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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
24 GP Routine antenatal checks.
29 Midwife Routine antenatal check. Blood tests ifindicated. Book parent craft classes forapprox. week 34 to 36.
32 GP Routine antenatal checks.
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
38 GP Routine antenatal checks.
39 Midwife Routine antenatal checks.
40 GP Routine antenatal checks.
41 Midwife Routine antenatal checks.
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
23
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
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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