This visit will take longer than any other visit and may last up to one hour. Initially a detailed history is taken by a midwife; followed by a full examination, ultrasound scan and consultation with your consultant.
If blood tests have already been performed by your G.P it is very important that you bring copies of them with you at this first visit. This will avoid unnecessary repetition of tests.
The purpose of ultrasound scans is to determine the number of foetuses, to confirm your dates and the presence of a foetal heartbeat(s). It is not always possible to determine the sex of the baby.
If someone wishes to have a detailed scan to identify possible abnormalities an appointment will be organised for you at a specialist feto-maternal centre. There are a number of feto-maternal centres in Dublin, Cork, Limerick and Galway.
Specialist scans and bloods tests can be performed as early as 11 weeks to identify Downs Syndrome. It is crucial that you get an early appointment at our clinic if this is a service you wish to access.
At the end of your first visit any specific risk factors or concerns will be discussed with you and a care plan for the rest of your pregnancy will be devised by the team.
Women who wish to draft birth plans will be assisted in every way – this is best done after attending classes and reading around the subject of pregnancy. You should be aware that pregnancy is not always clear-cut and birth plans may be modified in labour.
An ultrasound scan may be performed by placing a special probe across your abdomen. A special water-based gel is placed on your skin prior to starting the test. It is necessary to have a full bladder for an ultrasound scan.
Occasionally, particularly for very early pregnancy and fertility scanning, a transvaginal scan is necessary. In this case a small probe, covered with gel and a special probe cover, are gently placed in the vagina.
It is important to know that this is not a painful procedure and will not affect pregnancy.
An ultrasound scan may be performed by a doctor or an ultrasonographer. An ultrasonographer is a radiographer or nurse who is specifically trained to perform ultrasound scans.
If your ultrasound scan is performed by an ultrasonographer they will report the findings to the medical staff and the final diagnosis/ decision with regard to treatment will be made by them.
SUBSEQUENT VISITS
There are usually a total of five to six visits to The Scotia Clinic. However the number of visits may be increased in high risk, “at risk” or twin pregnancies.
You will also attend your GP in between times. For each visit you must bring a urine sample. When producing a urine sample it is important that we get a mid-stream sample. This involves passing the first few drops of urine into the toilet and putting the middle-stream into the appropriate container.
Your blood pressure will be checked and the baby’s wellbeing assessed. During these visits time will be allocated to discuss any concerns you may have.
At least one visit in your pregnancy will be a “midwife only” visit. In addition to assessing the wellbeing of you and your baby, time will be given to dealing with any concerns you may have-particularly in relation to your in-hospital care. If someone is planning a Vaginal Birth After Caesarean (VBAC) then this is an ideal time to talk about a care plan. Equally twin deliveries and other non-routine care can be addressed in conjunction with your midwife and obstetrician.
Towards the end of the pregnancy advice with regard to labour, admission to hospital and signs of your baby’s wellbeing will be discussed. At appropriate intervals throughout your pregnancy blood tests will be performed. Support, assistance and guidance are always available to facilitate the ongoing development and delivery of an antenatal care programme specific to each couple’s needs.
YOUR BABY’S MOVEMENTS
Baby movements first become apparent at 20-22 weeks. Initially these may be soft “fluttery movements”. As pregnancy progresses the movements will become stronger. From 28 weeks or so the baby should move at least 10 times in twelve hours. If you ever feel that the movements were lessening you should report the fact to one of you health care providers.
MEDICAL NOTES
The Scotia Clinic patients carry their own maternity notes. The practice is computerised and at the end of your first visit a copy of your notes, including a Kerry General Hospital chart, will be given to you. It is important that you bring these notes to each visit. Most importantly it is crucial that these notes are brought to the hospital at each and every admission or visit, particularly when you come in to the hospital in labour. At the end of each consultation your records will be updated.
PROBLEMS BETWEEN VISITS
If concerns arise between your scheduled visits you should contact your GP in the first instance who can discuss your case with our staff.
In emergencies you may call the Foetal Assessment Unit in Kerry General Hospital for advice: Monday – Friday between the hours of 9-5pm (066 7184123) or the Delivery Suite (066 7184324) at any other time
ADMISSION TO HOSPITAL
On arrival at the hospital you should go to the Ardfert Ward. There is a bell at the door which you should ring and a midwife will attend to you. It is helpful to ring in advance so that we can get your chart ready and prepare for your arrival. When you are admitted, a midwife will see you initially. The consultant will then be informed and a care plan initiated
DIETICIAN
Dieticians see patients with diabetes, those who are overweight or have other dietary needs.
Research now clearly demonstrates that women having a high BMI in pregnancy are at increased of miscarriage, pre-eclampsia, gestational diabetes mellitus. Babies of women who have a high BMI at commencement of pregnancy have a significantly higher birth weights. It is never too late to intervene in terms of dietary changes. We would recommend weight loss through exercise and diet modification. The GI Diet is a healthy type of eating programme. WEIGHT MANAGEMENT PAGE
SPECIALIST MEDICAL AND SURGICAL SERVICES
Consultations and specialist opinions are available for any patient with medical, surgical or orthopaedic problems which arise during. Psychiatry provides support for postnatal depression or other problems.
ENT advice is also available in the hospital.
Visiting consultants include Neurology, Rheumatology and Dermatology and Cardiology. Full intensive care facilities are available – patients with high blood pressure (pre-eclampsia) or severe bleeding may be transferred to this area for intensive monitoring and specialised nursing care.
HYGIENE/INFECTION CONTROL
Nowadays we are all very aware of the need to prevent the spread of infection within medical care facilities. If you think that you have been in contact with any infection such as German measles, Chicken Pox etc it would be important to make us aware before attending a clinic visit. Equally any person attending with you who suffers from any of these infections should not attend.
With regard to MRSA, this infection is prevented primarily by very good hand washing and hand hygiene. Separate leaflets are available for your information on this topic. Please ask us for one if you wish to read it. It is important that at all times your care providers both at The Scotia Clinic and at Kerry General Hospital undertake best practice with regard to hygiene. However the public also have a role to play. For example you should discourage your visitors from lying on the hospital beds and over handling of your baby, particular if they may have an infection. Approximately 30% of the community in this country carry MRSA and have no symptoms of this. MRSA normally does not cause problems for people other than those who maybe at risk i.e. very premature babies or those whose immune systems are not working effectively.
INDUCTION OF LABOUR
Labour may begin spontaneously between 37 and 42 weeks of pregnancy. However labour may need to be started artificially (induced) in certain circumstances. This is usually because you are overdue; the baby is small for dates, high blood pressure or other reasons. Induction usually involves placing a gel into the vagina to soften the neck of the womb and/or “breaking the waters” some hours later. Managed appropriately it is not necessarily a more painful labour. A special leaflet is available explaining in more detail induction of labour. If you are being admitted for induction of labour it is useful to read these leaflets.
LABOUR
One birth companion may accompany you in the labour ward. Unless there is a medical contraindication you will be encouraged to walk around as this helps labour to progress. You may also wish to have a bath. You may use aromatherapy oils etc. Unless there is a medical reason continuous monitoring in labour may not be necessary. Once you are in established labour you will be in a single room until the birth of your baby. At the delivery two midwives will attend you. In certain circumstances a paediatrician (doctor who cares for children) may also be in attendance.
Where possible, and where medically appropriate, we will facilitate your requests with regard to positions in labour, monitoring, “breaking the waters”, episiotomies etc.
There are many options to use for pain relief in labour www.oaa.:
- In very early labour tablets may be enough.
- TENS is another option and women may hire TENS machine from BOOTS or Medicare.
- Entonox is a mixture of oxygen and nitrous oxide which is breathed through a mask at the time of a contraction.
- Pethidine will provide sedation but it does not take the pain away and can have a negative effect – if given too late in labour women may be too drowsy to push. It will also pass to the baby via the placenta. It can take a baby up to 36 hours to eliminate pethidine from its system. It can also affect a baby’s sucking reflex.
- Epidural and spinal anaesthesia is a procedure performed by an anaesthetist where a special fine catheter is placed into the lower back and a local anaesthetic is infused around the nerves in the spine. The dose can be varied and in the latter stages of labour women should still have a sensation to push the baby out.
- An episiotomy is a cut performed just before the baby is about to deliver. The decision to perform an episiotomy is made by the midwife or doctor based on the clinical situation at the time. Approximately 15-20% of women have an episiotomy
There are numerous good books to read. We particularly recommend” The Irish Pregnancy Book” by Peter Boylan.
In particular the Irish website http://www.eumon.com/ is very informative.
The Royal College of Obstetricians and Gynaecologists have very informative patient information on their website –
In particular, they have specific information on:
- Induction of labour;
- Antenatal care ;
- Caesarean sections;
- Foetal monitoring in labour;
After the baby is born the baby will be given to you, dried, weighed and name bands placed on the baby. A special electronic baby tagging system is in place as part of hospital security. Vitamin K is given to the baby to enhance their blood clotting – this is usually an injection.
Kerry General Hospital is a Breastfeeding Initiative Unit. Our aim is to encourage our mothers to breast feed. To facilitate this mothers are encouraged to “room in” with their babies. We also encourage skin-to skin contact immediately after delivery to help to initiate breast feeding early after delivery. However if you do not wish to breast feed your baby your decision will be respected.
Your baby will then be dressed and put in a cot next to you and your partner. You will be washed and given a much-wanted cup of tea and toast. Occasionally the baby is transferred to Emly Ward (NICU) if the paediatrician feels it is medically necessary.
If you require stitches this is usually done while your baby is being weighed etc.
CAESAREAN SECTIONS
Approximately 24% of babies in Kerry General Hospital are delivered by caesarean section. This figure is in line with the national average. This is generally done under spinal anaesthetic. There may be medical circumstances which negate spinal anaesthesia but in general it is regarded as the better medical option. Partners are welcome at caesarean sections.
POSTNATAL CARE
There is a limited number of private rooms at Kerry General Hospital.. These may not be booked in advance. Please check with your insurance company regarding the amount of cover you will have.
The usual length of stay is as follows:
First baby: 3– 4 days
Second baby: 2-3 days
C-Section – 4 days.
However your insurance company may not cover all of your stay.
If you wish to take early discharge you should discuss it with the staff on the ward.
Special postnatal physiotherapy classes are held on the wards prior to your discharge from hospital. These classes teach you about pelvic floor exercises and are very important if you had a long second stage of labour and/or a forceps/vacuum delivery.
Parenting classes and breastfeeding support is also available.
A six-week post natal check-up will be organised for you at The Scotia Clinic to address such issues as future family planning and physiotherapy. At this visit you will also have the opportunity to discuss the outcome of your pregnancy, labour and its implications for any future pregnancies.
