Where should I have my baby? What are the choices?

Going to your GP

Traditionally, women went to the family GP once they found out they were pregnant. From here they were referred onto specialist maternity care providers. However, now women are getting more and more advice and information from the Internet and social media. Some of this advice is useful and pertinent to Ireland and some of it highlights practices that are rarely used here or options that are as yet unavailable in Ireland. Some of the information is very subjective and based on the experiences or opinions of particular individuals. Ideally if you are searching the Internet for information on choices for pregnancy and birth you should try to find sources that are evidenced based. Unfortunately, many clinical practices in the Irish maternity services are NOT evidenced based and this can be confusing for mothers seeking choices that research states are best for them and their babies.

Even after ploughing through all the Internet has to offer, most mothers call to their GP to announce their pregnancy. Please note that under the Maternity and Infant Act visits to your GP that are directly related to pregnancy and the postpartum (6 weeks after your baby is born) are free and must not be charged for. Your GP will probably ask you where you plan to have your baby and offer you a few “choices”. The choices are usually based on whether you have private health insurance as this will determine whether you are entitled to private obstetric care.

Most GPs will logically assume that if you have been paying for health insurance you will probably want to put it to some use for the birth of your baby and so you will be offered “choices” based on what your health insurance can offer you. For most women this will be a referral to a private consultant obstetrician or to a semi-private clinic overseen by a consultant obstetrician in a local maternity hospital. If you have no health insurance you will just be referred to the local maternity hospital. When there is more than one maternity units to choose from, there might be a discussion about the merits of either based on distance or subjective personal opinion.

STOP right there!

There is so much more to choice of where to have your baby than a discussion in your GP’s surgery about your capacity to afford private health insurance. In terms of where to have your baby there is the initial choice as to hospital, home or something in-between.

The vast majority of births in Ireland take place in hospital, either in a dedicated maternity hospital or in the maternity unit of an acute hospital, but some women choose to have their baby at home and others choose a more low-tech approach in which they are cared for primarily by midwives rather than obstetricians.

This brings us onto the key choice, which is not so much about where to have your baby as to whom is going to care for you and your baby. Whilst at first these two statements may seem to be saying the same thing there is a wealth of difference between them, especially in the larger maternity hospitals.

Postcode Lottery

If you live outside Dublin, the chances are that you will only have the choice of one hospital. So there may not be much of a choice in that regard.

If you live in Dublin you have the choice of three Maternity hospitals; the Coombe Women’s and Infants University Hospital, The National Maternity Hospital at Holles St and the Rotunda Hospital. All three hospitals are a tertiary referral centre in terms of NICU and all three. We would suggest that you browse the patient safety statements of all three hospitals and look at the following parameters:

  1. C section rates for first time mothers (nulliparous)
  2. C section rates for mothers who have birthed before (multiparous)
  3. Induction rates
  4. Instrumental delivery rates

Maternity Patient safety statements can be found here

In some areas however even within the one hospital there may be different choice in terms of care pathways, so for example there may be:

Consultant led care (standard care provided by doctors and midwives with a doctor in charge)

Midwifery led care (DOMINO, MLU, Early Transfer Home) where the midwife is the lead carer for a woman and her baby

There may also be different clinics, for example the Rotunda have a VBAC (Vaginal Birth After Caesarean Section) clinic run by a midwifery team. Or there may be different settings, for example The NMH offer a home birth service unlike the other two Dublin maternity hospitals. The NMH also have the highest Breastfeeding initiation rate for 2016, despite not having Baby Friendly Status. The Coombe, unlike the other two hospitals offer the option of labouring and birthing in water, and in early 2017, the Coombe celebrated 100 water births.

All three hospitals offer Early Transfer home where the woman leaves hsopital after 6-24 hours and is cared for at home

OLOL and Cavan General

Not all interesting options are outside Dublin though! These two units have Midwifery Led Units in which low risk women are cared for by midwives and in which there are options of labouring and birthing in water.

What’s available round the country?

Consultant led care: All 19 maternity Units

Private care, semi private care, shared care public care: All 19 maternity units

Midwifery Led care: OLOL and Cavan General

DOMINO with Homebirth: NMH, Wexford,

DOMINO without Homebirth: Waterford, Cork

Community Midwifery antenatal care: Coombe, Rotunda NMH

Early Transfer Home: Coombe, Rotunda, NMH, CUMH,UCHG

Waterbirth: Coombe, Cavan OLOL (by arrangement Portuncula)

Birth pools for labouring and birth: Coombe, Cavan, OLOL

Homebirth: Dublin, Louth, Meath, West Meath, Offaly, Tipperary, Kilkenny, Carlow, Cork, Kerry, Limerick, East Clare, Kildare, Wicklow, Wexford, Waterford, Longford, Roscommon, Monaghan, Cavan, Laoise. Currently unavailable in Donegal, Sligo, Mayo, Galway, West Clare, Leitrim. These services may not be free and may not be provided by the HSE but by private carers, so you may need private health insurance to afford them.

More information on home birth services can be found here www.homebirthireland.com