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Choosing the right maternity care for you

If you’re expecting a baby there’s a whole new world about to open up in front of you. Not just the incredible joy of becoming a mum or dad but also the wave of pregnancy-related information that’s heading towards you in a big swell, just like that lovely bump!

How your baby arrives into the world has a big impact on not just you as parents but also on your baby, so it’s important that you make the right choices for all of you. If you’ve just found out you’re expecting, or even better – you’re trying for a baby – here’s your complete guide to maternity care options in Ireland.

Maternity and Infant Scheme

Every pregnant woman living in Ireland is entitled to maternity care free of charge. It is a combined-care package provided by a GP of your choice and a hospital. It includes all of your antenatal appointments which are shared between the doctor and the hospital, your scan, blood tests etc., the delivery of your baby and two post-natal appointments with your GP at two weeks and six weeks. If you go to your GP to confirm your pregnancy, they will give you the forms to complete at your appointment. You can read more about the scheme here on the HSE website.

Consultant-led care

Consultant-led care is the most widely available form of maternity care in Ireland and also the most popular. This is where your maternity care is provided by an obstetrician in a hospital or a member of his team. No matter where you have your baby, this care option is available to you. Depending on where you live in the country, your health insurance and the hospital you are attending, there may be up to three consultant-led care options available to you.

Private

Private consultant-led care is where you to see an obstetrician of your own choosing in their private rooms for your antenatal appointments and post-natally. When you arrive in the hospital in labour, you will still be under the care of hospital midwives, however, your obstetrician will be informed that you are in labour and hopefully will be there for the delivery. You may be able to avail of a private room after your baby is born if there is one available, but it is not guaranteed. If you have private health insurance, depending on the policy, your hospital stay is usually covered, however you will have to pay a private fee directly to the consultant that will be in addition to your health insurance. This could be anywhere from €1,500 – €6,000 depending on the consultant. Your ultrasound scans and tests may also be subject to a fee.

Many women like the continuity of care and fixed appointment times that they receive from a private consultant. They also like the option of having a private room in the hospital if there’s one available. One thing to be aware of is that research does show that being in the care of a private consultant increases your chances of having a C-section, although further research is required to ascertain the specific reasons for this.

Private consultant-led care is not available in all hospitals so it’s worth checking with your local maternity unit if you’re interested in this service.

Semi-private

Some hospitals around the country, and all of the Dublin maternity hospitals, offer a semi-private maternity care option. This is where you are assigned to an obstetrician’s team in the hospital and you attend the semi-private clinics there. You may see the obstetrician at your appointments but are more likely to see a member of their team. Remember you can always insist on been seen by the obstetrician if you would prefer to. When you arrive at the hospital in labour, you will be attended to by the hospital midwives and be seen by the on-call obstetrician if it is required. Semi-private accommodation may be available to you post-natally but it is not guaranteed. Usually semi-private customers will avail of the Maternity and Infant Scheme and share their care between their GP and the hospital. You’ll generally have your two post-natal visits with your GP if this is the case. Hospitals offering semi-private care options usually run clinics led by specific obstetricians on different days of the week. If you would like to be under the care of a specific consultant, it’s worth checking with the hospital what day their clinic is on and booking in for that one.

It is important to note that you will be required to pay an additional professional fee to the hospital above what your health insurance covers when booking semi-private care. This can be upwards of €1200 so it is certainly worth checking with the hospital in advance. You may also be required to pay for your ultrasound scan but this varies from hospital to hospital and also depends on your health insurance plan.

Another point worth considering is that you don’t have a fixed appointment as a private customer would. In fact some would question the cost benefits of paying for semi-private care considering that your semi-private accommodation is not guaranteed and apart from that it is difficult to see how the service differs from what you would receive as a public customer.

Public

All maternity units in Ireland offer a public consultant-led maternity option. This is when you are under the care of an obstetrician and their team. Again, similar to semi-private care, different obstetricians run clinics on different days of the week so if you are interested in being under the care of a specific consultant, make sure that you know when their clinic is on and book into that.

When you avail of public care, all of your antenatal and post-natal care, your hospital stay and all scans and tests are free of charge. You can share care with the hospital and your GP. When you arrive in hospital in labour you will be attended to by the hospital midwives and the on call obstetrician if required. You will be on a post-natal ward with a number of other mothers and babies after your baby is born. Usually your post-natal checks will be with your GP.

Midwife-led care

There are a number of midwife-led care options in Ireland; however, it is not available nationally and there is very limited space available. Many women like to choose a midwife-led care option because of the more personal level of care you receive, the focus on natural birth, the continuity of care and the community care options. Pain relief options are available under midwife-led care, but if you feel you need an epidural you will be transferred to consultant-led care to avail of this. Midwife-led care is usually only available to low risk women within a defined criteria based on the hospital’s own policy. These criteria can be quite strict so it’s worth doing your research in advance to see if you qualify. Also, don’t be afraid to question the reasons provided for being refused midwife-led care if you feel you should be admitted on the scheme. Because of the limited availability of midwife-led care options, demand far outstrips supply so if you have your heart set on this care model make sure you have the number on speed dial as you pee on the stick! In some units, the midwife-led clinic is completely booked up by the time you’re six weeks pregnant. Other important things to look into before booking your maternity care is whether the  midwife-led clinic is open to semi-private patients. If not, make sure you register as a public patient. You also need to check the geographical catchment area of the scheme.

There is a huge body of research (including this 2013 Cochrane Review) that shows that midwife-led care is the most appropriate model of care for low risk women and leads to considerably fewer interventions. There are a number of different midwife-led care options available.

Midwife-led clinic in the hospital

Some maternity units offer a midwife-led clinic based in the hospital. This is where all of your antenatal care is provided by midwives and you’ll only see the doctor if there are any health concerns. You will deliver your baby attended by hospital midwives and may qualify for an early transfer home if your maternity unit offers that option.

DOMINO

DOMINO care is a midwifery care model where a team of midwives provide your antenatal care in community based clinic, you transfer home usually between 6-12 hours after your baby is born assuming all is well, and the same midwives continue to provide postnatal care in your home for up to 10 days afterwards.

The National Maternity Hospital and the Coombe in Dublin, as well as Wexford General Hospital and Waterford Regional Hospital offer a DOMINO service. Cork University Maternity Hospital has just launched a pilot scheme which will hopefully be expanded in the next couple of years. The Rotunda used to offer a full DOMINO service but no longer do, offering instead community-based antenatal clinics only.

Midwife-led unit

A midwife-led unit or MLU is a unit managed and run by midwives within a hospital. All of your care is provided by the unit including the delivery of your baby. MLUs usually have private spaces with birth pools and other non-drug labour tools. There are only two MLUs in Ireland at the moment – one in Our Lady of Lourdes in Drogheda and one in the Midlands Regional Hospital in Cavan.

Early Transfer Home

Some hospitals offer an Early Transfer Home (ETH) option whereby if all is well with you and your baby, you can leave the hospital within 6-24 hours after the birth of your baby and your care is transferred to the ETH team who will care for you post-natally in your home for up to 10 days afterwards. All the Dublin hospitals offer this option but is dependent on whether you live within a fixed catchment area.  Check with your local hospital if you qualify. Again, some hospitals limit this option to public patients only so check this out too.

Antenatal and post-natal care with a private midwife

A relatively new option available to women is hiring a private midwife to provide your antenatal and post-natal care. You book into your local hospital as normal for the delivery of your baby and you attend there for your scans and blood tests, however your midwife will come to your home for all your antenatal appointments. Following the birth of your baby, you can avail of transferring home early because your midwife will take over your care at home. As with private consultant-led care, there is a cost involved in this option. A number of health insurance policies do cover part if not all payment. This service is currently being offered by a company called Neighbourhood Midwives.

Homebirth

There are two types of homebirth option available in Ireland. The National Maternity Hospital and Waterford Regional Hospital offer a hospital-based homebirth scheme whereby you are under the care of community midwives for your whole pregnancy and post-natally. They come to your home for the delivery of your baby. Both schemes are free and operate under strict low risk and geographical criteria.

The second option is to hire a self-employed community midwife (SECM) to attend you during pregnancy, birth and post-natally. This scheme is provided free by the HSE but is limited by the very small number of midwives available around the country (fewer than 25). Many of the midwives also offer extended packages whereby you can pay for additional antenatal and post-natal appointments above those provided by the HSE scheme. SECMs are in high demand from women who wish to avail of this option so you do need to be very quick off the mark to get booked in as soon as possible.

It is worth noting that the criteria for having a homebirth are in fact less restrictive than that set by the MLUs and some of the other midwife-led schemes in hospitals, so you may qualify for a homebirth where you have been refused midwife-led care elsewhere. Homebirth and midwife-led care options are more than suitable for first time mothers and in fact research would show that these models of care are more appropriate for low risk women than consultant-led care so it’s definitely worth thinking about it if the idea appeals to you.

There’s a huge amount of information in there but where and how you give birth, especially when it’s your first baby, is such an important decision and has a big impact on the rest of your pregnancies and birth options. Do your research and make the best decision for you! Exciting times ahead!

Don’t forget you can get started on the GentleBirth programme as soon as you find out your pregnant, it’s never too early! Pick up your complete box set here and take a look at the 2014 dates for your AlphaBirth GentleBirth workshop.

© Sylda Dwyer, AlphaBirth 2014.  Unauthorised use and/or duplication of this material without express and written permission from the owner is strictly prohibited.
 
This article first appeared on www.parent.ie