The purpose of antenatal care is to promote good physical and mental health throughout the pregnancy and to make sure that all is well with the mother and her baby. It also aims to identify problems early and to treat them appropriately.
The purpose of antenatal care is to promote good physical and mental health throughout the pregnancy and to make sure that all is well with the mother and her baby. It also aims to identify problems early and to treat them appropriately.
The first antenatal (or booking) visit at the hospital can take a few hours as you will meet several healthcare workers. The midwife will talk to you about your medical, surgical, obstetric and family history. You will have an ultrasound scan performed, as well as blood tests. Also, the doctor may carry out a physical examination, which includes checking your heart and lungs.
After you check in with the clerical staff, you will meet your midwife who will talk to you about making a plan for the months ahead. She will ask you questions about:
The midwife will talk to you about health issues such as smoking, alcohol and your diet. She will give you information and advice on eating well in pregnancy and on foods to avoid. She will also talk to you about the options of care available to you during your pregnancy and will give you information on preparing to breastfeed. The midwife will discuss any concerns or worries you may have about your pregnancy and can give you the contact details of other services or organisations that can provide additional help and support.
If you have had a complicated pregnancy in the past, or you have a medical problem, for example high blood pressure, diabetes, or a blood clotting disorder, you will be referred to the appropriate specialist doctor for the duration of your pregnancy.
Your height, weight and blood pressure will be checked as well as your urine to make sure you don’t have any infection. A number of blood screening tests will be done so that treatment, if necessary, can be carried out during your pregnancy to protect you and your baby.
A number of blood tests will be taken at your booking visit. These blood tests will:
Check your haemoglobin level (iron),which is the iron containing oxygen in the red blood cells. The baby will take as much of this iron as it needs from your body. This can often leave the mother anaemic and feeling very tired with no energy. The aim is to keep your haemoglobin level above 10.5.
Check your blood group. There are four types of blood group – A, B, AB or O. For each of the blood groups, there is Rhesus factor – either positive or negative. The rhesus factor is very important in pregnancy because a rhesus negative mother could develop antibodies against the baby’s blood, causing anaemia and jaundice in the baby. For this reason, any woman who has a vaginal bleed or any trauma to her abdomen, such as a blow or a fall, must get their blood group and antibodies checked in the hospital as soon as possible after the event. If rhesus negative, she will be given an injection of Anti-D, which will offer protection to the mother and baby to prevent complications arising in this and future pregnancies. All women who are rhesus negative are also offered an Anti-D injection at 28 weeks.
Check your rubella immunity (German measles). Women are routinely tested to find out if they have immunity to rubella. Most women are immune to rubella due to the MMR vaccination they received as a child. If the blood test shows that you are not immune, you will be advised how best to avoid exposure to rubella during the pregnancy and you should get the vaccine from your GP after your baby is born.
Check for sexually transmitted infections.If your blood test is positive for syphilis, you will be offered treatment by means of injections of penicillin. If left untreated, syphilis can lead to miscarriage and stillbirth. Hepatitis B and C are viral infections that can cause liver disease. If you are Hepatitis B positive, giving your baby immunoglobulin treatment soon after birth and follow-up immunisation in the months ahead can protect it. All women are offered testing for HIV and, if you test positive, you will start on antiretroviral treatment, which reduces the risk of transmitting HIV to your baby.
Check for varicella (chickenpox). If the blood test confirms that you are not immune, you will be advised to avoid direct contact with people who have chickenpox. If you are not immune and you come into direct contact with somebody who has chickenpox, you must contact the hospital, as you may need immunoglobulin to protect your baby.
Check for sickle cell anaemia and thalassaemia.If you are of African or Mediterranean origin, you will be offered a special test to find out if you have sickle cell or thalassaemia trait. Sickle cell and thalassaemia are inherited blood conditions that affect the way oxygen is carried around the body. Healthy people can be carriers of sickle cell or thalassaemia without knowing it and can pass it on to their children. If you have the trait, your partner will be asked to attend the hospital to check his status, since there is a chance that your baby could develop a double dose of the trait and develop the disease.
The results of all these tests can take up to 14 days to complete. If any test needs to be repeated, you will be contacted by phone or letter by the hospital staff. You will not receive notification if the blood tests are normal.
Your urine is checked at every antenatal visit. The two main tests are for protein and glucose (sugar). The most common cause of protein in the urine is an infection in your kidneys or urinary tract. Women are more likely to get infections during pregnancy because all the tubes that make up the urinary system are more relaxed because of pregnancy hormones. Also, the position of the bladder in relation to your womb (uterus) can be a factor. Checking protein levels in late pregnancy is very important, as it can be a sign of the condition called pre-eclampsia.
Glucose in your urine is a concern as it could mean that you are developing pregnancy-related diabetes. If you are found to have glucose in your urine, the midwife will ask you if you were fasting when you gave the sample. If not, she will ask you to return to the hospital the following day with a fasting sample. If this sample is negative for glucose, no action is taken.
If, however, there is still glucose present, the midwife will ask that you have further blood tests to see if you have developed pregnancy-related diabetes. If you have, you will be referred to a specialist team for the remainder of your pregnancy.
Checking and recording your blood pressure at the first visit is important. This first reading is used as a ‘baseline reading’. Every time your blood pressure is checked after that, it is compared to this reading. If your blood pressure rises it could be a sign of pre-eclampsia which needs to be monitored carefully as it could result in the early birth of your baby.
If you are of average height and weight, you can expect to gain about 12 – 16 kg during the pregnancy. The only time that you are weighed is at your first visit, unless you are attending the diabetic or anaesthetic clinics. It is important not to gain too much weight as this can lead to complications during the pregnancy.
However, it is essential that you eat well and stick to a healthy balanced diet made up of carbohydrates, proteins, fats, vitamins and minerals. Your baby is totally dependent on you for its supply of nourishment in order to grow and develop. (See the page – staying healthy during pregnancy).
Women are offered an ultrasound scan at their booking visit. This scan is able to check your dates, the number of babies you are expecting and it will show you the baby’s heart beating. Please contact the fetal medicine department if you require further information on screening tests for chromosomal abnormalities – 01 872 6572.
You will need to have a full bladder for any scan before 15 weeks. Special gel is applied to your tummy and a probe is moved up and down your tummy. Ultrasound uses sound waves to build up a picture of your baby. An image of your baby, the placenta (afterbirth) and the fluid surrounding your baby appears on the screen. The staff member will measure your baby so that we know when your baby is due to be born. This is very important, especially if you don’t know the date of your last period or if you had irregular periods or you have recently come off the pill.
Your partner may accompany you to all your scan appointments but unfortunately children are not allowed. Recording devices are not allowed.
You can usually get a printout picture of your baby at the end of the examination. To keep your picture in good condition, don’t leave it in sunlight for a long period of time and don’t laminate it, as this will cause the picture to fade, losing your precious memories.
All women are offered this detailed ultrasound scan at about 20 weeks to assess the growth and development of their baby and to check for any structural abnormalities. While most women give birth to healthy babies, about 3% will have a major birth defect; usually either a genetic or chromosomal abnormality. Many such abnormalities can be diagnosed or ruled out with the fetal anatomy scan. It is also important to realise that ultrasound scans in pregnancy do not detect problems like cerebral palsy or autism.
Reasons to have this scan include:
This ultrasound scan is very accurate but it cannot diagnose all birth defects. Sometimes, we cannot get clear images of the baby due to the way that your baby may be lying in the womb or because of the mother’s size. If the scan is complete, we would expect to pick up at least:
Some babies with chromosomal abnormalities have signs called ‘soft’ markers. Some such markers increase the risk for a chromosomal abnormality while others are not significant if identified on their own. While some babies with chromosomal abnormalities have these soft markers, it is important to remember that 15% of normal babies have at least one ultrasound soft marker. The only way to diagnose or exclude a chromosomal problem for certain is to have an amniocentesis. If you would prefer not to know about these markers please inform us prior to the scan.
If the scan suggests a problem or an abnormality, you and your partner will be informed. We will arrange for you to meet with a consultant who specialises in fetal medicine as soon as possible or within 2 working days. A full support service will be available for you should any problems be detected, including referral to appropriate specialists. It is important to remember that you will be involved in all decisions regarding the management of your pregnancy.
When you attend for this scan we will tell you about everything that we see, unless you advise us that there are certain things that you don’t want to know about, such as the sex of your baby or markers for chromosome problems. Should you have any questions or concerns please contact the staff in the prenatal diagnosis clinic by phoning 01 872 6572.
The anatomy scan is usually the last scan taken during pregnancy unless you are referred by the medical team for further scans. Ultrasound scans can also be used in late pregnancy to determine if the baby is growing properly and to check the liquor or fluid around your baby. They help to compile a ‘biophysical profile’ of your baby. This profile is a list of things that are checked and given scores by the midwife or doctor to see how well your baby is doing. The things checked and scored include the baby’s muscle tone, breathing, movements and the amount of fluid around the baby. Other reasons for ultrasound scans in late pregnancy are if there is a possibility your waters have broken or to locate the exact position of the placenta. However, towards the end of pregnancy it can be difficult to get a complete picture on the printout, as the baby is now too big.
Having regular check-ups is important for you and your baby.
At around 28 weeks, you may have your haemoglobin (iron level) rechecked. If you are rhesus negative, you will already have received information in the post about your blood group and your antibody level will be assessed and you will be given an injection of Anti-D. It may be necessary to do other specialist blood tests at this stage of the pregnancy, for example, if you develop high blood pressure or a body itch. A glucose tolerance test (GTT) may also be performed around this time – you will receive instructions by post. Always talk to your midwife or doctor if you have any worries. They will be able to advise you and keep you informed of your progress.
If your due date arrives and you have not gone into labour, your pregnancy is now termed ‘post mature’ or simply, overdue. Nearly half of all pregnant women are still pregnant at 40 weeks but most will go into labour in the coming week. You will be seen again in the antenatal clinic at 41 weeks if you still haven’t gone into labour. The doctor will discuss your care plan with you.
If by any chance you can’t make it to an antenatal appointment, please telephone your clinic so that another appointment can be scheduled. Towards the end of the pregnancy, your appointments will be more frequent. In the last few weeks, your GP, midwife or hospital doctor will probably see you on a weekly basis.
Generally, you will start feeling the baby move between 18 – 22 weeks. In the beginning, the movements are very gentle and will become stronger as the baby grows. You should be able to feel your baby kick every day right up to the day of birth.
Every baby’s movements are different and it is very important that you are aware of your own baby’s pattern of movements. If you think your baby’s movements have changed, slowed down or stopped, you should contact the emergency and assessment unit for advice – 1800 522 687. Do not use any hand held monitors or phone apps to check your baby’s heart beat.
The Rotunda provides a number of specialist clinics for pregnant women in order to provide the best care during pregnancy. Consultants and specialist registrars with an interest in the specific pregnancy-related condition run these clinics. They are supported by a midwife who has a wealth of knowledge to offer you during your pregnancy.
The current specialist clinics are:
This clinic is a combined obstetric/cardiac clinic led by Dr Jennifer Donnelly, consultant obstetrician, Dr Kevin Walsh, a heart specialist (cardiologist) from the Mater, anaesthetists who work in the Mater and the Rotunda who have a specific interest in this problem, and Dr Fionnuala Ní Áinle, consultant haematologist. Women with a known heart condition prior to pregnancy are referred to this clinic early in the pregnancy. The cardiac support midwife will arrange appointments for you to attend this service and will link up with the cardiac department in the Mater hospital for any tests you need during the pregnancy.
This is a combined obstetric/diabetic clinic led by Dr Fionnuala Breathnach and Dr Richard Horgan, consultant obstetricians and Dr Maria Byrne, consultant endocrinologist from the Mater hospital. Women with diabetes are asked to attend this clinic from early in their pregnancy. You may need to start taking insulin or, if you are already taking insulin, the dose may need to be adjusted regularly during your pregnancy. Good control of blood sugar levels is essential during pregnancy.
You will have close links with the diabetic midwives, Jackie Edwards and Aileen Fleming throughout your pregnancy as you will need to speak with them every week. You will also be seen by the dietitian. If you have diabetes or had pregnancy related (gestational) diabetes in the past, please contact the support midwife immediately you know you are pregnant to arrange an appointment. She may be contacted by phoning 087 – 683 2477 during office hours.
This service looks after the specific needs of pregnant women who have or are at risk of blood and sexually transmitted bacterial/viral infections.
For example, you would attend the DOVE clinic if:
While attending the DOVE clinic, you will receive care from a multidisciplinary team who will provide individualised care throughout your pregnancy and the birth of your baby. At your clinic visits you will meet Dr Maeve Eogan, consultant obstetrician, the DOVE liaison midwife Mairéad Lawless, and/or the addiction liaison midwife, Justin Gleeson as well as the DOVE clinic social worker. You may also be seen by the consultant in infectious diseases, Dr Jack Lambert or Dr Barry Kelleher, consultant hepatologist (liver specialist). After giving birth, your baby will be reviewed by the paediatrician from the DOVE team, Dr Wendy Ferguson.
It is important that you feel comfortable and can discuss issues openly with the team at the clinic and we hope that attending the clinic is a positive experience for you and your baby. You may contact the DOVE liaison midwife directly by phoning 087 – 415 1478 during office hours.
This service oversees the management of most endocrine conditions during pregnancy and is led by Dr Maria Byrne, consultant endocrinologist from the Mater hospital. However, women with hypothyroidism have their condition managed between their GP and their obstetric team.
Women with epilepsy should book their first visit as early as possible so that they can be referred to Dr Nicola Maher, consultant obstetrician who will care for them during their pregnancy. Epileptic seizures can increase during pregnancy or seizures can reoccur. Your medication may need to be adjusted. A plan to reduce the possibility of seizures during pregnancy and labour will be prepared for you.
This service is for women who have been diagnosed with a blood clot in this pregnancy or at any time in the past. It also provides care for women with a bleeding disorder (or a family history of bleeding disorders). The service is led by Dr Fionnuala Ní Áinle, consultant haematologist and midwife Audrey O’Gorman. You may be referred to this service following the review of your medical and family history at the booking visit.
Consultant anaesthetists and specialist midwives Sinead Corbett and Esther McWilliams provide this service to women who may require additional care or assessment, if an anaesthetic is required. This includes women with particular medical conditions or a musculoskeletal problem. You will be referred for review by your midwife or doctor.
Dr Jennifer Donnelly, Dr Etaoin Kent and Dr Nicola Maher consultant obstetricians and midwife Cathy Elliot provide this service for women with pre-existing medical conditions, which require specialist care during pregnancy. You could be referred to this clinic from your booking visit or by your GP or medical team in a general hospital.
A specialist medical team led by Dr Colm Magee, consultant nephrologist from Beaumont hospital and midwife Joyce Boland provide this service for women with high blood pressure, kidney conditions and urinary tract infections. If you are already attending Beaumont hospital for any of these conditions, you will be transferred to the combined obstetric/medical service early in your pregnancy.
Women with a multiple pregnancy (twins or more) will be referred to this clinic after their booking visit. Dr Ronan Gleeson, consultant obstetrician and midwife Mary Ryan lead this service. As part of your care you will have regular ultrasound scans to check on the growth, position and wellbeing of your babies.
The community midwifery team and Dr Sam Coulter Smith, consultant obstetrician provide this service for women who have had one previous caesarean section. You will be referred to the clinic at your booking visit, provided certain criteria are met. You will be seen between 18 and 20 weeks for a support visit when your previous delivery will be reviewed. You will be given evidenced based information and your options for the birth of this baby will be discussed. You can attend the community midwifery team or the midwives’ clinic in the hospital for your ongoing antenatal care.
This specialist clinic, run by Dr Etaoin Kent, consultant obstetrician, provides care to women who have had a previous preterm birth (before 34 weeks gestation), if they are considered likely to have another preterm birth. You could be referred to this clinic from your booking visit and care is provided in the fetal medicine department.
Women who have had three or more miscarriages in a row are referred to this clinic as soon as a pregnancy is confirmed. The clinic is run by Dr Karen Flood, consultant obstetrician and midwife Patricia Fletcher. They will provide emotional and physical support during the early stages of the pregnancy, before transferring your care to the regular obstetric service.
This service is available to women who are dependent on recreational drugs. The service is led by Dr Maeve Eogan, constant obstetrician, a specialist midwife (Justin Gleeson) and medical social worker. The addiction liaison midwife will also support you on a methadone programme, if it’s needed, during your pregnancy.
This clinic provides care for teenagers up to 17 years of age and to vulnerable young women. The service is led by Dr Geraldine Connolly, consultant obstetrician, Debbie Browne, teenage support midwife and a medical social worker. Age specific antenatal classes are provided by the teenage support midwife, which focus on preparing for labour and on caring for a newborn baby. A postnatal follow-up visit is also provided, with an emphasis on contraception. Teenagers may contact the support midwife directly by phoning 087 – 913 8430 during office hours.
All these clinics take place within the main outpatients department. Appointments are arranged through the clerical staff in the outpatients department or by phoning them at 01 873 0596 or 01 873 0632. Support and advice is available through the emergency and assessment unit outside of clinic working hours.
To ensure that women with support needs, such as reduced hearing, eyesight, movement or speaking skills, have an equal opportunity to benefit from maternity care, a variety of facilities are available, such as:
If you have a support need and you need any help, please ask a member of staff who will be pleased to help. With your permission we can record your specific needs in your healthcare record so that staff are aware of the support you need during your time in the hospital.
The Access Officer in the hospital will work with staff to ensure you can easily access the services you require
Miscarriage or fetal loss is the most common complication of pregnancy and affects on average 20 percent of all pregnancies.
Please come to the clinic with a full bladder to make the ultrasound easier. In some cases the examination or scan findings may be unclear and additional blood tests may also be taken. These test results are usually available within 24 hours and we will contact you with the results and discuss your care with you.
If the bleeding is heavy or your have worsening abdominal pain or pain in your shoulder tip you should attend your GP or the hospital for urgent review. If a miscarriage occurs or you are diagnosed with an ectopic pregnancy (pregnancy outside the womb), the doctor and midwife will explain all the options of care available to you. They will give you information on support and counselling which can help you through this difficult time. If you need to be admitted to hospital, the staff will arrange this as soon as possible.
The early pregnancy assessment unit aims to offer women an appointment at 8 weeks if they have had two previous miscarriages or at 6 weeks if they have had a previous ectopic pregnancy or molar pregnancy. Alternatively an early booking visit for 10 weeks of pregnancy may be arranged.
Clinics are held by appointment on Monday – Friday from 8.00 am until 1.00 pm. You can be referred to the unit by your GP or from the emergency and assessment unit in the hospital. Or, you can simply refer yourself by phoning 01 817 6846. (You must be over six weeks pregnant before you can be seen in the unit.) If the staff can’t take your call, please leave a message giving your name and phone number and they will return your call as soon as possible.
Fetal medicine focuses on the management of high risk pregnancies and includes the assessment of fetal (unborn baby) growth and the diagnosis of fetal abnormality. Fetal medicine can be broadly divided into two branches: prenatal diagnosis and fetal treatment. Prenatal diagnosis is the ability to detect abnormal conditions of the fetus. The most common test used for prenatal diagnosis is ultrasound. Some abnormalities may be identified from additional blood screening or invasive diagnostic tests. Fetal treatment includes a series of interventions performed on the fetus with the aim of achieving fetal wellbeing. These interventions include medical (non-invasive) and surgical procedures.
The prenatal diagnosis clinic (PNDC) provides pregnancy screening, diagnostic testing, intrauterine therapies, and patient support and counselling. We provide a standard of excellence in the field of prenatal diagnosis and fetal medicine for patients from our own catchment area as well as for women referred to the clinic from other centres around the country. Our ultrasound scans are performed to the highest international standards and women are supported by informative and sensitive counselling services. Women and their partners receive personalised care by a team of specialist doctors and midwives.
Non-invasive prenatal testing (NIPT) is a screening test that helps to identify if your baby is likely to have a chromosomal condition, for example, Down syndrome (Trisomy 21), Edward syndrome (Trisomy 18) or Patau syndrome (Trisomy 13). The blood test can be performed from 10 weeks of pregnancy onwards. There is no risk of miscarriage associated with this screening test. The test can be helpful in deciding if an invasive screening test is required to out rule one of the syndromes mentioned above.
This test is not carried out routinely on all pregnant women. It is an ‘opt-in’ service and there is a fee for the screening test. Please contact the department for further information.
Chorionic villus sampling (CVS) is a test where a small sample of tissue is taken from your baby’s placenta, which is tested for chromosomal or genetic abnormalities. The test is performed between 10 weeks + 5 days and 14 weeks gestation. Amniocentesis involves taking a small amount of amniotic fluid from the pregnancy sac around the baby in the womb, which is tested for chromosomal or genetic abnormalities. This test is performed after 16 weeks of pregnancy.
If you have a family history of certain heart conditions or if your baby is suspected of having a heart problem on ultrasound scan you will need to attend the clinic for a fetal cardiac echo (scan) with a fetal medicine consultant. You may then be referred to a special cardiac clinic where you will also meet a paediatric cardiologist. If there is an abnormality they will support and counsel you and will discuss the plan of care which is best for you and your baby.
Sometimes babies do not grow at the appropriate rate for their gestation. If this happens we will need to investigate the cause and monitor your baby more frequently with ultrasound scans during the remainder of your pregnancy.
If you have a twin or triplet pregnancy you will attend a special clinic to monitor your babies’ growth and wellbeing. Sometimes babies share amniotic fluid sacs and placentas, which makes the pregnancy more complicated. However there are some treatments available if complications develop, including fetoscopic laser ablation.
Some babies require treatment while they are still in the womb. These may include intrauterine transfusion, fetoscopic laser ablation, vesicocentesis and cordocentesis. We will provide you with information on any treatments you may require.
While most women give birth to healthy babies, about 3% will have a major birth defect. Most of these result from either a genetic or chromosomal disorder. When this happens we will provide parents with expert personal counselling and support and detailed information so that they can be involved in making decisions about their care. We will support you no matter what decisions you make about your pregnancy.
All the doctors and midwife specialists who work in the fetal medicine centre have had special training in diagnosing abnormalities and in supporting couples who are attending the clinic. They work very closely with the paediatric team, specialist consultants in the paediatric hospitals and with the bereavement support team, where appropriate. Weekly multidisciplinary team meetings are held to discuss patients and assist with planning the management and care for the pregnancy and birth. We will provide you with the contact details and information on the relevant support groups and organisations.
If we know that a baby may be stillborn or may not live for long after birth, parents may also wish to contact a bereavement support organisation when the diagnosis has been made. They provide helpful and important information to help and support parents at the time they are told the sad news that their baby has died or is expected to die shortly after birth.
During your pregnancy you may be asked to attend the day assessment unit (DAU) for additional monitoring and assessment to ensure that all is well with you and your baby. Some women may attend the unit just once, while others may attend regularly during their pregnancy. Attendance at the unit helps to reduce the likelihood of admission to hospital, but sometimes this may still be necessary.
A visit to the unit may take up to 4 hours. (Reduced rates for parking are available in the Parnell Centre Car Park, once your ticket is validated by security staff in the hospital and the ticket is presented to the car park office for payment.)
The assessment may include:
Due to the number of women attending the unit and because of space restrictions, we ask women to please attend the day assessment unit on their own. Children are not allowed in the unit, except for newborn babies. Tea, coffee and some light refreshments are available. For further information, or if you are unable to attend, please contact the unit by phoning 01 817 2524.