Cois Tí (translated as near home) is Cork University Maternity Hospital’s outreach clinic initiative. It brings maternity and gynaecology services to the community and is part of the Supported Care Pathway of the Maternity strategy 2016-2026 providing continuity of care by midwives for normal/low-risk women in a location close to the woman’s home. 

Who can attend Midwifery Led Services?

At your 12-week visit to CUMH OUtpatients, a risk assessment will be carried out. If you are normal/low risk, then you can attend the Midwifery-led services in the CUMH Midwives clinic, or in the Cois Tí (Outreach) clinic in the locations listed below. If you are interested in midwife-led services please discuss with your hospital doctor to see if you are suitable to attend.

Locations

Midwives provide antenatal care to ladies with normal-risk pregnancies at these locations as part of the Supported Care Pathway.

Ultrasound scanning is also available by a trained midwife in all locations for scans when clinically needed

Seven Outreach centres are now operational with a variety of services available:

An Advanced Midwife Practitioner clinic is also held in CUMH on Tuesdays as part of the Supported Care Pathway.

Appointments for these clinics can be made by contacting central appointments at +353 (0)21 4920600 or when booking your return appointments in the Outpatients Department in CUMH.

Domino Care pathway

The Domino (Domiciliary Care In and Out of hospital) Service aims to provide the same team of midwives to care for the mother throughout her pregnancy and birth and to continue to provide her with care when she returns home. This service choice is offered to normal/low-risk women within a 15km radius of the hospital attending the maternity services in CUMH. This approach gives mothers continuity of care, facilitates a hospital-based birth, and provides an early discharge from the hospital with feeding support at home and is part of the Supported Care Pathway(Maternity Strategy 2016-2026)

The Domino team support the philosophy that pregnancy and birth is a normal albeit life-changing event. The Domino team aims to empower and educate women to give them the knowledge, skills, and confidence to birth without medical intervention in a calm, quiet environment with the support of a midwife who is known to them.

As every woman is an individual, the facilities for our women within the CUMH are designed specifically with this in mind. The birthing room is equipped to support and facilitate freedom of choice in labour (eg. the water pool or birthing balls). Women are encouraged to personalise the birthing room environment and every effort is made to create a woman-centred service within a safe relaxed environment. We hope that giving birth, will for those women using our service, be a fulfilling memorable experience.

Further information

The philosophy of the Domino midwives is to facilitate a healthy pregnancy, an active and positive birth experience, and ultimately a healthy mother and baby. The Domino midwives aim to facilitate women to achieve a normal natural birth. To do this we actively encourage women to prepare the mind and body for pregnancy, birth, and adaptation to parenthood.

This can be achieved by:

• Education- discussion with your midwife/reading/ attending parentcraft classes.
• Nutrition- maintaining a healthy balanced diet to nourish you and your baby.
• Exercising- giving birth is a physical task that requires stamina and strength. It is essential to maintain a good level of fitness whilst accommodating the possible limitations that pregnancy may cause.
• Mental preparation- appreciation of the fact that this is a unique time that can be psychologically challenging and may unearth emotional issues which can sometimes be difficult

  The CUMH Domino Service aims to give you: 

• The same team of midwives to care for you throughout your pregnancy up until one week after your baby is born.
• One-to-one midwifery care throughout your birth.
• Additional choice for childbirth.
• Small teams of midwives provide your care therefore you get to know your midwife.
• We place particular emphasis on helping mothers to achieve a normal birth with as few interventions as possible.
• We promote the use of water immersion for labour to facilitate a normal birth.
• The same team of midwives will support you before and after the birth of your baby, so your new family gets the best possible start

What is a Midwife? 

The word midwife means ‘with woman’. We work in partnership with you and help you and your families take an active part in your maternity care. We are also able to recognise problems and refer you to a doctor if you need to see one

Who works in the CUMH Domino Service? 

Midwives, midwifery students, and midwife managers work in the CUMH Domino Service. Our midwives are highly skilled in the art and science of midwifery practice and are committed to the underlying philosophy of care.

What hospital facilities are available for the CUMH Domino Service? 

When you arrive to give birth, you will be in a birthing room in the Delivery Suite with your birth companion. Your midwife will help to make the room a relaxed and informal environment and encourage upright birthing positions.

After you give birth, you will move to the postnatal ward for at least 6 -12 hours for a period of recovery before you go home to the care of your community midwife team.

What about my birth plan? 

You prepare for birth in the CUMH Domino Service the same way you do when attending the consultant team. It is important that you discuss your birth plan with your midwife while you are pregnant. Midwives in the CUMH will also be involved in Domino antenatal education classes, which are the classes you go to before you have your baby.

How long do I stay in the hospital after I have my baby? 

Women generally transfer home 6-12 hours after birth but may need to stay longer if any complications arise in labour or the postpartum period.

Your CUMH Domino midwife continues to look after you and your baby at home until the 5th postnatal day. If you or your baby develops a medical problem or you need to stay more than 24 hours, your care may be transferred to the consultant team. 

What happens after I go home from the hospital?

 A midwife who works in the CUMH Domino team will visit you and your baby. You and your midwife will decide together how often you need a visit after the birth. Five days after the birth, a public health nurse will take over your care from your midwife. Your local public health nurse, who may also be a midwife, is employed by your local HSE Primary Care Service. Later, your GP will carry out the postnatal examinations of you and your baby, known as the Six Week Check-up, as part of the Maternity and Infant Care Scheme.

Will the Domino Service suit every mother-to-be? 

National and international studies show that midwifery-led care is a safe alternative to consultant care for women who are healthy and likely to have a normal pregnancy and birth. The United Kingdom has been using midwifery-led models of care for numerous years. Results from this model of care have been proven to be very safe with positive empowering birth outcomes and are also part of the Irish Maternity Strategy 2016-2026.

A risk assessment will be done at your first antenatal visit to ensure you do not have any contraindications to attending the Domino service. You will also have a 22-week fetal anomaly scan of your baby as part of the Domino Service. The best international practice recommends that ultrasound scans at 12-14 weeks and 20-22 weeks are the standard for low-risk pregnancies. A scan for liquor volume will also be performed by your midwife if you go beyond your due date

Sometimes women need to change to consultant care for the safety of either Mum or baby during the pregnancy.

If a medical review is needed at any time before your baby is born, or during labour your care will be looked after by the consultant team.

If you transfer from CUMH Domino Care during labour, the midwife who has been caring for you in the Domino Service will, wherever possible, continue to care for you and provide some postnatal visits in your home after your discharge from CUMH.

Can my care be shared with my GP? 

Your GP will continue to look after you as part of the Maternity and Infant Care Scheme whilst you are in the CUMH Domino Service. We recommend you register your pregnancy with your GP as early as possible. 

Who can avail of the CUMH Domino Service?

If you are likely to have a normal pregnancy and live within a 15km radius of Cork University Maternity Hospital then our service may be perfect for you. You can book the Domino service when you or your GP makes your first antenatal appointment in CUMH. If you have already made this appointment then just mention that you are interested in the Domino service to the midwife at that visit and subsequent appointments can be with the Domino team

I would like to speak to someone about the CUMH Domino Service. Who do I contact?

If you would like more information, please contact Martina Dillon, Domino Lead Midwife 

Phone: (086) 7872396

Email: martina.dillon@hse.ie 

 

 

 

Birth After Caesarean

This information is for you if you have had one previous caesarean section birth. If you are pregnant (or planning on becoming pregnant), there are a lot of resources and information on how to plan your next birth 

You have 2 options;

1. Vaginal Birth After Caesarean (known as VBAC)
2. Planned Caesarean section birth (sometimes called 'elective caesarean section')

In most cases, both options (VBAC or planned caesarean section) provide a safe choice for you and your baby; however, both carry different benefits and different risks. It is important that you have a good knowledge of these benefits and risks so that you make the best decision for yourself and your family. 

In CUMH and UHK, you also have access to a specialised clinic where you can have a detailed discussion about your options with an Advanced Midwife Practitioner or Seinor Clinician. You will also have an opportunity to ask questions. 

In CUMH it is called the Birth After Caesarean clinic.

In UHK it is called the Birth Choice Clinic.

You can be referred to this clinic at your booking appointment, or at any later appointment. Typically we aim to see you before 24 weeks gestation. If you already know what type of birth you want, we can give you extra information about planning and preparing for this. If you, like many women, are undecided we can also explain your options regarding other aspects of planning your birth.

In CUMH you can also sign up for VBAC classes. These virtual sessions provide a great opportunity for you to find out more about having a VBAC, and how to prepare for this type of birth.

Education & Preparation

In UHK you can sign up for VBAC classes and/or hypnobirthing classes to help you prepare you for your upcoming birth.

You may have been advised that a VBAC is not recommended for you. This can be due to complications from your last caesarean birth or certain medical or pregnancy related conditions. If this is the case for you, please discuss it with your doctor or midwife at your next appointment. If you have your old hospital notes, bring these to the appointment as well. 

In the majority of cases, its up to you what type of birth you plan for this time around. Below are some links to information on the benefits and risks to both types of birth after caesarean.

VBAC Guidelines Ireland 2023

VBAC Guidelines Ireland 2023 Quick Summary

Royal College of Obstetricians and Gynaecologists Birth After Caesarean

The HSE Home Birth Service is provided by self employed community midwives (SECMs), on behalf of the HSE, to women who choose this model of maternity care.

Research shows that a planned home birth is an acceptable and safe alternative to a planned hospital birth for low-risk pregnant women. Consult with your midwife or doctor to help you decide if planning a home birth, is a safe option for you.

A Liaison will consult with all women planning a home birth at our monthly clinic in CUMH where they will discuss this model of maternity care with you and assess your suitability for a home birth. Your midwife, GP or hospital staff can arrange this appointment for you. Your chosen midwife and your GP will provide you with the remainder of your antenatal care and refer you to CUMH for further assessment, only if required. Your midwife will provide care for you during your labour, birth and throughout the early postnatal period for up to 14 days, at home. She will arrange for a second midwife to be present for your birth also. If your midwife needs to transfer your care to CUMH during labour, your midwife can accompany you into the hospital and continue to support you during your labour. Your midwife will speak to you about this and all other aspects of your care when you meet.

If your midwife feels you are suitable for this model of maternity care she will provide you with the information letter and application form for the service. The midwife will go through this application process with you and forward your signed application form to the DMOs for Homebirth service.

Who are the Self-Employed Community Midwives (SECMs) in Cork & Kerry?

Jo Delaney & Denise Malone are the Designated Midwifery Officers for home births in Cork and Kerry and will process your application for your home birth. They can be contacted by email at homebirth.south@hse.ie or by phone (087) 288 9499 / (087) 6313457

See more on the Homebirth Service and recent research.