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

From our survey, it seems that some aspects of care form a common experience for the majority of women.  We have therefore outlined below what you might typically experience going through the Irish maternity services.  Unless otherwise stated the information relates to what to expect with a straightforward pregnancy and birth - obviously complications may alter circumstances.

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Your care and the care of your baby should be based on informed decisions by you (and your partner if applicable).  This means you don't have to comply with hospital policies and practices simply because they're routine.  Nor do you have to agree to any form of treatment / care / feeding method for your baby with which you are unhappy.  This link outlines your rights as a hospital patient and this one explores informed consent and informed refusal in maternity care.

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Antenatal Care

You can book directly with some hospitals or clinics although some units require a letter of referral so you may need to visit your G.P. first.  If your local maternity unit is busy it is advisable to make contact with the hospital early in pregnancy.

At around 12 to 14 weeks you will have your first clinic appointment at the hospital/unit, known as the Booking Clinic.  The usual tests offered at this appointment include blood tests, blood pressure, urine tests and sometimes a weight check.  Ultrasound scans are offered at different times and frequencies in different patterns of care and in different units.  In general there is at least one scan offered early in pregnancy.  At the booking clinic you can inform your carers whether or not you are opting for combined care with your G.P.  (See Choices in Types of Care for more information about who cares for you during your pregnancy.)

Antenatal Classes

Antenatal classes at the hospital may cover some or all of the following topics: Foetal Development; Emotional changes in pregnancy; Exercise in pregnancy; Nutrition in pregnancy; Relaxation; Positions in labour; Breathing techniques; When to go into hospital; Pain Relief; Partner's role in labour; Breastfeeding, Contraception; Pelvic floor care; Baby care and Parenting skills; Postnatal Depression; Birth Plan Preparation.

Some hospitals charge for antenatal classes so do check if that is the case before you book your course and ask whether or not your partner is welcome to attend each class.

Some Health Boards offer antenatal classes in the community or you may choose to attend classes with independent teachers (e.g. Cuidiú-ICT Classes - click here for more information).  Many but not all hospitals are happy for you to visit the labour ward even when you are not attending the hospital classes.

Labour

When you arrive at the hospital in labour you will be met by a midwife who will take you through the admission procedure.  This usually includes noting your account of how labour started, checking your temperature, pulse, blood pressure and urine.  The midwife will offer to feel your abdomen to find out the baby's position and will listen to the baby's heart.  You will probably be offered an internal examination to assess how labour is progressing.  In many hospitals but not all it is still routine practice to monitor the baby’s heart rate using an external electronic (belt) monitor for 20 to 30 minutes soon after arriving at the hospital. Alternatives include offering women intermittent monitoring (using hand-held devices) which is less restrictive in terms of positions and movement.

In most busy units the accomodation in early labour is a communal room with more than one bed.  Your partner/birth companion will be welcome to stay with you but may be asked to leave occasionally when staff are carrying out rounds or procedures.  This is to ensure the privacy of other women in the ward.

For as long as you are comfortable, which may be throughout your entire labour, you will be encouraged to walk.  This is because movement helps you cope with labour and gravity helps to keep your labour progressing when you are upright.  You will have access to a bath or a shower for washing, but very few units have ensuite facilities.

You may have the baby's father as your birth companion or you may choose someone else such as your mother, sister or friend.  Many but not all hospitals restrict you to only one birth companion unless there are special circumstances and prior arrangements have been made.  If you wish to have more than one person with you, for any reason, you should negotiate this with your caregivers before your labour.

Once you are in established labour there may be restrictions in what you eat and drink depending on hospital policy.  Hospitals differ quite a lot in this area.  Policies range from whatever you want, through 'light diet', to 'fluids only' and even to 'ice only' in one unit.  Remember, you don't have to comply with something that doesn't feel right to you. 

You may find that you can manage your labour with the support of your birth companion and the midwife.  They can assist you with changes of position, breathing techniques, massage and psychological support.  Methods of pain relief for labour vary from hospital to hospital but Transcutaneous Electrical Nerve Stimulation (TENS), Entonox (Gas & Air) , Pethidine and Epidural anaesthesia appear to be widely available.  Only a few units offer alternative therapies (e.g. reflexology, acupuncture, homeopathy, hypnotherapy, aromatherapy etc.) or facilitate an alternative therapy practitioner to accompany you.

Researching ways of coping with labour and / or drug-based pain relief during pregnancy will help you to make informed decisions during labour.

Almost all hospitals stated that they facilitate a wide variety of labouring positions.  However, not all of these units had the birthing aids (floor mats, bean bags, birth balls etc.) required to really make this possible.

Birthing pools are available in 2 units for labouring only and 2 more units have pools but are not utilising them yet.  (Birthing pools are available for hire for homebirths.)  Currently babies are not born underwater in Irish hospitals (correct at time of publication).

If your labour is normal you will be offered intermittent monitoring of the baby's heartbeat by Pinard's Stethoscope or Sonicaid. The criteria for continuous monitoring depends on the hospital policy or the individual obstetrician.  However, if you have an epidural, pethidine, or if there is any other condition or complication, continuous electronic monitoring may be recommended.

Many hospitals (but not all) set time limits for each stage of labour (Active Management of Labour).  In order to meet these time limits you may be offered the use of a Syntocinon drip to artificially speed up labour.  You do not have to agree to this.

Birth

You usually give birth in the same single room where you and your birth companion spend the latter part of your labour. Birthing beds are available in some units and many hospitals stated a flexible approach to the position in which a mother gives birth.

Note: the figures given in the paragraphs below are based on data provided by the hospitals.  Not every unit provided figures for all categories and averages were based on those that did respond.  In particular, only about half of the units surveys provided data for first-time mothers.

You are likely to have a normal (spontaneous vaginal) birth.  In 2005 about 60% of women gave birth this way.  The figures for first-time mothers was lower - 46%.  

In 2005 over almost 15% of mothers had an assisted birth by vacuum or forceps.  The figures for first-time mothers is quite a bit higher - just over 27%.

In 2005 over 25% of mothers gave birth via Caesarean Section.  First-time mothers had a higher rate again in this category - 27%.  Your partner usually accompanies you in the operating theatre if the Caesarean Section is under an epidural or spinal anaesthetic, but usually not where a general anaesthetic is used.

You may be surprised to know that the figures above can vary from one unit to another by quite a significant degree.  Click here to see this variation in national comparison tables.

Episiotomies are still very common in some units in Ireland.

After your baby is born you will probably be offered an injection to speed up the delivery of the placenta which necessitates that the cord is cut promptly (Active Management of the third stage of labour).  Some units facilitate natural third stage management (which means that they give the placenta time to come away naturally and the cord is not cut until it stops pulsating).  In some hospitals the father cuts the umbilical cord if he requests to do so.

Skin-to-skin contact has been shown to regulate a baby's breathing and temperature, help get breastfeeding off to a good start and to enhance bonding between mother and baby.  Most units actively encourage it in the hour after birth.  However only 6 units stated that mothers and babies remain together in the recovery room if the birth has been by Caesarean Section.

Hospital policies vary in relation to the administration of Vitamin K for the baby but it is your choice whether your baby receives it by injection (one dose) or orally (three doses) or not at all. 

Postnatal

On the postnatal ward, you will be shown how to bath your baby and change nappies, how to care for the umbilical cord and keep your baby warm.  You will be encouraged to breastfeed and offered support, which will include assistance with early feeds and showing you positions for breastfeeding. (If you choose to formula feed you will be shown how to safely make up and store bottles of formula.  You may choose the brand of formula milk you prefer.)

In most hospitals you can obtain something to eat between your evening meal and breakfast.  In some hospitals a microwave is available for something more substantial to be prepared, which you may need especially if you are breastfeeding.

Usually a physiotherapist will see you on the postnatal ward and give you advice on suitable exercises to assist in postnatal recovery.  (Most hospitals have a Stress Incontinence Programme for those women who have longer-term pelvic floor problems.)

The heel prick test for metabolic disorders (PKU/Guthrie Test) is done on your baby four or five days after birth either in hospital or in the community.  Depending on where you live in the country you may be offered an opportunity to have your baby immunised against tuberculosis with the BCG vaccine in the hospital or in the community. 

Visiting arrangements vary widely and can be found in each unit's policies and practices document.  Generally speaking, partners can visit at any time during the day or evening.

If this is your first baby you can opt to stay in hospital for around three days if you have had a vaginal birth and around five days if you have had a Caesarean birth.  Your stay is typically shorter if you have had a baby before.  Early discharge schemes are available in some units.

At Home

The hospital will notify your local Public Health Nurse of your baby's birth.  She will visit you and your baby within a few days and will be able to offer you support and information.  The Public Health Nurse, many of whom are also qualified midwives, will maintain contact with you throughout your baby's early childhood.

When you leave the hospital your GP will usually have been informed, but you might like to let him/her know you and the baby are home.  The community health care professionals - Public Health Nurse, Area Medical Officer, GP and sometimes a Practice Nurse - offer a number of services to the new mother and her baby, e.g. baby clinics, advice and encouragement with breastfeeding, immunisation.  Voluntary organisations like Cuidiú - Irish Childbirth Trust and La Leche League also provide valuable breastfeeding support.  (Cuidiú runs other acitivities for mothers and babies too - see here for more details of local Cuidiú branches.)

Most hospitals stated that they continue to offer support for up to six weeks after your baby's birth.  This may take the form of: emergency 24-hour mother and baby services, a drop-in baby clinic, breastfeeding clinic or telephone contact person/helpline.

You will have a postnatal check-up when your baby is about six weeks old - done at the hospital or with your GP.  This is done to assess your recovery from the pregnancy and childbirth.  A cervical smear test is available three months after the birth or when breastfeeding has ceased.

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Remember, knowing what to expect doesn't mean you have to accept routine care for you or your baby just because it's routine.  You can make informed decisions about the care you and your baby receive.

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