dear mum to be, - national maternity hospital, dublin midwives... · dear mum to be, supporting the...

Dear Mum to be,

Supporting The National Maternity Hospital for over

a generation, Medicare Health and Living, a wholly owned

Irish Company, is delighted to sponsor this important

information brochure.

By listening to you and working with leading clinicians,

we recognise the need to resource mums by providing hospital

grade Medela Breast pumps and Obstetric TENS as well as

many other useful products.

Our philosophy to promote natural breastfeeding,

together with our desire to create a range of pre and post

natal holistic therapies led to the birth of Umamma.

Umamma offers Physiotherapy Programmes, Pilates

and Yoga classes and a range of luxurious therapies especially

designed for pregnancy and beyond.

Having made your choice of hospital, let Medicare and

Umamma enhance your pregnancy experience.

Paula and Michael Doherty

I found the Community Midwifery Service really suited my needs; all the

midwives that cared for me were really great both on a professional and

a personal level. Just sorry I wasn’t with you for the other 3!

The National Maternity Hospital (NMH) is situated near the centre of

Dublin city. It is one of the largest maternity hospitals in Western Europe,

where 8,984 women gave birth to 9,143 babies in 2008. In an effort to

encourage a holistic approach in the care of healthy women, having babies,

the NMH offers a range of Community Midwifery Services. “Midwife” means

“with woman”. The care we therefore offer is based on the philosophy that

the birth process is not just a physical act but a profound social and psycho-

logical life event. Our aim is to facilitate informed choice and to foster a

non-interventionist, non-intrusive approach to birth, whenever possible,

within the realms of safe midwifery practice.

As midwives working at NMH we recognise that childbirth is a life-

enhancing event with the anticipation of a normal outcome. Community

Midwifery Care is committed to the right of every woman to have up-to-

date information and be involved in decisions about the welfare of herself

and her baby. Community Midwifery Care includes physical, emotional and

social support as well as health education for the woman and her family.

The Community Midwifery Service includes the following options:

1. Domino

2. Homebirth

3. Early Transfer Home

1

2

WHO CAN AVAIL OF THIS SERVICE?

These services are available to women living in South Dublin, Bray,

and North Wicklow. If you are planning to have your baby in NMH and

you live in the catchment area of the service you may be eligible to join

one of the community midwifery care programmes. This is a public service

and therefore free of charge. Should you require information on any of

the services please call the phone numbers as listed below.

NMH Dublin 01 637 3177 | Wicklow 01 274 4163 | ETH Team 01 637 3276

WHAT OPTIONS ARE THERE?

Domino/ Homebirth Services

This service was first launched in 1999 and up to December 2008,

over 2,945 women have given birth under the care of the community

midwives. Over 250 babies have been born at home. The community

midwives team consists of 14 experienced midwives, working in two

teams, the majority of whom have international midwifery experience.

Continuous education and training in areas such as active birth,

breastfeeding, adult and infant resuscitation, ensure high quality,

evidence based care thereby supporting birth with confidence and

competence. Our team of midwives operate as autonomous accountable

practitioners in accordance with our scope of practice and An Bord

Altranais guidelines (2001). We work closely with our hospital colleagues

and also with the colleges involved in educating midwives.

The term “Domino” means ‘IN’ and ‘OUT’.The service provides care for

women choosing to:

– Avail of Community Midwifery Antenatal

Care, in conjunction with their GP in

pregnancy.

– Give birth to their baby ‘IN’ hospital with a

Community Midwife caring for them.

– Transfer ‘OUT’ home 6 – 12 hours following

the birth, with post natal care at home for

up to 10 days. All this care is provided by

the same team of Community Midwives.

1. Domiciliary:

Community Midwives offer the choice to low risk women to give birth

to your baby at home. Your initial booking visit takes place in a Community

Midwifery Clinic but all subsequent antenatal visits are carried out in your

own home. One of the Community Midwives will support you on the day

or night of your labour and a second Community Midwife will be present

for your baby’s birth. As with the Domino service you will also benefit

from up to 10 days post natal care at home. Should you wish to have a

homebirth please discuss this option with your Community Midwife at

your booking visit.

2. Homebirth Service: (Available in South Dublin Area only)

3

The Early Transfer Home Programme (ETHP), a team of experienced

midwives, began in January 2002 and up to December 2008, 5,450 women

have availed of its service. Many women attend an Obstetrician, in either

the Public/ Semi-Private/ Private clinics. These women can have the

option of ETH, which includes home visits with the community midwife

for 5 days post birth. Women, who may be higher risk in pregnancy and

require obstetric care, may avail of ETH after the birth of their baby.

The ETH catchment area is the same as the DOMINO catchment area.

(See Map, page 24).

The ETH can offer antenatal care in conjunction with your GP. When in

labour, you will be cared for by our Labour Ward Midwives. You then have

the opportunity to go home from the hospital within 36 hours of your

baby’s birth, secure in the knowledge that the ETH midwives will visit you

in your own home up until day 5 offering post natal care and support.

4

3. Early Transfer Home Programme:

Fiona | Community Midwife

WHAT HAPPENS IF PROBLEMS ARISE?

An integral part of practising midwifery is recognising any deviation

from what is deemed to be “normal”. If a problem arises at any stage,

during the pregnancy, in labour or in the post natal period you can be

referred to an obstetrician in the hospital at any time.

Both the Domino/ Homebirth and Early Transfer Home Scheme work

with the support of a multi-disciplinary hospital based teams. Should

complications be identified, responsibility for treatment lies with the

obstetric team; however, the midwives can still provide midwifery care

for you. In a very small number of cases care may need to be transferred

completely to an obstetric team; for example diabetes and multiple births.

Women can also avail of

the wealth of resources and

knowledge provided by other

departments in the NMH

e.g. Dietician, Breast Feeding

Specialist, Medical Social

Worker, Physiotherapy,

Mental Health Professional,

Anaesthetics and Chaplin.

5

DOMINO/ HOMEBIRTH SERVICES

What is the Ethos of the Community Midwifery CareDOMINO/ Homebirth Schemes?

– Community Midwifery Care will be provided in an environment which

is relaxed and homely. This promotes listening, where the dignity,

privacy and individual choice of each woman is respected at all times

– Childbirth is recognised as having the potential to be a life-enhancing

event with anticipation of a normal outcome. Community Midwifery

Care will be delivered in a way which will empower women during

this experience

– We care for women in a holistic manner, where partners or significant

others have the opportunity to participate. We offer care in a way

which is sensitive to the diversity of cultures, education, social and

economic circumstances of the community being served

– Our team of midwives work as autonomous accountable practitioners

in accordance with An Bord Altranais scope of practice and guidelines

– Community Midwives regularly review their case management with

Midwifery colleagues and other members of the Multi-Disciplinary

Team. Some members of the team are qualified and registered as

midwife prescribers which provides efficient personal care.

6

Bernie | Community Midwife

How do I book onto the Programme?

The first step to booking with the team of midwives is to obtain a

Booking Reference Number (BRN) by phoning the Central Booking Office

01 637 3288. On receiving your BRN call our secretary on 01 637 3177.

She will send you a booking history form which will be reviewed by

a team of midwives. Assuming you are eligible for our services,

an appointment will be made for you to meet with one of our midwives.

Women living in Wicklow can ring the Community Midwives in Bray on

01 274 4163.

Your Community Midwifery Care Plan:

The following table

(on page 8) is a guideline

for your antenatal care.

We encourage you to

have combined care with

your GP. This means that

you will see your GP at

every second visit and a

community midwife at all

other visits. The routine antenatal check consists of the midwife/ GP taking

your blood pressure, testing your urine, feeling your abdomen for size and

listening to the baby’s heart beat. At each visit to the Community Midwife

she will listen to any of your concerns and will refer you for further

assessment if necessary. Should you have any problems, between clinic

appointments, you can contact us 24 hours a day, 7 days a week. We run

local clinics in Ballinteer, Dun Laoghaire, Bray, Greystones and Carrickmines.

7

Once your pregnancy is confirmed, phone the NMH for your BRN numberand phone the Community midwifery service for a booking form to be sent to you.

Week Place WHAT TO EXPECT AT EACH VISIT

8 – 14 GP Register with your GP

12 – 14 NMH (midwife) Booking Visit: A midwife will establish abaseline set of observations e.g. bloodpressure and discuss your previoushistory, take bloods and book a scan.

16 GP Routine antenatal checks.

18 – 22 NMH (Fetal Assessment) Ultrasound Scan


29 Midwife Routine antenatal check. Blood tests ifindicated. Book parent craft classes forapprox. week 34 to 36.


32 – 36 ANTENATAL CLASSES.

34 Midwife Routine antenatal checks.

36 GP Routine antenatal checks. Book home visit.

37 HOME Further information on labour and postnatalcare is given and an opportunity to discussyour particular needs or wishes





41+5 NMH Scan and assessment by doctor on dutyis recommended

42 NMH Assessment by doctor on duty to devise aplan for induction of labour OR to re-scanand assess baby’s well being.

8

To see all our products visit our Retail Store Open 6 days a week,or view online

Medicare Health & Living LtdGlencormack Business Park(Beside Avoca Handweavers)KilmacanogueCo Wicklow

T: 01 201 4900 | E: [email protected] | www.medicare.ie

Supporting Pregnancyand BeyondPulsar Tens for Labour Pain Relief

A t Medicare Health & Living we provide the

strongest and the most effective Obstetric

Tens device for labour pain relief as recommended

by the National Maternity Hospital Holles St.

Visit our Retail Store or www.medicare.ie.

We stock high quality, endorsed products for Mum and baby

including Medela Breast Pumps, Respiration Monitors,

My Brest Friend Pillow, Doomoo seat cushions,

GR8X Backpacks and Boob clothing range.

Call us to register for our U Mamma

newsletter, mention this advert, and

you will be entitled to 10% discount

on all retail products and holistic therapies purchased in

store during your pregnancy.*

*Terms and conditions apply; see www.medicare.ie

Birth Preparation

Our Community Midwifery Team will provide you

with information throughout your pregnancy.

We are here to support and guide you

in your decisions. We will arrange for

you and your birthing partner to

attend antenatal classes at approxi-

mately 34 weeks to prepare you for the

labour, birth and post natal period.

We recommend that you prepare your body and mind for the birth of your

baby. This will involve a combination of healthy eating, taking regular

exercise and having adequate relaxation time. We also support you to

become informed regarding your new role as a parent.

We can advise you where to avail of yoga classes, swimming, and other

ways to assist you to prepare for the birth of your baby and on becoming

a new parent. We can also provide you with written information on birth

preparation and on caring for your new infant.

Should you wish to use alternative therapies during your pregnancy or

labour, talk to a recognised trained practitioner or one of the Midwives

at your appointment and they may be able to advise you accordingly.

We have information leaflets on some of the common ailments of pregnancy

like heartburn, oedema and high blood pressure. Should you require any

of these, don’t hesitate to ask one of your Midwives.

10

U Mamma Open Tues – Sat and late Thursday

Glencormack Business Park Visit www.umamma.ie

(Beside Avoca Handweavers)

Kilmacanogue

Co Wicklow

T: 01 201 4900 U Mamma is a Medicare Health and Living Company

PhysiotherapyU Mamma’s chartered physiotherapists specialising in

women’s health, will create a tailor made programme

to help you cope with your body’s natural physical

changes during the pre and post natal period.

ClassesDiscover U Mamma yoga and pilates pre and

post natal classes which will help you prepare

and recover from childbirth.

Holistic SanctuaryU Mamma Sanctuary is dedicated to giving mothers

and mothers-to-be the nurturing experience they

deserve by immersing themselves in our pre and

post natal luxurious therapies. All therapies are

designed to pamper and care for the more specific

needs of pregnancy.

What happens during labour?

When the signs of labour begin contact the Community Midwife for advice.

She may arrange to visit you at home or advise you to come to the hospital.

The Community Midwives will care for you during your labour and the birth

of your baby and all being well you will be able to return home within 6 – 12

hours after the baby is born.

If you are having a homebirth two Midwives will be present for the birth

of your baby. One of the Community Midwives will stay with you for two

hours after your baby is born.

What happens when you go home?

When you go home your

post natal care will be continued

by the Community Midwives

who will visit you for up to

10 days following the birth.

These visits will be scheduled

according to your needs.

We also hold a monthly post

natal support gathering for

mums and babies to get to know each other

and offer each other support and friendship.

12

What happens following discharge?

The Community Midwife will inform the Public Health Nurse (PHN) and GP

that you have been discharged from their care. This will be approximately

10 days after the birth of your baby. The PHN will arrange a visit. Your GP

also offers a 2 and 6 week check up for your baby and a 6 week check up

for mum, as part of the combined care scheme

Mums’ Experiences:

“The professionalism, expertise and knowledge of the community

midwives is outstanding. The scheme allows the pregnant woman get

to know her midwife, which is very important later during her labour.

Every moment during my pregnancy labour/ delivery I felt I was

taken care of in the best possible way”.

“The advice given was always to the point and practical. The main

bonus to me and my family was the antenatal home visits because the

midwives interacted very well with our other two children and

involved them e.g. listening to the heart beat. This was a gradual

introduction to them of their new sibling”

“Overall on this, my third baby, I am extremely pleased with the

professional, capable, efficient, very pleasant service I received from the

community midwives team. This model of care should be promoted more

heavily as the best care plan for all. There was excellent and immediate

attention to all issues raised and quick easy consultations with the medical

team, scans and the physio when required. Appointments outside the

hospital were convenient and very short waiting times. The complete

flexibility of birthing positions was excellent.”

13

“I would recommend that recommendations are made to the

HSE to make this cost effective and women/ family centred

form of care available in other hospitals”.

“The most important factors for me were never having to

wait long for appointments – always quick and efficient

and the telephone support I received post natal”.

“I was able to attend appointments near my own home and

got to know the midwives. The home visits after the births were

great and made me feel confident in my new role as a mother”.

“I had such a wonderful experience I may see you all again in 9 months”.

“I was treated as a person and not just a “MUM” with no name”.

“I had to stay in hospital for 48 hours and I found this very

difficult. My 2 year son was fretting at home for me and my

husband found this difficult. I received great support from the

midwives when I got home with breast feeding”.

“Truly amazing, in fact I find it hard to find

words to describe how wonderful I think you all are”.

“Knowing and trusting the midwife really makes a difference.

The community midwives were fantastic in every possible way.

I cannot speak highly enough about the service”.

14

EARLY TRANSFER HOME SCHEME:

Early Transfer Home (ETH) is a

model of maternity care which

offers women and their babies an

opportunity to leave hospital early,

within 36 hours following birth,

with experienced Community Midwives

visiting them at home up until day 5.

These Community Midwives offer you

and your baby post natal care, support and advice. The Public Health

Nurse will continue to support you after day 5. The team also offer

the option of attending for antenatal care in St. Michael’s Hospital,

Dun Laoghaire. This allows the midwives to provide care throughout

your pregnancy and in the post natal period.

How does the ETH differ from the Domino scheme?

The Domino scheme offers a total package of Community Midwifery

Care from the beginning of pregnancy, during labour and up to 10 days

post natal. By choosing the ETH model the community midwives provide

care during pregnancy and in the days following delivery. Hospital based

midwives provide your care during labour, birth and the immediate

post natal period. All women living in the catchment area, regardless

of whether they have availed of public, semi-private or private care can

avail of this service post natal.

15

ETH cares for women in partnership with the hospital multidisciplinary

team. As a result women who have had a previous complication in

pregnancy, Caesarean Section may book into the hospital and then

request to see the ETH team both ante natal and post natal.

How do I book/ join the scheme?

If you wish to attend the ETH for both antenatal and post natal care the

first step to booking is to obtain a Booking Reference Number (BRN) by

phoning the Central Booking Office 01 637 3288. On receiving your BRN

a booking appointment will be arranged for you in the NMH Outpatients

Department. Following this visit the ETH team of midwives will provide

your care in St. Michaels

Hospital, Dun Laoghaire.

If you choose to avail of

the post natal transfer

home package only, you

can register by calling

01 637 3276 or by asking

the midwife on the post

natal ward following the

birth of your baby.

16

Annemarie | Community Midwife

To see all our products visit our Retail Store Open 6 days a week,or view online

Medicare Health & Living LtdGlencormack Business Park(Beside Avoca Handweavers)KilmacanogueCo Wicklow

T: 01 201 4900 | E: [email protected] | www.medicare.ie

Supporting Breastfeeding

T he Medela Breast Pump

range, as supplied by Medicare

Health & Living, is exclusively used

in the National Maternity

Hospital, Holles St.

The symphony breast pump

shown here, is the first and only

pump with 2-Phase® Expression

Technology. It best replicates a baby's

natural sucking cycle.

Babies change the way they suckle at a mother's breast during breast-

feeding. Initially, they suckle rapidly to stimulate the Milk Ejection Reflex

and induce "let-down". Once the milk starts flowing, the speed of the

baby's sucking decreases for the actual feeding phase. With the unique

combination of a stimulation and expression phase the Symphony sets

the standard in both comfort and efficiency. The Symphony Breast Pump

comes closer to nature than ever! Medela Breast Pumps are exclusively

used by all Irish Maternity Hospitals.

Medela Breast Pumps are available for hire and sale at MedicareHealth & Living Ltd.

Your Community Midwife Care Plan:

We encourage you to do combined care with your GP. This means that

you will see your GP at every second visit and a community midwife at

all other visits. The routine antenatal check consists of the midwife/ GP

taking your blood pressure, testing your urine, feeling your abdomen for

size and listening to the baby’s heart beat. At each visit to the Midwife

she will listen to any of your concerns and will refer you for further

assessment if there are any concerns regarding your well being.

What happens during labour?

You will be cared for by our hospital

based Midwives during labour and

in the immediate post natal period.

The ETH team will be informed by

the Midwives that you wish to

avail of this service if you have

not already registered for it.

What happens when you go home?

When you go home your post natal care will be continued by the

Community Midwives who will visit you up until day 5 following the birth.

These visits will be scheduled according to your needs. As well as monitoring

you and your baby’s general wellbeing the Community Midwives offer

feeding support, and general advice. Once discharged the Public Health

Nurse will visit and your GP also provides a 2 and 6 week check up for your

baby and a 6 week check up for mum as part of the combined care scheme.

18

Holistic SanctuaryU Mamma our unique holistic sanctuary nurtures well-being in pre

and post natal women by providing a range of Ayurvidic inspired therapies.

At U Mamma we appreciate the deep connection between emotional

and physical well-being. Our therapies are specially designed to balance

and harmonise both body and soul during pregnancy and beyond.

Pregnancy is a time of transformation both physically and emotionally

as your unborn baby develops. Experience the power of natural healing to

alleviate muscle pain, overcome sleeping difficulties and relieve fluid

retention. All of our products are organic and 100% natural.

U Mamma Open Tues – Sat and late Thursday

Glencormack Business Park Visit www.umamma.ie

(Beside Avoca Handweavers)

Kilmacanogue

Co Wicklow

T: 01 201 4900 U Mamma is a Medicare Health and Living Company

What are the benefits of the Early Transfer Home Scheme?

– Continuity of care throughout your pregnancy and in the immediate

days post delivery

– Individual timed appointments for your antenatal visits with the

midwives in a community based setting; St Michaels Hospital,

Dun Laoghaire

– Prompt referral for medical opinion if required

– Early transfer home where an experienced midwife can continue to offer

you post natal support and advice in your own home up until day 5

– Excellent breastfeeding success rates.

What are the benefits of Community Midwife Care?

– Designated team of midwives, who offer continuity of care to low risk

women throughout pregnancy, labour and in the post natal period.

– Individual timed appointments for your visits with the midwives in

NMH or in convenient community based settings namely, St Michaels

Hospital Dun Laoghaire, Ballinteer, Carrickmines, Bray and Greystones

Health Centres

– 24 hour back up service where by a member of the Community

Midwifery team can be contacted. We can make prompt and or

immediate referral for medical opinion if required

– Early transfer home where an experienced midwife can continue

to offer you post natal support and advise in your own home

– You may know the midwife at the birth of your baby

– Midwifery led care empowers women to make informed decisions and

to take an active part in their care during this life altering experience.

20

TERMS

Antenatal: This is the period of time from conception through

pregnancy to the onset of labour.

Intrapartum: This is the period of time following the onset of regular

uterine contractions resulting in dilatation (opening) of the neck of the

womb (cervix) to the birth of the baby.

Post natal: This is the period of time following the birth of the baby

and the delivery of the after birth (placenta) incorporating establishment

of feeding techniques and the encouragement of parenting skills.

Community Midwife: Autonomous care provider for healthy women

with uncomplicated pregnancies in the community. They provide support

and guidance ante natal, in labour and in the post natal period.

ROLE OF COMMUNITY MIDWIFE

Antenatal: The Community Midwife provides ongoing assessment,

support and education throughout pregnancy. This encourages awareness

amongst women of their own responsibility and involvement in pregnancy

itself, labour and into parenthood. Ultimately this knowledge boosts a

women’s confidence in her ability to give birth.

21

Labour: Once a woman is established in labour the midwife continually

assesses the wellbeing of both mother and baby. The Community Midwife

assesses the woman to diagnose labour. She recognises normal progress

in labour. She will care and support the woman throughout labour and

assist the woman to give birth to her baby. She encourages the couple

to have an active birth and minimises interventions where possible.

In the event of complications arising, she will liaise with the medical

team. The midwife will be present at the birth of the baby.

Post natal: The midwife provides assistance to new parents while

they get to know their new arrival. Help and assistance is given to

establish feeding, learn parenting skills and boost confidence generally.

The Community midwife also cares for the mother after the birth to

ensure that she is well and recovers normally.

Public Health Nurse: The public health nurse (PHN) is the professional

placed in the community to provide support, information and guidance

on all aspects of the maternal health and caring for your baby. She is

based in the local health centre (HSE) and is accessible, through home

visits and clinics, to all parents, guardians, babies and their families free

of charge. The public health nurse (PHN) as a qualified nurse and with a

Higher Diploma in public health nursing, has expertise in dealing with

maternal health and infant care.

Obstetrician: A doctor that specialises in the care of woman with

complicated or high risk pregnancy.

22

2

1

4

3Cabinteely

Killiney

Ballybrack

Shankill

Little Bray

Bray

Greystones

Kilmacanoge

Enniskerry

Kilpedder

Delgany

Kilcoole

Loughlinstown

Foxrock

Dalkey

Booterstown

Blackrock

Monkstown Dun Laoghaire

Stillorgan

KnocklyonBallyboden

Whitechurch

Churchtown

Rathfarnham

Terenure

Harold’sCross

Dundrum

Kilternan

Stepaside

Sandyford

Ballinteer

Milltown

RanelaghRathmines

RathgarDonnybrook

SandymountIrishtown

BallsbridgeClonskeagh

RingsendJames St.

Sallynoggin

24

Community Care Areas 1, 2, 3 and 4

Images kindly supplied by PhotogenicPublished by www.reddoor.ie

. . . . . . . . . . . . . . . . . . . . . . . ......................................

......

....

... .

. .. . .

. . .. . .

. . . . .. .

The Home Birth Cycle

Register with hospital,Register with hospital,GP, Booking form,GP, Booking form,

Appointment.Appointment.

1st visit history1st visit historyand bloods takenand bloods taken

plus physical exam.plus physical exam.

Scan at 20 – 22Scan at 20 – 22weeksin hospitalweeksin hospital

Antenatal care atAntenatal care athome/ consenthome/ consent

Classes in hospitalClasses in hospitalor home at 32 – 36 weeksor home at 32 – 36 weeks

Sundries and gasesSundries and gasesto home at 36 weeksto home at 36 weeks

Midwives X 2 at the Labourat the Labour

Post natal carePost natal careat home. Informat home. Inform

GP and PHNGP and PHN

Paediatric checkPaediatric checkon Day 2 with GP

or Hospitalor Hospital

Post natalPost natalGet togetherGet together

Register with hospital,GP, Booking form,

Appointment.

1st visit historyand bloods taken

plus physical exam.

Scan at 20 – 22weeks in hospital

Antenatal care athome/ consent

Classes in hospitalor home at 32 – 36 weeks

Sundries and gasesto home at 36 weeks

Midwives X 2 at the Labour

Post natal careat home. Inform

GP and PHN

Paediatric check on Day 2 with GP

or Hospital

Post natalGet together

st

Contact your Community Midwives on the following numbers:

NMH Dublin 01 637 3177Wicklow 01 274 4163ETH Team 01 637 3276

Community Midwifery Services | National Maternity Hospital | Holles St | Dublin 2 | www.nmh.ie

T: 01 201 4900

dear mum to be, - national maternity hospital, dublin midwives... · dear mum to be, supporting the...

Documents