The 'Domino' Scheme Explained
In 1998 The National Maternity Hospital, Holles Street set up the Domino (Domiciliary Care In and Out of Hospital) and Homebirth scheme through its team of community midwives.
This gives low risk women the option to give birth outside of a hospital environment, either at home or in a special, more homely, 'birthing room' within the hospital, whilst still having access to a hospital based midwife team. Thus ensuring continuity of care throughout pregnancy, delivery, and the postnatal period.
At the moment this scheme is only available to women living in the Eastern Health Board community care areas 1 & 2. (Ballinteer, Bride Street, Ballybrack, Dundrum, Irishtown, Little Bray, Shankill, Stillorgan, Ranelagh, Rathmines, Ballsbridge, Cabinteely, Dalkey, Dun Laoghaire, Killiney, Loughlinstown, Booterstown, Monkstown, Milltown, Blackrock, Clonskeagh, Donnybrook, Deansgrange. Foxrock, Sallynoggin, Sandymount, Mount Merrion and Sandyford). The advantages of this kind of birth are:
- a relaxed peaceful atmosphere
- the security and comfort of a familiar environment
- the freedom to move around, choose positions, make whatever noise comes spontaneously
- having no unessential intervention i.e. ARM (artificial rupture of the membranes) oxytocin, epidural, episiotomy, continuous monitoring
- having other children close by
- being able to labour, drug-free
- never being separated from the baby
- having a birthing assistant who is familiar to you and who understands your desires
- women feel they can maintain control, by being given the options, consulted about preferences and making choices for themselves.
Women who opt for the Domino scheme have antenatal care at the hospital clinic or an outlying clinic in Ballinteer (a clinic in Loughlinstown Health Centre is planned for the near future) provided by the community team midwives. They have one antenatal visit at home at around 36 weeks. These women come to the hospital for labour and delivery with the team, are discharged 6-12 hours later and have their postnatal care at home. Women who choose a home birth have their antenatal care at home (the antenatal care provided has the same structure and policy as that provided in hospital) with two team midwives attending for delivery and daily visits at home for around 7 days after the birth.
Who is suitable?
Domino and home birth are only open to women considered low risk. Every woman interested will have a routine scan at around 18-22 weeks and a medical visit for a full physical examination to assess whether she is suitable for the scheme. A repeat scan may be necessary if there is any concern that the baby is small or that there may be other potential complications.
If any problems develop during the pregnancy or in labour the woman is immediately transferred back to full hospital care and becomes the responsibility of the overseeing hospital consultant or the assistant master on duty (around 31% of cases are transferred). In cases where this is necessary the woman continues to receive her antenatal, labour and postnatal care from the community midwife. This means there no break in the continuity of care and she continues to be looked after by a familiar face.
If you are interested in being considered for the scheme or would like more information, contact the community midwives at Holles street on 01 637 3100 or 01 637 3177.