Do you know what you are entitled to for antenatal care in Ireland?
All women ordinarily resident in Ireland are entitled to antenatal care under the Maternity and Infant Scheme. This scheme provides for shared care between your chosen GP and obstetrician (or midwife_ in the hospital. You are entitled to this service even if you don’t have a medical card.
The scheme includes the following visits with your GP.
Initial visit with GP (to confirm pregnancy usually before 12 weeks)
A further five visits (on your first pregnancy and six on subsequent pregnancies) over the duration of your pregnancy alternated with the hospital appointments.
The schedule will change but it will usually look something like this below:
(this is the info I give it my patients when I confirm their pregnancy at the first visit.)
Before 12 weeks GP visit 12 week scan Hospital Visit 20 weeks Hospital Visit 24 weeks GP visit 28 weeks GP visit (hospital if 1st pregnancy) 30 weeks GP visit 32 weeks Hospital 34 weeks GP visit 36 weeks Hospital 37 weeks GP visit 38 weeks Hospital 39 weeks GP visit 40 weeks Hospital
If you have a significant medical illness of pregnancy (for example diabetes or hypertension) then you are entitled to a further five visits to the GP.
Visits that are not related to your pregnancy are not covered by this scheme. For example if you have a cold / flu etc this visit is technically not covered & should be paid for if you are private.
The two and six- week check are also covered. Other post natal visits are not.
Mothers are entitled to free in-patient & out-patient public hospital services in respect of the pregnancy & birth & are not liable for any of the standard in-patient hospital charges. The GP should have the application form for this service that you can fill in at your initial appointment. If you decide to go private for your obstetric care then you would still subscribe to this scheme for your GP visits.
What to expect from your antenatal appointments?
Your first visit is usually with the GP to confirm your pregnancy. Some GPs will do a urine pregnancy test - some won’t especially if it’s early as often you can get a a false negative (the HSE ones are cheap and don’t work as good as some of the brand ones such as @clearblue ).
After that we will also check: Weight BP Urine dipstick
Usually we will take a history as well asking about previous pregnancies, miscarriages, abortions, medical history to see if you have any medical issues that might affect your pregnancy (previous clots, diabetes)
There isn’t much point in examining you at this stage as it’s usually too early to feel anything. Other important parts: Onward referral to an obstetrician or midwife of your choice. Info on healthy eating / diet Sign up to mother & infant scheme Reminder re vaccines (flu from 9 weeks, whooping cough 16-36)
From here on out then all appointments are pretty similar. At your booking appointment at the hospital they will usually go through a similar history and exam. They will take booking bloods (some GP surgeries will do this as well depending on where you are located.) When you are coming back for further appointments I think it’s good to let your GP know it’s an antenatal appointment when you are booking so we can be prepared. Always bring a fresh urine sample with you. Key points to touch on BP Urine Weight Any swelling / oedema Vaccine reminder
We measure the bump (literally 1 cm to each week to make sure baby is growing ok) & the Doppler will be used to listen to babies heartbeat (usually from 20 weeks onwards). Bloods are usually checked towards the 28 week mark by the hospital (but remember this changes depending on where you are based!). Scans are done according to the hospital - some will offer a 12 week dating scan and another anomaly scan at 20 weeks.
Post Natal Check Ups
Under the Mother and infant scheme your GP will examine baby at two weeks and both mother and baby at six weeks. Usually the two week check is a single appointment (10 or 15 minutes) whereas the six week check is a double appointment (20 or 30 mins). The two-week check is primarily for baby. Your GP will have a chat with you about the delivery & if there were any complications during birth. If your baby was admitted to the neonatal unit or if there were any concerns. They should also discuss feeding -whether that’s breast or bottle feeding and how baby is doing with same.
For the physical examination we would usually check baby’s weight. I usually do a quick once over on baby and listen to the heart, have a feel of the soft spot and check for femoral pulses. If you had any concerns we would look at those issues as well. I would also look at babies umbilical cord and make sure they had their newborn screenings.
Personally at the two- week check I usually check in with mum also to see if there are any issues. But under the maternity and infant care scheme this isn’t covered. I just can’t work out how you have mum there and don’t check in. If there were any concerns I would deal with these also. The six- week check is usually more comprehensive and looks at mum and baby. Ideally we should weigh baby again and measure their head circumference and length. We should also examine babies eyes, heart, hips and testes.
I would always discuss feeding again, make sure baby is having wet and dirty nappies and usually book in for their 2 month vaccines.
With mum I would check to make sure everything was ok. Discuss contraception. Check re urinary incontinence or any other pelvic floor issues. Check in on her mood. A vaginal exam isn’t usually undertaken but if mum had any concerns or wanted her stitches or scar checked then I would. But I don’t do this as standard. I advise most my patients to attend a women health physio if they have any concerns because they are much better at assessing women pelvic floors than GPs. More on the role of a women's health physio in the next blog post.
I hope you found this useful. I think its great to know what we are and aren't entitled too and I know you guys have had a very varied experience throughout your pregnancies. Be sure to let me know over on instagram if you have any questions.