“I can’t say enough about DOMINO; they were brilliant. I felt so reassured, they made everything so easy. When I had trouble breastfeeding my daughter at the beginning, the support they provided at home was second-to-none. It would never have established without that support and I subsequently went on to breastfeed my youngest daughter for 4 months. As a general nurse myself, I know how special it is to be able to provide that kind of one-to-one care”. Deirdre O’Connell with Ciara, 4.5 months and Róisín, 20 months
The DOMINO (Domicillary Care Inside and Outside of hospital) Scheme recently celebrated their fifth birthday in CUMH. Since January 2014, the DOMINO model of care facilitates low risk women within a 15km radius of the hospital to be cared for throughout their pregnancy, labour and post-natal period by a team of midwives, ensuring continuity of care and choice for each woman.
Women are encouraged towards a natural birth leading to a reduction in intervention rates and a positive, empowering birth experience. The DOMINO team support the philosophy that pregnancy and birth is a normal, albeit life changing event. The team of midwives 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. Intervention rates, such as caesarean rates, are as low as 10%.
In addition, the DOMINO Scheme facilitates an early return home and provides the support of the team to assist in the early, crucial days of initiating breastfeeding.
The average postnatal stay for most women in CUMH is 2-3 days; women giving birth within the DOMINO Scheme can be discharged home after 6-12 hours. Such an early discharge contributes significant savings to CUMH while also allowing the new mother the opportunity to smoothly and quickly integrate her new born baby into her family life.
The team of midwives visit mother and baby for five days, supporting her and her family with their first steps on their journey of parenthood. 95% of women continue to breastfeed at home, most likely due to the increased support the mother gets from the team.
Key Stats
- In the past year, the DOMINO team provided care for 282 women
- Of this cohort 72% went on to have a normal birth
- The Caesarean section rate amongst these women was 10.9%
- 887 Home visits to mothers and babies were provided
The philosophy of care embraced by the DOMINO Midwifery Team is key to its success and is consistent with the philosophy of regional, national and international policy documents. These emphasise that women should have choice, continuity and control over how, where and with whom their care is provided (A better future together: National Maternity Strategy 2016 - 2026).
The vision of the community team is to further develop both DOMINO and community services to include one third of the 8000+ women giving birth in CUMH each year, similar to the numbers in the Dublin Hospitals.
The 980 women who have availed of the service to date have been very satisfied, citing the relaxed informality of antenatal visits, calm birthing environment and supportive home visits by a known midwife, as the key advantages of this model of maternity care.
“The DOMINO team were able to provide me with the opportunity to have the birth I wanted. They empowered me to take control and took the fear out of giving birth. They were always so calm and warm and welcoming. It was so comforting to be able to go home soon after the birth and the one-to-one support I received at home was phenomenal.” Elaine Hales with 4 week old Maeve Hales
“The DOMINO experience was the most empowering experience of my life. Having been through an infertility diagnosis with my husband due to cancer, and many rounds of IVF, it was massive for me to have normal deliveries. I needed that normalcy. It made me see how powerful I am. It made us appreciate everything about the whole experience of birth” Katherine Studdert with Helen, 4 years, 4 months and Mark, age 1 year, 4 months
“I can’t say enough about DOMINO; they were brilliant. I felt so reassured, they made everything so easy. When I had trouble breastfeeding my daughter at the beginning, the support they provided at home was second-to-none. It would never have established without that support and I subsequently went on to breastfeed my youngest daughter for 4 months. As a general nurse myself, I know how special it is to be able to provide that kind of one-to-one care”. Deirdre O’Connell with Ciara, 4.5 months and Róisín, 20 months
“As a midwife myself, it was wonderful to have DOMINO care and support for my first baby. I knew I could ask any question I wanted, none were considered stupid. My midwife was amazing during my labour. It was also great to have that follow-through at home with visits for 5 days after the birth. The care is different, it’s so personal, it’s the extra time, the one-to-one time that makes the difference”. Cliona O’Leary, Postnatal midwife 2East, CUMH with Laoibhse O’Brien, 12 weeks
Authors: Martina Dillon, Domino Lead Midwife, CUMH and Monica O’Regan, A/CMM3 Midwifery Led Services, CUMH