Pregnancy & Antenatal Care

Pregnancy and birth is a time of enormous change in the life of a mother & her family.

The time before the birth, the antenatal period, is a time when there is a lot of contact with the health services. The experience of pregnancy and birth is enhanced by laying down some good foundations for pregnancy and after the birth, in areas like developing good health habits, breastfeeding and promoting positive mental health.

Good antenatal education and antenatal care is essential for parents to be. Health care services aim to provide person-centred antenatal education and antenatal care, in a manner that is equitable, sensitive, flexible and of high quality.

Your First GP Visit
If you think you are pregnant, the first step is to visit your GP as soon as possible. Your GP will then refer you to the hospital. Visiting your GP promptly will help to make sure you receive antenatal care that takes into account all your health needs and preferences.

At this first GP visit, you will be given information about:
• Folic acid and vitamin D supplements
• Nutrition, Diet and Food hygiene
• Lifestyle factors that may affect your health or the health of your baby, such as smoking, drinking alcohol and drug use
• Antenatal screening tests

Your GP will use the date of your last monthly period (LMP) to estimate the date the baby is due (EDD). He/she will then discuss your health needs, and the GP will complete a ‘letter of referral’ to the maternity hospital.
During this first visit the GP will give you information on keeping healthy, and ask whether you have had any previous health or pregnancy issues, such as complications in pregnancy.

It’s important to tell your midwife or doctor if:
• You’ve had any complications or infections in a previous pregnancy or delivery, such as pre-eclampsia or premature birth.
• You’re being treated for a chronic disease, such as diabetes or high blood pressure.
• You or anyone in your family have previously had a baby with an abnormality, such as spina bifida.
• There’s a family history of an inherited disease, such as sickle cell or cystic fibrosis.

What is Antenatal Care?
Antenatal care is the care and support given to pregnant women by Midwives, Obstetricians, and GP Practices. The Irish health system provides antenatal care for all women under the Maternity and Infant Care Scheme, which is a system of combined care, the GP and the hospital Obstetrician (a doctor who specialises in pregnancy and birth) will take shared responsibility for your maternity care. This means that the GP, Obstetrician and a team of midwives will all see you during your pregnancy.
The Antenatal care you receive from the healthcare professionals during your pregnancy will be provided in a series of appointments with the GP practice, the hospital antenatal clinic and the hospital Fetal Assessment Unit.(FAU)
Alternatively, you may opt for services as a private patient to the Obstetrician, attending his/her private rooms, as opposed to the antenatal clinic. The GP should state this choice on the ‘letter of referral’ to the maternity hospital.

Antenatal Classes
An important part of antenatal care is getting information that will help you to make informed choices about your pregnancy and birth. You will also be offered antenatal education classes, including breastfeeding. You should book antenatal classes in advance, hospital classes are booked at your first hospital booking visit, community classes are booked via your Public Health Nurse, at your local health centre. Ask your midwife/doctor about when and where you should book classes in your area.

Public Care
All expectant mothers who are ordinarily resident in the State are entitled to free maternity care, covering her antenatal visits, labour and delivery and postnatal care. When you visit the GP for your first appointment, you will be asked if you intend to visit as a public or private.

If you are a public patient, you will attend the hospital’s antenatal clinic (or hospital clinics based in the community). You may see the same doctor or midwife on each visit, or you may not. When you come into the hospital for labour and delivery, you will be delivered by staff midwives and may not see a doctor unless you experience complications. You may not have met the midwives or doctors who attend your labour and delivery. After the birth of your baby, you will be moved to the public ward for your stay, generally of about three days. For details, please contact your local hospital or consult the Cuidiu Consumer Guide to Maternity Services in Ireland.

Private Care
If you are attending privately, you will be appointed to a consultant whom you will see at each visit, at his/her consulting room. The consultant will be contacted for the birth of your baby, he or she may not necessarily be available to attend the birth of your baby. If the consultant is unavailable, a team member may assist in the birth your baby, or the doctor on duty at the time. Your consultant Private care also entitles you to a private room, although, again, this is dependent on availability.

Antenatal Appointments
The pattern of visits recommended is usually monthly until 30 weeks, then fortnightly to 36 weeks, and then weekly until the birth of your baby.
If you’re expecting your first baby, you’ll have up to 10 antenatal appointments. If you’ve had a baby before, you’ll have around seven antenatal appointments. Under certain circumstances, for example if you develop a medical condition, you may have more.
Your midwife or doctor will give you information about how many appointments you’re likely to have and when they’ll happen. You should have a chance to discuss the schedule with them. If you can’t keep an antenatal appointment, let the clinic know and make another appointment.

  • Your first appointment is with your GP and will take place in your GP surgery.
  • You will then receive a hospital appointment to attend the Fetal Assessment. Unit (FAU) for your first dating scan in at approximately 10-13 weeks of pregnancy. You will also have preliminary antenatal booking blood tests taken at this visit.
  • You will also receive a hospital appointment to attend for your first Antenatal Booking Visit at the Antenatal Clinic, when you are approximately 12-16 weeks pregnant.
  • You will also receive a hospital appointment to attend the Fetal Assessment Unit (FAU) for your anomaly scan at 18-22 weeks. This detailed scan is to check the physical development of your baby and screen for possible abnormalities.
  • Your next hospital visit will be at 28 weeks of pregnancy, you will have routine pregnancy bloods checked at this visit.
  • Subsequent visits will be shared between hospital, GP, a midwife in certain geographical areas, follow up appointments may take place in the community.

The First Hospital Visit (Booking Appointment)
Your first hospital appointment should happen when you are 12-16 weeks pregnant. This is called the booking visit or booking appointment. It will last for up to two hours, and will take place at the hospital, follow up appointments will alternate between the GP surgery and the hospital, in certain geographical areas, follow up appointments may take place in the community.

You will see a midwife and a doctor. You may also be offered an ultrasound scan. You will be given information about:
• How the baby develops during pregnancy
• Folic acid and vitamin D supplements
• Nutrition and diet in pregnancy
• Exercise in pregnancy and pelvic floor exercises
• Antenatal screening tests
• Antenatal care and antenatal classes
• Breastfeeding
• Maternity and paternity benefits
• Lifestyle factors that may affect your health or the health of your baby, such as smoking, drinking alcohol and drug use

To give you the best pregnancy care, your midwife will do a detailed health assessment, which involves asking you many questions about your health, your family’s health and your preferences.

Questions that may be asked during this assessment include;
• The date of the first day of your last period
• Your health
• Any previous illnesses and operations
• Any previous pregnancies and miscarriages
• Ethnic origins of you and your partner, to find out whether your baby is at risk of certain inherited conditions, or other relevant factors, such as whether your family has a history of twins
• Your job or your partner’s job, and what kind of accommodation you live in to see whether your circumstances might affect your pregnancy
• How you’re feeling and your mental health wellness

Your booking appointment is also an opportunity to to discuss with your midwife or doctor if you’re in a vulnerable situation or if you need extra support. The midwife or doctor will ask questions to build up a picture of you and your pregnancy. This is to make sure you’re given the support you need, and so that any risks are spotted early.
You will probably want to ask a lot of questions. It often helps to write down what you want to say in advance, as it’s easy to forget once you’re there. All Antenatal appointments offer a setting where you feel able to discuss sensitive issues that may affect you, such as domestic violence, mental illness or drug use, sexual abuse or female genital mutilation

Your midwife or doctor should:
• Give you your maternity notes and plan of care
• Assess if you may need additional care or support and refer appropriately
• Plan the care you will get throughout your pregnancy
• Identify any potential risks associated with any work you may do
• Measure your height and weight and calculate your body mass index (BMI)
• Measure your blood pressure and test your urine
• Find out whether you are at increased risk of gestational diabetes or pre-eclampsia
• Offer you screening tests, and make sure you understand what is involved before you decide to have any of them
• Offer you an ultrasound scan

Later Antenatal Visits
Later visits are usually quite short.

Your midwife or doctor will:
• Check your urine and blood pressure
• Feel your abdomen (tummy) to check the baby’s position
• Measure your uterus (womb) to check your baby’s growth
• Listen to your baby’s heartbeat or offer you a scan if required

You can also ask questions or talk about anything that’s worrying you. Talking about your feelings is as important as all the antenatal tests and examinations.

You should be given information about:
• Your birth plan
• Preparing for labour and birth
• How to tell if you’re in active labour
• Induction of labour if your baby is overdue (after your expected date of delivery)
• The “Baby Blues” and Postnatal Depression(PND)
• Breastfeeding your baby

Checking your Baby’s Development and Wellbeing
At each antenatal appointment from 24 weeks of pregnancy, your midwife or doctor will check your baby’s development and wellbeing. In the last weeks of pregnancy, you may also be asked to keep track of your baby’s movements. If your baby’s movements become less frequent, slow down or stop, contact your midwife or doctor immediately. You’ll be offered an ultrasound scan if they have any concerns about how your baby is growing and developing.

Your Maternity Notes
At your first hospital appointment in FAU and at the antenatal clinic booking appointment, your midwife will enter your details in a record book and will add to them at each visit. These are your maternity notes, sometimes called hand-held notes. You’ll be asked to keep your maternity notes at home and to bring them along to all your antenatal appointments.

Take your notes with you wherever you go in case you need medical attention while you’re away from home. Always ask your maternity team to explain anything in your notes that you don’t understand. These notes remain at the hospital following the birth of your baby.

Waiting times in clinics can vary and having to wait a long time for an appointment can be particularly difficult if you have young children with you.

Planning ahead can make your visits easier, so here are some suggestions:

  • Write a list of any questions you want to ask and take it with you
  • Make sure you get answers to your questions or the opportunity to discuss any worries
  • If your partner is free, they may be able to go with you. This can make them feel more involved in the pregnancy
  • Take a snack with you if you’re likely to get hungry

For information on services for Pregnancy & Antenatal Care click here