Wednesday, 3 May 2017

Domino midwife-led care at the Rotunda: a first time mother's experience

From September through to March when my baby was born I was registered with the Domino scheme at the Rotunda.  Prior to that I was living in the UK so I was getting my antenatal care solely through the NHS. I was really keen to have my birth experience as midwife-led as possible. I am uncomfortable with the medicalisation of childbirth and pregnancy and know midwives to be more than competent when it comes to the excellent work they do helping women to give birth. 

I wanted that experience for myself especially as, faced with the prospect of giving birth in Ireland, I was very worried about the implications of religious influences on healthcare (and the rhetoric about the 8th Amendment, quite frankly, had me scared senseless, something which was unfounded, I came to realise). As it turned out, the Domino scheme was just right for me. The midwives were at all times professional and caring, and the early release from the hospital was exactly what I wanted. Their postnatal care was an absolute godsend. That being said, there were some issues I had with the scheme, mostly from an organisational point of view, and I will discuss these too.

What is the Domino scheme?

Domino is midwife-led antenatal and postnatal care 'in the community'. For low-risk women there is the option of attending a health centre in the local area to have checkups with midwives. This means you can avoid going into the busy and often frenetic Rotunda outpatients for your checkups, which are frequent. If you need any specific checks, you can just go into the Rotunda and a Domino midwife will do what needs to be done. I had to go in for an extra ultrasound to check baby wasn't in breach (she wasn't, she just had a big bum that felt like a head!) and she just told me at 11 am that morning to meet her there at 2 pm, and I was in and out within ten minutes.

Postnatally, a community midwife will visit you for up to a week. I can only speak for my own experience, but the midwives checked mysutures (stitches for tears, most women will tear a little), checked my mental and physical wellbeing (a bit ironic really, the time you need the most sleep and rest is the time of your life you will not get it), weigh your baby (crucial in the early days), and offer breastfeeding support (latch latch latch, ladies).

The Domino midwives also have a mobile number you can ring 8am-8pm and while they don't always answer it (high demand) I was able to reach them a number of times for specific information.

Getting on the Domino scheme

I called the Rotunda in advance to ask about the scheme. The website didn't mention Killester, the area I was living in Dublin 5, but I was really relieved to hear that I would be covered. In fact, we moved just before the birth, to Donabate, Co. Dublin, and again the midwives were happy for me to continue my Domino care. Luckily, they have a clinic in Swords which is nearby. At my booking appointment I inquired about the Domino scheme and was referred to the Darndale clinic from that point on. 

The practicalities of the Domino visits

I attended the Darndale clinic because I was told it was heavily undersubscribed (territorial stigma, eat your heart out).  I found the process to be wonderful. Since I am a PhD student it was no problem to have my appointments in the morning, so the Darndale clinic suited me better than, say, Coolock which were all in the evening.

I would cycle over for the appointment around 10am (I received a reminder text the night before) and combine some exercise and fresh air with the visit. The queuing system was somewhat disorganised, you took a number but there wasn't really any connection between these numbers and the midwives, it was just for us women to organise ourselves. It felt quite typically Irish, to be honest, and added to the feeling of confusion on my first visit, when I sat for over an hour waiting.

The appointments usually last between 10 and 20 minutes. Your urine is tested (when you're pregnant you pee in containers constantly), blood pressure checked, maybe a blood sample taken if you have low red blood cell count. Then you stomach is palpated and the midwife listens to baby's heart. There's always the opportunity to ask questions, and the midwives seemed to really cater their care to how they perceived my preferences to be. For example, I asked a lot about natural birth options, whether a Doula could be brought in (no, basically) etc. so I was recommended hypnobirthing a number of times.

You take your own medical file and keep it at home, which made me feel more involved overall.

The good and the bad

The maternity services in Ireland, like the health sector in general, are not the most efficient. That being said, during my antenatal, birth and postnatal care, I received a highly professional and caring service from all midwives and doctors. My only sources of stress stemmed from the administration of the care (breastfeeding support aside, but I will address that in another post). Unfortunately, how the system is structured really does affect how you will receive your care, so the two cannot be separated.

The 'goods' were plentiful. I received amazing care for highly qualified individuals, and got the opportunity to educate myself through antenatal classes and researching for and writing a birth plan. The appointments were convenient and short, and the clinic was quiet and not stress-inducing (the Rotunda, on the other hand, was very stress-inducing for me).

The bad - Postnatally, the midwives visit your home for up to a week. However, they don't give you a definite time-frame, it could be any time of the day. This uncertainty, coupled with a new baby, no sleep, recovery pain and a messy house, does nothing for your mental wellbeing. I was woken from brief naps several times by the buzz of the doorbell. A little forewarning of, for example, a three hour window in which they might call would have made all the difference. 

As mentioned above, the queuing system and general atmosphere behind the midwife's door was often chaotic. I don't like to be rushed, especially when I'm concerned about aspects of my care, or just really really confused, as I often was (hey, there's a lot to learn first time round). Depending on the midwife I met, we could either go through all my questions in detail until I was satisfied, or I could end up feeling, frankly, fobbed off. I persevered and eventually I got all the information I needed, but I do understand why many women end up being unprepared for their births and why misinformation abounds and intervention rates are so high.

Final thoughts

That the Domino scheme exists and operates so successfully is a huge credit to the maternity system. I would love to see a shift towards this type of care as standard. It would unburden the Rotunda hospital to an extent, and make life easier for women. If you value midwife-led care and the convenience of attending appointments nearer your home, and if leaving the hospital shortly after giving birth (I left 20 hours after delivery) is something you want, the scheme is really useful. Having a midwife visit your home is so handy, especially in the early days of breastfeeding. 

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