Cuidiú-ICT's Consumer Guide to Maternity Services in Ireland

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,  public care,  semi-private care,  private care and  Independent Domiciliary Midwives.

Choosing your carer and maternity unit is an important decision and we hope this Guide helps you.

Midwifery-Led Units

A Midwifery-Led Unit offers you the chance to birth in a homely environment with a midwife you have come to know during your antenatal care.   These units provide healthy women, who don't have 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 birth 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, supportive aids (gym ball, bean bags etc) and Entonox (also known as 'Gas & Air') 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 at home daily if necessary 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 2 Midwifery-Led Units (MLU) in the Republic of Ireland –

• MLU at Cavan General Hospital
• MLU at Our Lady of Lourdes Hospital, Drogheda

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 health centre near the mother.  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 –

• National Maternity Hospital, Dublin (Community Midwives)
• Rotunda Hospital, Dublin (Domino Midwives)
• Waterford Regional Hospital (Community Midwives)
• Wexford General Hospital (Community Midwives)

Combined Care

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 doublecheck with your GP first.  Those GPs that participate are re-imbursed by 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 public, semi-private and private patients.  Some private obstetricians are happy for their clients to make antenatal visits to their GP and may reduce the fee accordingly.

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, BUPA-Ireland, VIVAS) 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 assisted birth or Caesarean Section, 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 for the birth of your baby.

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

Private Care

If you have private antenatal care, you will see your own 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.

The consultant is usually present for the birth of your baby but please note that there can be no guarantee of him/her being at the birth.  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.

Homebirth with Independent Midwives

If you engage an Independent Domiciliary Midwife to attend your home birth, you will see your own experienced midwife at each antenatal visit usually in your own home.  These midwives provide a range of antenatal services and offer continuity of care.  They attend the birth of your baby in your home and visit you daily for about ten days postnatally.   

Women who wish to have a home birth with an Independent (Domiciliary) Midwife need to contact the midwife directly.  The independent midwives assess each woman's suitabilty for homebirth.  In most parts of the country they are paid directly by their clients (except the Cork area).  In some geographical areas grants are available from the health authorities but this varies.  If you have private health insurance a portion of the cost of hiring an independent midwife is covered.

Contact the Home Birth Association (HBA) for further details. The HBA publish an information booklet on organising a homebirth, offer one to one telephone support for those interested in this option and host monthly meetings around the country specifically for those planning a homebirth.

Early Transfer Home Scheme

This is where you receive individualised care from a hospital midwife in the first week of having your baby. Under this scheme, if you have a normal birth and feel well, you leave the hospital about six hours after the birth or, if you give birth at night, the next morning.  You will be offered a full assessment in the hospital to make sure that you are ready for transfer home.  A midwife will visit you in your home every day up to and including day 5. A sixth visit will be made if required.

Some hospitals provide this service even if they don’t have a community/domino scheme; please check with the hospital of your choice to see if they provide the service.

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MAKING YOUR DECISION ABOUT WHO CARES FOR YOU AND YOUR BABY

Most women who opt to give birth in hospital choose the unit that is nearest to their home or the one that is recommended by their GP.  Many women are influenced in their choice by the experiences of family members or friends.

Whilst all maternity hospitals offer a basic range of services for the pregnant woman and the new mother, there are some situations that may make a hospital more or less appropriate for you.  If there is an aspect of particular importance to you, we suggest that you check directly with the hospital concerned.  The physical accommodation of hospitals varies considerably regarding size, comfort, privacy and bathroom facilities.  Perhaps you want to know what the antenatal wards, labour and birthing areas, bathrooms and postnatal wards are like.  Perhaps you would like to know how different hospitals compare on key birth statistics before you make your choice.  You may wish to see what this Guide has to say before you choose where to have your baby and who will care for you both.  You may even decide to go and look around.

The World Health Organisation (WHO) acknowledges that the midwife is the expert in normal birth with extensive professional training and specialist skills to support birth and recognises the midwife as the most appropriate caregiver for women with healthy pregnancies who can anticipate uncomplicated births (WHO, 1997). This is where midwives come into their own as the key providers of care. 

For more on choices in care in childbirth in Ireland click here or if you'd like to read a leaflet about it click here.

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