There is a new confidence emerging among pregnant women in this country, a confidence which demands more of health professionals in terms of the individual attention given to women throughout their pregnancies, in labour and in post-natal care.
It is not surprising, then, that the National Maternity Hospital, Holles Street in Dublin, together with the Eastern Health Board, has just begun a community midwifery service which promises to offer a greater flexibility and a more client-centred approach to the whole business of caring for women during this important period in their lives.
Having a midwife visit the pregnant woman in her own home for some of her antenatal care; allowing for early discharge from hospital following a trouble-free birth; and providing follow-up midwifery support in the home for five days after a birth are some of the most attractive elements of the scheme. The option of a homebirth for those who want one is also part of the plan, which will run initially as a two-year pilot project.
An ESRI study into women's health-needs (1994) found that 14 per cent of women "would have liked a homebirth". However, Maureen Fallon, assistant matron at the National Maternity Hospital, estimates the real demand for home-births to be closer to 5 or 6 per cent of births. Part of the Eastern Health Board's impetus for setting up the service came from requests from women for a home-based maternity service.
The new community midwifery service, which is run by a team of eight midwives, is only available to women with low-risk pregnancies. Women who have medical problems such as diabetes or epilepsy or who have had difficult pregnancies or Caesarian births will not come within its ambit.
A similar community midwifery service is also currently being set up at University College Hospital, Galway, with plans to be ready to take their first clients during the summer.
"There has been a large number of women of child-bearing age returning from Britain who have already experienced the community midwife system and they are thrilled to use our service," says Valerie Seymour, one of the community midwives at Hollis Street.
"The fact that they can go home within 12 hours of having their baby and that they don't have to go out to a GP two days after they have had their baby is appealing.
"For a lot of women, rest is of great importance after having a baby and they feel they will get more rest at home where they have more control over their environment and such things as what time they have breakfast at and how many visitors they have.
"Many women also like to have their partners with them 24 hours a day. Going home early also allows the mother to introduce the baby to other siblings in their own environment.
"First-time mums need a lot of input in terms of baby care and it is an ideal opportunity to get other family members involved - especially dads," she says. Even when the new father shares care of the baby and other children, Seymour stresses the importance of a good support network for new mothers (their own mothers, mothers-in-law, sisters, whoever - but someone to help) when they return home.
At present, the catchment area for the National Maternity Hospital service is limited to the Eastern Health Board community care areas one and two, which roughly speaking includes south Co Dublin, Dublin 4 and parts of Dublin 6 and Dublin 14. Outreach clinics will operate in Ballinteer and Blackrock.
Public and private patients can use the new service and women can also have their antenatal care shared between their consultant or GP and the community midwifery service. All women are seen by a consultant obstetrician at their booking appointment.
In terms of the birth itself, the philosophy of the community midwives is to inform women of all their pain relief options so that they can choose what's best for them. While birth plans are not actively promoted, birth preferences will be accommodated. "We will encourage mothers to use alternative forms of pain relief such as taking a shower or using a TENS (Transcutaneous Electrical Nerve Stimulations) machine - but if a woman wants an epidural, of course she can have one," says Seymour.
Unlike the community midwife system in Britain and the independent midwife system here (where women are under the care of the same midwife throughout their pregnancy, in labour and post-natally), women will be looked after by the team and be tended to by whichever community midwife is on duty. "We looked into the community midwife system in Britain and we found that there was high burnout from being on call for long periods of time, so we opted for the team approach," says Maureen Fallon.
"Each woman will have met all the community midwives at her antenatal visits so she will know them all before her baby is born," Valerie Seymour points out.
"We are also keen to avoid conflicting advice, especially in relation to breast-feeding. All the team midwives have the same philosophy regarding breast-feeding and we offer our breast-feeding courses to public health nurses free of charge to achieve a reasonably good continuity of care," says Fallon. Conscious that mistakes have been made regarding breast-feeding advice, she adds: "In over-medicalising the areas, we have over-mystified breast-feeding which has sometimes undermined women's own self-confidence. We now have breast-feeding manuals on the wards and we have to educate women to trust their instincts." While it may not go the whole way in terms of offering individual women exactly what they would like in maternity care, the community midwifery service is certainly a promising advance. Meanwhile, more home-births and early discharge following hospital births will free up bed-spaces during the current baby boom.