Midwife and mum of one Avril Flynn gives her expert advice on maternity care models and what options mothers-to-be have in Ireland today.

One of the questions a lot of people ask as soon as you tell them you are pregnant is “Where are you going?” meaning, "what maternity hospital will you attend to birth your baby?"

While there are some amazing homebirth Midwives working in Ireland and more and more women are choosing a to have their babies at home, the vast majority of mums will give birth in a hospital setting. 

What is slightly less understood is that within that system the difference between being a public patient, a semi-private patient or a fully private patient.

Public Care

If you are a resident of Ireland and become pregnant, you are entitled to free public care. This care is usually called ‘combined care’, whereby your hospital and GP share your care and see you on alternate visits throughout your pregnancy and up to 6 weeks after you give birth.

This is the most usual avenue for mums and means that you don’t have to pay anything.  You will fill out a form with your GP and then get a letter welcoming you on the scheme which is called the “Maternity and Infant Care Scheme”.  You will attend a ‘booking visit’ in the hospital of your choice and you will give birth in that hospital.

What some people aren’t aware of is that within the public care scheme, and depending on which hospital you attend, there are other options which may be available to you. 

If you are considered ‘low risk’ (your risk is based on a number of factors such as age, if you’ve had babies before, family history and medical history) you may be able to attend a Midwifery-Led Unit (MLU), a Midwife-Led Clinic or avail of different schemes such as  Domino Scheme, Community Midwifery or Early Transfer Home Scheme. 

These Midwifery led approaches view pregnancy as a normal life event and women who have used them may feel they get a more personalised and empowering pregnancy and birth experience. 

Unfortunately, in Ireland, we are years behind the likes of the UK and New Zealand where the Midwife Led approach is the norm, but more and more maternity units are taking these on board.

Before you decide on which birth unit you will attend, do some research to see what sort of services they offer.  The differences between maternity units in both their ethos and what they can offer you and your family can be huge. 

For example, if you wish to have a more holistic birth experience you would be well advised to make sure the unit and hospital you attend will be supportive or your wishes. 

It makes me very uncomfortable that in 2019, any woman would not have their birth wishes respected. However, the simple fact is that we have a highly medicalised service in Ireland where woman-centred and individualized care may not be the focus, and remain years behind our counterparts in other countries. 

So ask questions, do your homework and check what each unit can offer you with regards choice.

Semi-Private Care

If you have health insurance, or even if you do not, you may decide to go privately or semi-privately - but what does that actually mean? 

Firstly, contact your insurance company to see exactly what they cover.  While you may be entitled to private care, this generally means that although the cost of your room will be covered, you will still have to pay substantial fees to the consultant you choose.

There is not a guarantee you will get a room, it’s only if there is one available and these allocated on a first-come, first-served basis, you can’t book them in advance! 

Semi-private care costs start at about €1,800. Semi-private rooms may have up to 5 people in them and there can be very little difference between public care and semi-private cover. Make sure you ask exactly what you are getting for the extra money. 

Another really important fact to note, and what may surprise people, is that all labour wards and birth units are public and staffed by the same midwives and care assistants. 

Whether you are public, private, or semi-private, your birth will be aided by the same staff and in the same labour ward or delivery suite as everyone else. There are no private delivery rooms or private delivery midwives.

Private Care

Costs for fully private care start at about €3,000 and can go up as high as €8,500 (depending on which consultant and which hospital you attend).  Clients might rightly assume that for this huge cost, you would be guaranteed that the Consultant employed by you would be at the delivery, but this is often not the case.

Lots of Consultants will ensure they attend each private delivery but not all. It is midwives who are the experts in normal uncomplicated deliveries, and they will be the ones that will care for you while you are in labour and might also be the one that helps you birth your baby.  Some Consultants might only wish to be contacted if there is a problem with labour or birth.  

It is very important that you actually do your own research and shop around to see who is offering what and for what expense. With a huge financial outlay, it’s important that you ask questions such as:

• Are you getting value for your money?
• Will your Consultant actually attend the Delivery?
• If they are unavailable, who will be caring for you?
• Are there any hidden costs, such as if you need extra scans?

I would have loved to have had midwifery-led care when I was pregnant but, due to my complicated gynae and obstetric history, I went privately.  However, I feel I really got great care for the money I spent and had a wonderful experience. 

As a pregnant person, the important thing is empowering yourself with knowledge regarding your different options and making sure whatever care model you opt for; you are happy with it.

For more information on different maternity choices, visit these great resources:

• https://www.hse.ie/eng/services/list/3/maternity/homebirth-services.html
• http://homebirthireland.com
• https://www.hse.ie/eng/services/list/3/maternity/
• https://www2.hse.ie/wellbeing/child-health/antenatal-and-maternity-care-options/private-care.html