Who leads your maternity care in Ireland: GP, midwife or consultant

Combined care is the default

Ireland runs a shared model. Under the Maternity and Infant Care Scheme, your maternity care is provided by your family doctor and a maternity unit or hospital together. The scheme is free if you live in Ireland or intend to live here for at least a year, and you can use it even if you do not have a medical card or GP visit card.

The practical effect is that you have two care settings running in parallel rather than one lead professional. Your GP handles roughly half your routine visits and knows your wider health history; the hospital handles scans, screening and the birth.

Who you actually see at hospital appointments

Under free public care, the HSE says 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.

That last sentence is the escalation rule. Midwife-led for straightforward pregnancy, joint obstetric and midwifery care where there is a clinical reason. You do not have to ask for it; the hospital assesses and adjusts.

The visit schedule you are entitled to

This is unusually specific and worth holding your maternity unit to. If this is your 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 maternity unit or hospital visits.

If it is not your first pregnancy, you have 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 visits with your GP. Your schedule may be changed by your GP or hospital obstetrician depending on your situation.

After the birth 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.

How the scheme is started

When your pregnancy is confirmed, your GP applies for services under the scheme, and the diagnosis of pregnancy itself forms part of the scheme. The application form is completed by both you and your GP, and your GP sends it to the HSE. So the first appointment to book is with your GP.

Semi-private care: a consultant, in Dublin only

Semi-private care is only available in Dublin maternity hospitals. It combines public and private care: part of your care is free and you pay for additional services, and private health insurance may cover part of the cost.

If you choose it, a consultant obstetrician oversees your care and you meet a consultant or specialist obstetrician at each hospital visit rather than a midwife. A semi-private ward may be provided after the birth if one is available.

Private care: a named consultant

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

The fee structure has a trap in it. You usually 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 your insurer for their contribution in writing, before you book.

Midwife-led community schemes

The DOMINO scheme is a community maternity scheme led by midwives, and the HSE also runs a home birth service, both within free public care. If you use DOMINO or have a home birth, your midwife visits you at home and then hands your care over to the public health nurse.

After the birth, the public health nurse takes over

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. The public health nurse provides nursing and midwifery care in the community and checks your baby's development at set stages, free of charge. Your child automatically gets free GP visits until they are 8 years old.

What we could not pin down

Consultant fees for semi-private and private maternity care are set individually and are not published in a national schedule, so we are not going to quote a figure. Which units run DOMINO or a home birth service depends on local midwifery staffing and is not published as a single national list. Ask your maternity hospital directly.

What happens after the birth

Care shifts to the community, and it is more structured than many people realise. A public health nurse provides nursing and midwifery care in the community and, if you had your baby in hospital, visits you and your baby at home free of charge, usually within three days of your coming home.

The public health nurse then checks your baby's development at different stages, free of charge. At nine months, for example, they check your baby's eyesight and hearing, motor development, vocalisation and general growth.

What your child gets automatically

Your child will automatically get free GP visits until they are eight years old. If you have a medical card and are getting Child Benefit, you can apply for a medical card for your child, which gives them the same medical card services as you. All recommended childhood vaccines are provided free of charge through the Primary Childhood Immunisation Schedule.

None of that depends on whether you chose public, semi-private or private maternity care, so the tier decision does not follow your child into their first years.