
	What else can a woman or her caregiver do first or instead?
Indications for use of Syntocinon	First-time mothers	N/A
	2nd- & subsequent-time mothers	N/A
	What else can a woman or her caregiver do first or instead?
Indications for unplanned/emergency caesarean section in the first stage of labour	First-time mothers	N/A
	2nd- & subsequent-time mothers	N/A
	What else can a woman or her caregiver do first or instead?
Unit policy/guideline (if any) on length of second stage of labour for first-time mothers who are not using epidural anaesthesia.		2 hours
Unit policy/guideline (if any) on length of second stage of labour for first-time mothers who are using epidural anaesthesia		N/A
Unit policy/guideline (if any) on length of second stage of labour for second- or subsequent-time mothers who are not using epidural anaesthesia		1 hour
Unit policy/guideline (if any) on length of second stage of labour for second- or subsequent-time mothers who are using epidural anaesthesia		N/A
In the second stage	Self-directed pushing is practiced	Yes
	Caregiver-directed pushing and breath-holding is practiced
	Combination, depending on circumstances
	Additional comment
Indications for episiotomy	First-time mothers	Suspected fetal distress
	2nd- & subsequent-time mothers	Suspected fetal distress
	What else can a woman or her caregiver do first or instead?
Describe measures in place to minimise the use of episiotomies		Information given on perineal massage given at 32 week
Indications for use of forceps (please indicate type usually used)	First-time mothers	N/A
	2nd- & subsequent-time mothers	N/A
	What else can a woman or her caregiver do first or instead?
Indications for use of ventouse (please indicate type of vacuum extractor usually used)	First-time mothers	N/A
	2nd- & subsequent-time mothers	N/A
	What else can a woman or her caregiver do first or instead?
Indications for unplanned/emergency caesarean section in the second stage of labour	First-time mothers	N/A
	2nd- & subsequent-time mothers	N/A
	What else can a woman or her caregiver do first or instead?
Is a physiological (natural) third stage practiced?	Always
	Mostly
	Sometimes
	Never
	At maternal request	Yes
	Additional comment
Is the third stage routinely actively managed? (Please provide indications for use and dosages)	Yes, with Syntocinon
	Yes, with Syntometrine
	No	Woman's choice
	Additional comment	Syntocinon 10iu IM
Unit policy/guideline on delayed (optimal) cord clamping		Woman's choice
Unit policy/guideline in relation to cord cutting (including timing and by whom)		Woman's choice
Under what circumstances must the cord be clamped and cut immediately?		Baby requiring resuscitation
Are beside Resuscitaires available so that babies can be resuscitated with the cord intact and pulsating?		No
Does the unit facilitate the harvesting of cord blood?	Yes/No	No
	Additional comment including under what circumstances this is facilitated
If parents wish to take the placenta home, what do they need to do?		Bring in their own lidded container. Advise the midwife when they arrive in labour.
How is skin-to-skin with mother encouraged?		Facilitated by midwives, women stay in same room following delivery.
In what circumstances is skin-to-skin with mother replaced by skin-to-skin with father/birth partner and how is this facilitated?
Circumstances under which the baby is cleaned and wrapped		If the baby required resuscitation will be dried and wrapped but returned to mum for skin-to-skin when appropriate.
Are mothers encouraged and facilitated to breastfeed their baby when the baby shows signs of readiness (usually within the first hour)?	Always	Yes
	Mostly
	Sometimes
	Rarely
	Never
	Additional comment
Is it the unit policy that babies have their first feed before they leave the birthing room?	Yes, for breastfed babies
	Yes, for formula fed babies
	No
	Additional comment	Stay in the same room postnatally
What tests and checks are performed on the baby soon after birth? (Please indicate which can be done whilst the baby is in the mother's arms/on the mother's chest)		Initial physical examination following birth. Can be done in the mothers arms.
Unit policy/guideline on the mode of birth for women who have had one previous caesarean birth (please include details of any policies/guidelines on induction of labour, monitoring and the length of labour for this group)		Not eligible for MLU care
Given the nationwide rise in caesarean births over the past decade, what strategies are in place to reduce the numbers of caesarean births in the unit? How successful have these strategies been?		Not eligible for MLU care
Unit percentage planned VBAC (Vaginal Birth After Caesarean) rate for 2014 and 2015	2014
	2015
	How is the rate calculated?
Unit policy/guideline on the mode of birth for women who have had two previous caesarean births (please include details of any policies/guidelines on induction of labour, monitoring and the length of labour for this group)		Not eligible for MLU care
Number of planned VBA2C (Vaginal Birth After 2 Caesareans) births for 2014 and 2015	2014
	2015
Are any of the following available to women who wish to have a more ‘natural’ caesarean birth: lowered or see-through drapes, slow emergence of the baby, baby lifted out by mother, optimal cord clamping, parents discovering the baby’s sex etc.?		N/A
How is skin-to-skin with mother encouraged after a caesarean birth?		Not eligible for MLU care
In what circumstances is skin-to-skin with mother replaced by skin-to-skin with father/birth partner after a caesarean birth and how is this facilitated?
Under what circumstances is the cord left to stop pulsating before clamping after a caesarean birth?		N/A
What methods does the unit support for the mother to seed her baby’s microbiome after a caesarean birth?
Circumstances under which the baby is cleaned and wrapped after a caesarean birth		Not eligible for MLU care
Unit policy/guideline on women having their babies with them in the recovery room after a caesarean birth		Not eligible for MLU care
How are mothers who have had a caesarean birth assisted when giving their baby their first feed?		Not eligible for MLU care
Description of the training that staff in the labour ward undergo to promote, support and protect breastfeeding (please list topics, course duration, frequency of updates and specify staff who undergo this training (midwives, obstetricians, anaesthetists, nurses, care assistants etc.)		20 hour breastfeeding course. 2 yearly 1 day refresher. 2 lactation consultants in the MLU.
Percentage of labour ward staff who have been trained this way	Midwives	100%
	Obstetricians
	Anaesthetists
	Nurses
	Care assistants
	Others