Where to give birth in Ireland: hospital, home or DOMINO

In Ireland, the first choice is a tier, not a building

Ask where you can give birth in Ireland and you get an unusual answer: almost everyone gives birth in a maternity hospital or a maternity unit attached to a general hospital, and the decision that actually changes your experience is which type of care you choose. The HSE lists three: free public care, semi-private care, and private care.

That is worth internalising early, because the tier you pick determines who you see at appointments, who has overall responsibility for your care, what kind of ward you recover on, and what you pay.

Free public care, and what it covers

If you live in Ireland or intend to live here for at least one year, you can get free maternity care through the Maternity and Infant Care Scheme. The HSE is explicit that free public care covers births in hospitals and the HSE home birth service.

Under public care your hospital appointments will usually be with a midwife, and you can also choose to see your GP for some appointments. If your pregnancy is higher risk, obstetricians and midwives will provide your care together.

You get free in-patient, out-patient and emergency care in public hospitals for your pregnancy and your baby's birth under the scheme, and you do not pay hospital charges. You can get this even if you do not have a medical card or a GP visit card. Care for an illness unrelated to your pregnancy is not covered by the scheme, although there are no longer hospital charges for public in-patient and day care services.

The schedule you are entitled to

For a first pregnancy, your first examination is carried out by your GP, ideally before week 12, followed by a further 5 examinations alternating between GP visits and hospital visits. If this is not your first pregnancy, you get an initial examination and a further 6 examinations. If you have a significant illness such as diabetes or hypertension, you may have up to 5 additional GP visits.

Afterwards you get 2 postnatal GP visits: an examination of the baby at 2 weeks old, and an examination of you and the baby at 6 weeks old.

Semi-private care: Dublin only

This is the tier people are most often surprised by. Semi-private care is only available in Dublin maternity hospitals. It combines public and private care, so part of your care is free and you pay for additional services. If you have private health insurance, it may cover part of the cost.

If you choose semi-private, a consultant obstetrician oversees your care and you meet a consultant or specialist obstetrician at each hospital visit. A semi-private ward may be provided after the birth if one is available; if not, you may stay on a public ward until a semi-private bed frees up.

Private care, and the fee split that catches people

Private antenatal and maternity care is available in all maternity hospitals. You have a named consultant obstetrician, and any extra scans or tests you need during pregnancy are covered. You may also get your own private room after the birth if one is available.

Here is the detail worth reading twice. You will usually need to pay a consultant's fee as well as a hospital fee. Your private insurance will cover most of the hospital fee, but may not cover the consultant's fee. Ask the consultant's secretary for the fee in writing and ask your insurer, in writing, what portion they will pay, before you book.

Home birth and the DOMINO scheme

The HSE home birth service is part of free public care, which makes Ireland unusual: a planned home birth with an HSE-funded self-employed community midwife does not sit outside the public system. Eligibility criteria are clinical and strict, and availability is geographic, so the first call is to your maternity hospital or the HSE.

The DOMINO scheme is a midwife-led community maternity scheme where midwives provide your care and you go home early after the birth. If you have had a home birth or used the DOMINO scheme, your midwife will already have visited you and will then hand your care over to the public health nurse.

After the birth, wherever you gave birth

If you had your baby in hospital, a public health nurse visits you and your baby at home free of charge, usually within 3 days of your coming home. Your child will automatically get free GP visits until they are 8 years old, and all recommended childhood vaccines are provided free through the Primary Childhood Immunisation Schedule.

What we could not pin down

Consultant fees for private maternity care are set individually and are not published in a national schedule, so we are not going to quote a figure. Nor is there a single national list of which units run DOMINO or home birth, because that depends on hospital and community midwifery staffing. Ask your maternity hospital directly, and get the fee answer from your insurer in writing.

Before your first hospital visit

The scheme starts with your GP. When your pregnancy is confirmed, your GP applies for services under the Maternity and Infant Care Scheme, the application form is completed by both of you, and your GP sends it to the HSE. The diagnosis of pregnancy itself forms part of the scheme, so the first appointment to make is with your GP rather than the hospital.

What the hospital does not decide

Choosing public, semi-private or private is your decision, and it can be revisited, though hospitals book out by due month so earlier is better. If you go public and your pregnancy turns out to be higher risk, obstetricians and midwives will provide your care together without you needing to pay for private care to get consultant involvement.

After the birth, care shifts to the community. A public health nurse visits you and your baby at home free of charge, usually within three days of your coming home, and your child automatically gets free GP visits until they are eight years old.