Firstly, you need to decide which option of care is right for you (see the options of care section under maternity care). You should then telephone the appropriate department as soon as possible to arrange your first antenatal visit. The staff will record your name, date of birth, address and phone number and allocate you a hospital number. You will be offered an appointment date and time for your ‘booking visit’ when you are 12-14 weeks pregnant. If you have any problems in the meantime such as abdominal pain or vaginal bleeding you should contact your GP or telephone the assessment and emergency unit of the hospital.

This appointment is referred to as your ‘booking visit’. On this visit the midwife will review your history in detail along with your partner. Depending on the care option you have chosen, you may also see a doctor. You will have a physical examination, blood tests and an ultrasound scan to confirm your expected date of delivery and that all is well with your pregnancy. There is no need to fast, but you will need a full bladder for the scan. The blood tests will determine your blood group, your haemoglobin (blood iron) level and what infections you have either had or been vaccinated against. Please allow 2 – 3 hours for this visit. Please see the ‘first antenatal visit’ section under antenatal care for more detailed information.

Please bring your PPS number and your medical card, GNIB card or details of your private health insurance as applicable with you, along with a GP letter if you have one. If you are on any medication please bring it with you. Please register with the reception staff who will take your details and show you to a waiting area. You should not arrive more than 15 minutes before your appointment time.

In uncomplicated pregnancies we recommend that your antenatal care is shared between the hospital staff and your GP. This is known as ‘combined care’. Your first visit in the hospital is generally followed by a visit to your GP at around 20 weeks and a return visit to the hospital staff around 28 weeks. You will be seen more frequently from 28 weeks onwards and weekly by either the hospital staff or your GP as you approach your due date. You will also have additional appointments for your ultrasound scan and where applicable parent education antenatal classes. It is important to attend all your appointments and please contact the hospital if you need to change an appointment.

Bleeding in early pregnancy is treated as a threatened miscarriage. Implantation bleeding can occur as the fertilised egg is implanted in the lining of the womb (uterus). Typically implantation bleeding will happen between a week and a few days before your expected period. If you have bright red blood loss or heavy bleeding or worsening abdominal pain we advise you to contact your GP or telephone the assessment and emergency unit in the hospital for advice.

If you are not able to drink some fluids without vomiting and are unable to eat for 24 hours you should go to your GP and have your urine checked to see if you are becoming dehydrated. If you are showing signs of dehydration your doctor may refer you to the hospital for treatment.

Over-the-counter cough or cold remedies may contain alcohol or other ingredients that should be avoided during pregnancy. You should drink plenty of water and other fluids. If you have a fever (high temperature) that isn’t settling a low dose of paracetamol (500 mg to 1 gram) can be taken to reduce the temperature. Please talk to your pharmacist or GP before taking any medication.

You may have had chickenpox as a child and were unaware of it or have forgotten. It is important that you get your blood checked because if you have not had chickenpox you are at risk of contracting it as you do not have any immunity. You need to contact the assessment and emergency unit in the hospital. If you had a previous pregnancy, we may be able to confirm if you have immunity or not. If not, we will arrange for you to have a blood test taken to check for chickenpox antibodies. If you do not have the antibodies you will be offered the varicella (chickenpox) vaccine to protect you and your baby against the disease. Chickenpox is infectious and children who have chickenpox can transmit the infection from before the spots appear until the spots have crusted over. For this reason we ask you to avoid close contact (being in the same room) with a child or the family of a child who has chickenpox where possible.

The general advice is to avoid contact with most chemicals in early pregnancy but there is no current data linking hair dye with pregnancy complications.

A woman who is expecting her first baby will usually start to feel the baby move between the 18th and 20th week of pregnancy. These movements will initially feel like flutters and later in pregnancy they will become more pronounced and become definite ‘kicks’. On subsequent pregnancies a woman will usually start to feel her baby moving around 16 to 18 weeks. It is very important to be aware of your baby’s movements and you should feel at least 10 movements in 12 hours. You should monitor your baby’s movements from 28 weeks onwards and you can record these on a ‘kick chart’ available from the hospital. If you have concerns that your baby is not moving as much as normal you should go immediately to the assessment and emergency unit in the hospital.

It is quite common to have more vaginal discharge in pregnancy because of the increased oestrogen hormone and greater blood flow to the vaginal area. Healthy vaginal discharge should be clear and white and should not smell unpleasant. If the vaginal discharge is coloured or smells strange or you feel itchy or sore you may have a vaginal infection such as thrush which requires treatment. In this case please attend your GP for review.

The vomiting and diarrhoea caused by a tummy bug will usually pass within 24 – 48 hours so try to take plenty of fluids and rest. However, if you are unable to tolerate fluids and the vomiting or diarrhoea lasts for more than 24 – 48 hours you should contact the assessment and emergency unit in the hospital, by phone. Please do not attend that hospital without prior arrangement as the bug is likely to be highly contagious and can spread very easily to other people.

You should contact the assessment and emergency unit in the hospital by phone for advice. If the bleeding is light or there is vaginal spotting only you may be given an appointment to attend the early pregnancy unit in the hospital where you will be examined and have an ultrasound scan. If the vaginal bleeding is heavy or you have worsening abdominal pains you should attend the assessment and emergency unit in the hospital.

Dental problems are more common in pregnancy. Tell your dentist that you are pregnant and they will assess whether it is appropriate to treat you during pregnancy or not. It is generally advised to avoid amalgam fillings in pregnancy due to the mercury content but your dentist could offer you an alternative. Local anaesthetic to perform dental treatment is used with caution in pregnancy particularly during the first twelve weeks. However, it is very important to visit your dentist at least once during pregnancy.

If you smoke and would like to quit while you are pregnant, we would be delighted to help you. We have a smoking cessation support midwife who will provide you with practical support to help you stop smoking. There are proven benefits to your baby if you stop smoking at any stage during pregnancy. Unfortunately nicotine replacement patches are not considered safe in pregnancy as it is the nicotine that can damage the placenta which is the baby’s life support.

This occurs when the bag of fluid (liquor) surrounding your baby either starts to leak or breaks with a gush. You may feel a slow trickle or have a sudden gush that you cannot control. You should note the time this happens and the colour of the fluid, which is usually clear, slightly straw coloured or it may have a vague tinge of pink. If you think your waters have broken you should phone the assessment and emergency unit in the hospital for advice. If the fluid is green or green/brown in colour or heavily blood stained, you should come into the assessment and emergency unit immediately.

The ‘show’ is a plug of mucous which seals the neck of the womb (cervix) in pregnancy. It comes away when the cervix is starting to soften and open up. The show can be heavily bloodstained, pinky streaked or dark brown stained mucous. There is no need to come to the hospital with a ‘show’ alone but it can indicate that labour is starting. A show is never vaginal bleeding. If you are bleeding come directly to the assessment and emergency unit in the hospital.

Regular painful contractions are the only definite sign that labour has started. These contractions occur when the muscles of the uterus contract and then relax resulting in dilatation of the cervix. Contractions develop into a pattern that increases in strength, intensity and duration over time. You should come into the assessment and emergency unit in the hospital when you are having regular contractions approximately 5 minutes apart lasting 45 – 50 seconds. However, if you are in a lot of pain, live a significant distance from the hospital, have a history of fast labours or need pain relief you are advised to come to the hospital sooner for assessment. In the case of an emergency where urgent medical attention is needed you may need to ring an ambulance.

Please check in at the main reception desk in the hospital and give the staff your details. They will let the midwife in the assessment and emergency unit know that you are here for review. You will then be examined by a midwife and have a tracing done on baby’s heart beat. If you are in established labour we will bring you to the delivery suite. If you are in the early stages of labour we may admit you to the prenatal ward where we can monitor you and your baby until you are in active labour.

Crying is baby’s natural way of communicating. While you were pregnant your baby let you know they were happy with their movement and kicking, now the baby is more vocal and there are many reasons for crying.

As you get to know your baby you will begin to understand their different cries and what each one means. Reasons for crying can include that your baby:

• is hungry or thirsty;
• has a wet or dirty nappy and needs a change;
• has trapped wind or colic;
• is either too hot or too cold;
• is sick or in pain; or
• is lonely and wants a cuddle and some attention.

How to soothe a crying baby

• Pick your baby up and hold them close to your body.
• Talk or sing to your baby and gently massage their back.
• Feed your baby.
• Change their nappy.
• Go for a short walk with your baby.

If your baby continues to cry, ask another member of the family to take over as sometimes the baby can sense if you are under stress. It is best to seek medical advice as soon as possible if:

• you think the baby is in pain;
• the type of crying is unusual;
• the baby is pale
• the baby has a purple or red rash on its body; or
• the baby feels hot.

Remember never shake your baby as this can damage the baby’s body and brain.

Some babies will take to feeding without any problems while others need a little bit of encouragement. Your midwife will guide you on feeding; for most babies we recommend that you feed them when they seem to want it -‘demand feeding’. Small or jaundiced babies may require more frequent feeds.

You will recognise when your baby has had enough because they:

• are happy and active
• sleep well between feeds and
• have wet and dirty nappies.

It is common for babies to lose a small amount of weight in the first few days; however, your baby should return to their birth weight by the time they are two weeks old. The midwife will weigh your baby before you go home from hospital. The public health nurse will also check your baby’s weight when she visits you at home. If you have any concerns about your baby’s weight always ask for advice early from your midwife or doctor.

Trapped wind can give rise to tummy pains and the baby will cry and will not settle after the feed. There are simple techniques that usually work to deal with wind, like holding your baby up against your chest as well as gently massaging the baby’s back. Sometimes walking up and down stairs with your baby held against your or your partner’s chest can help to shift the baby’s trapped wind.

Many babies have milk spots on their nose or face, which usually disappear in a few weeks without treatment. Newborns can develop spots on their bodies as they get used to the outside world. Generally these spots appear for a short time and then disappear. Please consult your midwife, public health nurse or GP if you are concerned about spots on your baby.

Your baby will pass a sticky green-black bowel motion for the first few days. This is called meconium; following this the stools turn yellowish. Formula fed babies commonly pass firmer stools than breastfed babies. However, if you find the baby is constantly passing very runny stools tell the midwife or doctor because a baby can become dehydrated quickly.

The ammonia in urine can irritate the soft skin of a baby’s bottom and could lead to nappy rash. To avoid this becoming a problem, wash your baby’s bottom with warm water at each nappy change even if it is only a wet nappy. Avoid baby wipes in the early days as the perfume and chemicals in them may irritate the baby’s skin.

If you notice your baby’s bottom becoming red then use a small amount of a barrier cream until it improves. Do not use talcum powder on newborn skin.

‘Sticky eyes’ are usually due to a mild eye infection. You can usually solve the problem by gently cleaning the affected eye with a piece of cotton wool dipped in cooled boiled (sterile) water. Use each piece of cotton wool just once and wipe the eyes from the inside (near the nose) to the outside. Sometimes a baby will need an antibiotic depending on the infection.

Young babies frequently bring up some of their feed, which is called ‘posseting’, particularly if they are trying to bring up wind – this is normal. You only need to tell your midwife or doctor if:

• the vomiting is forceful or repeated effortlessly and
• occurs after every feed.

It is normal to have a light discharge that changes throughout the menstrual cycle. It is not normal to have a heavy or smelly vaginal discharge. If you are concerned or think you may have a sexually transmitted infection, please attend your GP who will examine you and do some investigations or refer you to the hospital or a specialist clinic if required.

Period pain is common and is normal. However some women have pain that is severe enough to limit their normal daily activities and their ability to work during their periods. This type of pain is less common. There are several treatment options. They include pain relief, hormonal treatment (including the contraceptive pill or Mirena coil) and, in some cases, surgery. If you have concerns please attend your GP to discuss treatment options and investigations.

Bleeding between periods is not normal but is common. It can be related to hormones or to changes in the neck of your womb or the lining of your womb. If you have bleeding between periods or after intercourse please attend your GP who will examine you. It is also important that you attend regularly for your smear test. Please find more information on the cervical screening programme on their website www.cervicalcheck.ie

Pelvic pain is pain in the lower abdomen or pelvis. Chronic pelvic pain is pain that is present for six months or longer. In some cases the pain can be worse during your periods but it is also present between periods. The cause of the pain can be related to any of the abdominal or pelvic organs, the supporting muscles or ligaments and occasionally psychological stressors. The investigations undertaken will depend on the nature and location of the pain which will be determined after a detailed history and examination. If you have chronic pelvic pain, please attend your GP who will refer you to the hospital if required.

One in five couples will have difficulty getting pregnant and will not be pregnant after one year of unprotected sex. If you are having difficulty getting pregnant please attend your GP who will discuss some first line investigations for you and your partner and will refer you to see one of our specialists in the Rotunda fertility Hub. In the meantime please continue to take your folic acid and vitamin D. If you are on any additional medication please discuss this with your GP before trying for a baby as they may need to be changed. Information for the Rotunda Fertility Hub can be found at www.rotunda.ie/fertility 

You should discuss this with your GP. Many GPs will insert the Mirena coil for you as an outpatient. A vaginal swab will be taken to ensure you have no infection before insertion of the coil. You will then be asked to return to have the Mirena coil inserted sometime during the first seven days of your period. Insertion is usually quick and relatively painless in women who have had a previous vaginal birth. If your GP does not insert the Mirena coil you will be referred to the hospital for a visit where your history will be taken and a prescription for the Mirena will be provided to you to be filled by your pharmacy. An appointment will then be arranged for insertion of the device. A small number of women will need to be admitted for the Mirena to be inserted under general anaesthetic in theatre.

Initially there can be some irregular heavy bleeding following coil insertion which may last up to twelve weeks. However it may take up to 6 months to see the full benefit of the Mirena coil. If the bleeding is heavy or bothersome for longer than twelve weeks you should contact your GP or Gynaecologist.

The pelvic organs including the uterus (womb), bowel and rectum and bladder are held in place by muscles, tissues and ligaments. Prolapse happens when these muscles and ligaments become weakened and as a result the support for the pelvic organs is less. It occurs mainly in women who have had children or chronic lung problems and becomes more common with the onset of the menopause. It is also associated with being overweight.

Treatment will depend on the severity of the prolapse. Mild cases may require pelvic floor exercises and lifestyle changes such as weight loss. More severe cases may require the insertion of a vaginal pessary or ring that helps to keep the prolapsed organ in place. Surgery such as a hysterectomy may eventually be required. If you are concerned that you have a prolapsed womb please attend your GP or your gynaecologist.

There are several options for contraception. They include condoms, the oral contraceptive pill, an intrauterine contraceptive device (for example the Mirena coil) and tubal ligation (where the fallopian tubes are surgically closed). Your choice of contraception depends on your age, medical history and the presence of other gynaecological conditions (such as heavy periods). Your GP will discuss your options with you and provide you with information to help you make the right choice.

Surgical methods of contraception include tubal ligation for women and vasectomy for men. These are permanent and irreversible. There are failure rates with both procedures. We ask all women attending requesting sterilisation that they discuss vasectomy with their partners. This is because tubal ligation for a woman involves a general anaesthetic and surgery while a vasectomy is done under local anaesthetic.

Information on contraception options can be found here www.sexualwellbeing.ie/sexual-health/contraception

When you have a LLETZ procedure to remove cells from the neck of the womb you may have bleeding for a few weeks afterwards, which should become lighter each day. You may have brown spotting for up to 6 weeks after the procedure. There is also a risk of infection so we ask that you not use tampons or have intercourse over this time (LLETZ Information Leaflet). The bleeding should not be heavy and any discharge should not be excessive or offensive. If the bleeding gets heavy or you have any concerns please consult your GP or the colposcopy clinic, as you may have an infection that requires antibiotic treatment.

Please make an appointment to see your GP if your symptoms are making your life very difficult or if you are younger than the average age for the start of the menopause. There are many treatments available which aim to reduce the symptoms of the menopause. Information on Menopause can be found here www.rotunda.ie/menopause-clinic/ 

As sexual violence is a crime you should report it to An Garda Síochána. When you report an assault to An Garda Síochána, a guard will contact the Sexual Assault Treatment Unit (SATU) and a time will be agreed for you to attend for a forensic examination as soon as possible. Ideally the examination should take place within 3 hours of the report. Forensic samples can be taken up to 7 days after an assault but the sooner the better. For legal purposes a member of An Garda Síochána must be present for the examination when the forensic evidence is collected to ensure the chain of evidence is maintained.

Ideally, you should not eat, drink or smoke, have a shower or use the toilet before the examination is carried out, in order to preserve the forensic evidence. If you have any injuries which may need medical treatment you should get these attended to first at your local accident & emergency department before attending SATU. If you are under 18 years of age you must bring a parent or guardian with you, to consent to treatment.

Yes, you should still attend SATU. Patients who choose not to report the assault to An Garda Síochána will receive the same care as those who report to the Gardaí. However, the forensic samples will not be taken and care is provided during normal working hours – Monday to Friday from 9am to 5pm only. An out of hours service is not provided. If you are unsure whether you wish to report the incident to the Gardaí or not, you should contact your Garda Station or the Rape Crisis Centre to discuss your options in more detail.

A member of An Garda Síochána will bring you to SATU where you will be met by a nurse/midwife. She will introduce you to the other members of the team – a forensic examiner and a support worker from Dublin Rape Crisis Centre. The examination involves talking about your medical history and details of the actual assault. A physical examination will then be performed where forensic samples will be taken. All the details will be recorded in your healthcare record. You will then be allowed to shower and change your clothes. We will give you any medication necessary before you leave the unit and we will give you an appointment for follow-up care.

Every patient who attends SATU is offered a sexual health screen. This involves urine, blood tests and swabs being taken to see if you have any sexually transmitted or blood-borne infections, which can then be treated. You will be telephoned with your test results when they are available. You will return to SATU on three occasions to continue your treatment. You will be given the contact details of the people involved in your care so that you can contact them if you have any queries.