The Mothers’ Index has recently ranked Ireland as the 22nd best place to give birth out of 179 countries – Norway came top. As an expectant expat living in Ireland, you will find a range of choices under the country’s public healthcare scheme, which includes extensive provision for home births. The country has recently published a National Maternity Strategy, which commits to providing more choice to women as to where they can give birth, and their levels of care. It has proposed one model of care with three care pathways: supported care, assisted care and specialised care. We will look at some of your options below.
How to decide on a birth plan
A birth plan is a list of what you would like to have happen during labour and immediately afterwards. You may want to write one, so that your doctor knows what your wishes and expectations are. There are a number of things you may want to consider when writing your birth plan:
• Where do you want to give birth?
• Who do you want to have with you (e.g. your partner)?
• What kind of birth do you want (e.g. vaginal birth or a Caesarian)?
• Do you need any birthing aids?
• Do you want pain relief, and if so, what kind?
• What kind of birthing environment would you prefer?
Ireland has quite extensive provision for home birthing, which we will look at below. There are also options for using birthing aids, such as pools.
Caesarean section rates in Ireland are about 20% to 25%, according to the Health Service Executive (HSE), so if you want a C-section, or think that it might be necessary, you should consult your GP/obstetrician. You can expect to stay in hospital from three to five days after a C-section in the Irish public sector.
Irish maternity care
Care to all expectant mothers who are ordinarily resident in Ireland is available under the Maternity and Infant Care Scheme, a combined scheme involving your GP and your local maternity unit. This is regardless of your nationality, but to be classed as ‘ordinarily resident’, you will need to have been resident in the country for a year, or planning to be resident.
Normally, to access public healthcare in the country, you need a medical card or a GP visit card, but you will not need these in order to be eligible for maternity care under your GP and a hospital obstetrician. Almost all GPs have arrangements for maternity care with the HSE. Your GP will have application forms for the Maternity and Infant Care Scheme.
Once it is established that you are pregnant, you will be entitled to an examination with your GP, preferably within 12 weeks. Your GP will give you a letter of referral to the local maternity unit, if this is needed. You will then be entitled to an additional five GP visits, plus alternate appointments with the maternity unit, if this is your first pregnancy. If not, you will still be entitled to an initial examination, and then a further six examinations.
You are also eligible for five further GP appointments during your pregnancy, if you suffer from one or more non-communicable illnesses, such as diabetes. If you need additional care, you will be entitled to free in-patient, out-patient and accident and emergency/casualty services in the public sector, and will not have to pay a charge.
In addition to birthing care, you will be entitled to two postnatal visits with your GP, under the Maternity and Infant Care Scheme. These will usually be at two weeks and six weeks. You will have a visit from a public health nurse, generally within 72 hours of your discharge from hospital. Your child will also be entitled to some tests, including the so-called heel prick test, prior to leaving hospital, or at home if you have had a home birth.
Note that once you have used up your entitlement to public maternity care, the system reverts to normal and your baby will need either a GP visit card or a medical card. If you yourself are not entitled to the former, there is a GP visit card available for children under the age of six, and this comes with some additional benefits, such as checks for children with asthma.
You can, if you are experiencing a low-risk pregnancy, give birth at home. The HSE runs a National Home Birth Service, involving the services of a self-employed community midwife (SECM). If you want a home birth, you can contact your local health office, who will put you in touch with a midwife. Your midwife, who will be an SECM, will then send your application to the HSE designated midwifery officer (DMO), who will assess your suitability. If your application is accepted, you will be entitled to a number of free visits before the birth, and several postnatal visits.
If you choose to give birth in the private sector, you will have to pay a full range of charges. You can also arrange to give birth at home under private cover, for which you will need to enter into a private arrangement with an SECM – make sure that they have the correct insurance. Check your own insurance policy to make certain that it contains cover for your pregnancy.
Under the Maternity Protection Acts 1994 and 2004, you are entitled to 26 weeks’ paid maternity leave, and up to a further 16 weeks of unpaid leave. You must take two weeks before your baby is due, and at least four weeks after.
Employers are not obliged to pay women who are on maternity leave, so you will have to negotiate this with your employer. You may be eligible for maternity benefit from the Department of Employment Affairs and Social Protection if you have paid enough PRSI contributions.
Will the baby be an Irish citizen?
As long as one of your child’s parents is an Irish citizen, your child will be entitled to Irish citizenship. You will need to register your child’s birth in the Foreign Birth Register, and your child will then be eligible for an Irish passport.