Specialist Maternity Clinics

Introduction

At the National Maternity Hospital, we run Specialist Clinics which have dedicated multidisciplinary teams providing advice and care for pregnant women whose health needs are complex or who may need additional medical or other support. Specialist clinics are on the Specialised Care Pathway. The clinics are Consultant Led and delivered by both Consultants and Specialist Midwives. Individualised care is provided during your pregnancy and birth, taking into consideration factors relating to both your pregnancy and your medical condition. Your care will be tailored dependent on your medical condition.  Even though we recognise that some women will need a higher level of medical input and support we aim to normalise pregnancy and birth as much as possible.  In many of these clinics the obstetric team works in close liaison with other specialist Consultants and you will be seen jointly within the multi-disciplinary team.  At regular multidisciplinary team meetings, the team discuss the more complex cases with experts in the relevant area to ensure you get the best care.

You can attend any of our specialist clinics regardless of which maternity care option you have chosen - Public, Semi-Private or Private.

The Maternal Medicine Clinic (Anaesthesia, Cardiology, Epilepsy, Hepatology, Renal, Rheumatology, Substance Misuse Clinics)

The NMH has a Maternal Medicine Clinic which runs every Wednesday afternoon. This specialist clinic is for women with medical conditions in pregnancy, either pre-existing pregnancy or conditions that have developed during the pregnancy.

The Maternal Medicine Clinic is led by Consultant Obstetricians Prof Fionnuala McAuliffe, Prof Mary Higgins and Dr Siobhan Corcoran. This clinic provides specialised preconception, antenatal and postnatal care for women with medical conditions. The clinic links with a wider multidisciplinary team including cardiac (heart), renal (kidney), epilepsy, hepatology (liver), rheumatology (joint and muscle) and anaesthetics. The Maternal Medicine Clinic also works closely with the Haematology Clinic.

If one of the Consultant Obstetricians in the Maternal Medicine Clinic deems your medical condition to be currently stable, you may have some or all of your antenatal appointments with Specialist Midwife Celine O’Brien in the Maternal Medicine Clinic.

Specialist clinics run out of the maternal medicine clinic:


Anaesthesia clinic                                                                

Last Wednesday each month

This is a combined anaesthesia and obstetric specialist clinic led by the Maternal Medicine and Anaesthetic Consultants.  This clinic is for women with either pre-existing medical conditions or conditions that have developed during the pregnancy that require both anaesthetic and obstetric input.  Examples of conditions that seen at the clinic are Rheumatoid Arthritis, Lupus, Inflammatory Bowel Disease, Chronic Kidney Disease, Organ Transplant recipients, Autoimmune Hepatitis, Cardiomyopathy, Multiple Sclerosis.

Cardiology Clinic 

Third Wednesday each month

This is a specialist clinic run jointly by Prof Fionnuala McAuliffe, Consultant Obstetrician and Dr Carla Canniffe, Consultant Cardiologist (heart specialist) from St. Vincent’s University Hospital. If you have a heart condition prior to pregnancy or develop cardiac complications, you may be seen in this clinic. Sometimes you may need to be seen by Dr Canniffe in St. Vincent’s University Hospital initially. You will also attend St. Vincent’s University Hospital for any cardiac investigations required.

Epilepsy Clinic                                                                                   

Every second Wednesday

This is a Specialist Clinic led by Ms Sinead Murphy, Registered Advanced Nurse Practitioner in Epilepsy. This clinic is available for all pregnant women with epilepsy who attend The National Maternity Hospital. Please note referrals can be sent to the clinic in cases where a woman has a past history of epilepsy even if she is seizure free and off medication. In these instances, if the epilepsy is deemed stable, women will usually continue their antenatal care in their normal clinic. If there is a need for regular attendance at the epilepsy clinic, women will have their antenatal care in the Epilepsy Clinic.

Hepatology Clinic                                                                 

Second Wednesday each month

This is a specialist clinic led by Dr. Omar Elsherif, Consultant Hepatologist from St. Vincent’s University Hospital. This clinic is for women with liver disorders such as autoimmune hepatitis, Hepatitis B or C, severe cholestasis of pregnancy and fatty liver disease.

Renal Clinic                                                                

First Wednesday every second month

This is a specialist clinic led by Prof Fionnuala McAuliffe,Consultant Obstetrician and Dr John Holian Consultant Nephrologist (kidney specialist) from St. Vincent’s University Hospital. You may be referred to this clinic if you have kidney disease.

Rheumatology Clinic                                                            

Second Wednesday each month

This is a combined rheumatology and obstetric specialist clinic led by Prof Fionnuala McAuliffe Consultant Obstetrician, Prof Douglas Veale, Consultant Rheumatologist and Ms Louise Moore Registered Advanced Nurse Practitioner in Rheumatology. This clinic is available to all women with rheumatological disorders such as Rheumatoid Arthritis, Ankylosing Spondylitis, Sjögrens Syndrome, Psoriatic Arthritis and Lupus who attend The National Maternity Hospital.

Substance Misuse/Drugs & Alcohol Misuse Clinic                                     

Every Wednesday

This clinic is suitable for women who are pregnant and on methadone programmes and those experiencing substance misuse e.g. women who have issues with cocaine, alcohol, benzodiazepine and/or cannabis misuse. It is attended by drug liaison Midwife, Victoire Hurley who works closely with the community addiction services and the maternal medicine team, a dedicated social worker and the pharmacy team. It is important that women seek the advice of the Drug Liaison Midwife before considering any dose reduction or detox due to the potential dangers it may cause to their pregnancy. The Drug Liaison Midwife will provide women with additional information and will answer any questions. Women are supported throughout their pregnancy and for six weeks after.  Rapid access into drug programmes for pregnant opiate dependent women and their partners can be arranged through the clinic if required. The Drug Liason Midwife will assess and arrange inpatient treatment for women who need to stabilise their drug use in a protective and stable environment. Women can self -refer to this clinic or be referred by their GP or another health care professional.

More information is available at https://www.drugsandalcohol.ie/16462/1/Substance_Misuse_in_Pregnancy.pdf


Booking with a specialist clinic run under the Maternal Medicine clinic:

You can self-refer to the Maternal Medicine Specialist Clinics. If you are booking your pregnancy online simply outline your medical condition on the form and specify which specialist clinic you wish to attend in the comments box. If you are booking over the phone please specify which clinic you wish to attend. If you have any letters or information from your GP or treating Consultant, you should provide them so that they can be reviewed with your booking.  Please note, you cannot attach documents to your online booking. Please send these separately by post to the Maternal Medicine Team, The Holles Outpatients Department, Holles St, Dublin or email them to celine.obrien@nmh.ie

Referrals:

We accept referrals from your GP or treating consultant (or their medical team). Referrals can be sent in by letter to:

The Maternal Medicine Team, The Holles Outpatients Department, Holles Street, Dublin 2 or by Healthlink.

Contact

To contact any of The Maternal Medicine Specialist Clinics please email celine.obrien@nmh.ie

Anaemia Clinic

Our Consultant Led Anaemia Clinic provides care for women with anaemia in pregnancy and is managed by Specialist Midwife Ann Marie Murphy Cruse. Approximately 1 in 3 women will develop anaemia (lack of iron) in pregnancy.  Risk factors for anaemia include having inflammatory bowel disease, coeliac disease, history of surgery to the gut, a multiple pregnancy (having twins / triplets) or a history of anaemia outside of pregnancy. 

All pregnant women are monitored for anaemia. A full blood count is taken at intervals during pregnancy. If anaemia is detected you will be referred to the Anaemia Clinic.

Following referral to the Anaemia Clinic you will receive a phone call from our Specialist Midwife who will help to identify the cause of your anaemia. The midwife, in consultation with our Haematologist, will provide treatment options and monitoring to try and correct the anaemia.  Information on how to increase iron in your diet is provided and iron tablets may be recommended. Some women may need additional testing and intravenous iron (through a drip) may be recommended.  Occasionally when there is no response to iron tablets or intravenous iron, there may be a need for a blood transfusion. All treatments will be fully discussed with you and an individual care plan agreed.

Referrals

We accept GP referrals. Referrals can be sent in by letter to: The Anaemia Clinic, The Holles Outpatients Department, Holles Street, Dublin 2, or by Healthlink. Full medical history should be provided in the referral.

The Anaemia Clinic takes place every Tuesday morning

Daisy Teenage Clinic

The Daisy Teenage Clinic provides antenatal support and care for adolescent mothers aged 19 and younger who wish to attend.

As well as routine antenatal care provided by midwife, Anna Lyons, you will be linked in with other members of the team including dietician, Lorna O'Connor, who will advise you on healthy eating in pregnancy and our social worker, Deirdre Real, who will advise you on any benefits and supports available to you.  We also have antenatal classes specially tailored to meet the needs of teenagers.

Booking

You can refer yourself to the Daisy Teenage Clinic when you are booking your pregnancy online. Simply write that you wish to attend the Daisy Teenage Clinic in the comments box on the form. If you are booking over the phone please specify you wish to attend The Daisy Teenage Clinic

The Daisy Teenage Clinic takes place every Thursday.

Referrals

Your GP can refer you to the Daisy Teenage Clinic. If you are already attending another routine antenatal clinic you can ask to move to the Daisy Teenage Cinic if you wish. Referrals can be sent in by letter to: The Daisy Teenage Clinic, The Holles Outpatients Department, Holles Street, Dublin 2 or by Healthlink.

You will need to seen first in Dr Sheil’s Consultant Led clinic. Dr Sheil will then refer you to The Daisy Teenage Clinic if you are suitable to attend.

Diabetes in Pregnancy Clinic

This Diabetes in Pregnancy clinic provides diabetes and obstetric care for women with pre-existing diabetes (type 1 and type 2 diabetes) and women who develop Gestational Diabetes (diabetes in pregnancy) and who require medication. If you are attending this clinic, you will be reviewed every 3 - 4 weeks throughout your pregnancy. The Diabetes in Pregnancy multidisciplinary team consists of obstetrician’s Dr Jennifer Walsh, Prof Mary Higgins, and Dr Rhona Mahony, endocrinologist, Professor Mensud Hatunic, Advanced Midwife Practitioner, Ciara Coveney as well as a number of other specialist midwives and dieticians.

We also have a Gestational Diabetes Virtual Clinic which is suitable for women who develop gestational diabetes but do not require medication. You will be referred to this service if your blood sugar needs to be monitored. This service is run by the same team of specialist midwives as the Diabetes in Pregnancy Clinic. The team provide virtual appointments with blood sugar monitoring. The service also provides support and education to assist you in achieving and maintaining optimal blood glucose control from positive pregnancy test up to six weeks following birth.

Download the Gestational Diabetes Pathway here.

Booking

You can self-refer to the Diabetes in Pregnancy Clinic when you are booking your pregnancy online.  Simply specify that you wish to attend the Diabetes in Pregnancy Clinic in the comments box on the form. If you are booking over the phone please specify you wish to attend The Diabetes in Pregnancy Clinic. If you have any letters or information from your GP or treating Consultant, you should provide them so that they can be reviewed with your booking.  Please note, you cannot attach documents to your online booking. Please email these documents to diabetes@nmh.ie

The Diabetes in Pregnancy Clinic takes palce every Friday.

Referrals

If you have type 1 or type 2 diabetes and are planning to get pregnant, you can contact your GP or the general diabetes service you currently attend (e.g. Mater hospital day centre) for information on preconception care.

We accept referrals from your GP or your general diabetes service once you are pregnant. Referrals can be sent in by  Healthlink (please specify The Diabetes in Pregnancy Clinic in the referral), by email to: diabetes@nmh.ie or by letter to: The Diabetes in Pregnancy Clinic, The Holles Outpatients Department, Holles Street, Dublin 2.

Contact:

To contact The Diabetes in Pregnancy Clinic call 01 637 3314 Mon-Fri 8-3pm or Email diabetes@nmh.ie

Endocrine Clinic

Our specialist endocrine clinic is led by Consultant Endocrinologist Professor Mensud Hatunic. He is supported by his Registrar and Midwife Ellie Ahern.

This clinic provides care to pregnant women who have a range of endocrine conditions. You may be referred to the clinic if you have the following:

  • Hyperthyroidism
  • Hypothyroidism which has been diagnosed during pregnancy
  • Uncontrolled hypothyroidism where GP/obstetrician/private Endocrinologist are unable to manage same
  • A history of thyroid cancer or  if you have had a thyroidectomy.
  • Goitre or thyroid nodules diagnosed by ultrasound during pregnancy.
  • Macroprolcatinoma, Microprolactinoma, Adrenal disorders, Hypoparathyroidism, Hyperparathyroidism, Pituitary adenoma, previous pituitary surgery.

If you have the following conditions you do not need to be seen in the clinic, your obstetrician will manage your care. They will advise if you need further management during your pregnancy.

  • Normal Thyroid function tests (TFTs) in pregnancy
  • A history of hypothyroidism that is well controlled under the care ofyour GP/obstetrician/private endocrinologist.
  • Normal TFTs and positive TPO antibodies (Thyroid peroxidase antibodies).
  • A history of goitre of thyroid nodules diagnosed pre pregnancy.
  • High prolactin levels in the absence of pituitary adenoma (which must be documented on MRI of pituitary).

Booking

You can self-refer to the Endocrine Clinic when you are booking your pregnancy onlineSimply specify that you wish to attend the Endocrine Clinic and outline your medical history in the comments box. If you are booking over the phone please specify you wish to attend The Endocrine Clinic. If you have any letters or information from your GP or treating Consultant, you should provide them so that they can be reviewed with your booking. Please note, you cannot attach documents to your online booking. Please send these separately by post to The Endocrine Clinic, The Holles Outpatients Department, Holles St, Dublin or email them to endoclinic@nmh.ie

The Endocrine Clinic takes place on Friday morning.

Referral

Referral early in the 1st trimester is preferable. We accept referrals from GPs and Private Endocrine Specialists . Referrals can be sent in by letter to: The Endocrine Clinic, The Holles Outpatients Department, Holles Street, Dublin 2, by Healthlink or email to endoclinic@mh.ie. Full medical history should be provided in the referral. If you develop an endocrine problem during your pregnancy you will be referred by your Midwife or Doctor to the endocrine clinic for review.

Haematology Clinic

Our Haematology Clinic provides care for pregnant women who have a disorder affecting the blood, for example; clotting disorders, bleeding disorders or a family history of these that may require investigation, monitoring and possible treatment. Our team consists of Consultant haematologist Dr Karen Murphy, obstetricians and anaesthetists and specialist midwife Ann Marie Murphy Cruse. Some women will need intensive monitoring and continuous treatment and some may need less intervention throughout their pregnancy.

Our Specialist Midwife is available to provide support and answer queries outside of clinic times. 

This clinic works closely with specialists in The Maternal Medicine Clinic. We also work in collaboration with the National Coagulation Centre in St James Hospital.

Booking

You can self-refer to the Haematology Clinic when you are booking your pregnancy online. Simply specify that you wish to attend the Haematology Clinic and outline your medical history in the comments box. If you are booking over the phone please specify you wish to attend The Haematology Clinic. If you have any letters or information from your GP or treating Consultant, you should provide them so that they can be reviewed with your booking.  Please note, you cannot attach documents to your online booking. Please send these separately by post to The Haematology Clinic, The Holles Outpatients Department, Holles St, Dublin or email them to clinics@nmh.ie

The Haematology Clinic takes place every Wednesday afternoon.

Referrals

We accept GP and consultant haematologist referrals. Please note some women with disorders affecting the blood may need to be seen in the clinic before the first routine booking appointment. Referrals can be sent in by letter to: The Haematology Clinic, The Holles Outpatients Department, Holles Street, Dublin 2, or by Healthlink. Full medical history should be provided in the referral. 

Poppy Clinic

The Poppy Clinic (sometimes referred to as the Postnatal Maternal Morbidity Clinic) offers a follow up for women who have had a medical, surgical or obstetrical complication as a result of their pregnancy, labour or delivery and which is causing them ongoing problems. This clinic is unique to NMH and is run by AMP Caroline Brophy and Consultant Obstetrician, Dr Laoise O'Brien.

Below are examples of women we see at the Poppy Clinic:

  • Women who have caesarean section wound infections who have been referred by a GP or consultant.
  • Women who have a perineal wound breakdown, perineal pain or dyspareunia (pain during sexual intercourse) up to one year post birth.
  • Women who have had a large bleed (greater than 1.5litres) following delivery. We see these women for review, debrief and future pregnancy planning.
  • Women who have a low iron count (HB) less than 8g/dl. We see these women at 2 weeks following birth for review and repeat blood test.
  • Women who have had a medical complication during their pregnancy e.g. hypertensive disorders such a severe pre-eclampsia (PET), eclampsia, HELLP and women who have had an ICU admission after delivery. We see these women for review at 2 - 6 weeks following birth.
  • All women who have had a 3rd or 4th degree tear are seen 6 weeks post birth in The Poppy Clinic to assess their recovery. Women with ongoing problems will have their physiotherapy and perineal clinic appointments expedited if necessary. Please note, all women who have had a 3rd or 4th degree tear, will also have a follow up appointment at 4 – 6 months post birth in the Perineal Clinic.
  • Women with acute and chronic perineal pain and dyspareunia can be seen up to  1 year postnatal with GP referral.
  • Women who have had previous perineal trauma can be referred for review antenatally and postnatally.

Booking

You can self-refer to The Poppy Clinic when you are booking your pregnancy online. Simply specify that you wish to attend the The Poppy Clinic and outline your medical history in the comments box. If you are booking over the phone please specify you wish to attend The Poppy Clinic. If you have any letters or information from your GP or treating Consultant, you should provide them so that they can be reviewed with your booking. Please note, you cannot attach documents to your online booking. Please send these separately by post to The Poppy Clinic, The Holles Outpatients Department, Holles St, Dublin or email them to clinics@nmh.ie

The Poppy Clinic takes place on Tuesday morningThursday morning and afternoon (Advanced Midwife Practioner (AMP) Led); Friday afternoon (Consultant Led).

Referrals

We accept referrals from GPs, Public Health Nurses and Community Physiotherapists. We also accept referrals from Obstetricians within the Ireland East Hospital Group. Women can be referred to the Poppy Clinic by midwives, doctors and other members of the multidisciplinary team working in The National Maternity Hospital. Referrals can be sent in by letter to: The Poppy Clinic, The Holles Outpatients Department, Holles Street, Dublin 2, or by Healthlink. Full medical history should be provided in the referral.

To contact the Poppy Clinic call 01 6373100 and ask for Caroline Brophy on Bleep 211 Monday – Friday 7am - 3.30pm

Preterm Birth Clinic

This is a specialist antenatal clinic for women at risk of preterm birth. The clinic is run by Dr Siobhan Corcoran, Consultant Obstetrician and Gynaecologist & Specialist in preterm birth, a registrar, and Larissa Luethe, our dedicated Preterm Birth Clinic Midwife.

We see women who have experienced a preterm birth before 34 weeks, women who had two or more surgical treatments to the cervix after an abnormal smear test (LLETZ treatments), women who have had a single cone biopsy and women with congenital uterine abnormality (an abnormality of the womb you were born with). We also offer a preconceptual counselling service to women that are planning a pregnancy in the near future that are at high risk of preterm birth.

Your first visit to the clinic will ideally be in the first trimester. At your first appointment your history will be recorded by a midwife and bloods, swabs and urine samples will be taken. During your consultation with either the Consultant or Senior Registrar, your history will be discussed in-depth and an individual plan of care for your pregnancy will be made. The length of your cervix (cervical length) will be measured by internal (vaginal) ultrasound scan regularly as you will be reviewed in the clinic every 2 to 4 weeks. If the cervix becomes short, a stitch can be placed into the cervix to help reduce the risk of preterm birth. Some women will be prescribed medication from around 16 weeks pregnant to reduce the risk of preterm birth. After 28 weeks, if your pregnancy is stable you may be discharged to the clinic of your choice e.g. public, semiprivate or private. 

Booking

You can self-refer to the Preterm Birth Clinic when you are booking your pregnancy online. Simply specify that you wish to attend the Preterm Birth Clinic and outline your medical history in the comments box. If you are booking over the phone please specify you wish to attend The Preterm Birth Clinic. If  you have any letters or information from your GP or treating Consultant, you should provide them so that they can be reviewed with your booking.  Please note, you cannot attach documents to your online booking. Please send these separately by post to The Preterm Birth Clinic The Holles Outpatients Department, Holles St, Dublin or email them to Pretermsurveillanceclinic@nmh.ie

The Preterm Birth Clinic takes place every Monday.

Referral

We accept GP referrals.  It is very important that your full medical history is clearly specified on the referral. Referrals can be sent in by letter to: The Preterm Birth Clinic, The Holles Outpatients Department, Holles Street, Dublin 2 or by Healthlink.

TLC Clinic (Tender Loving Care Clinic) Recurrent Pregnancy Loss

The TLC (Tender Loving Care) clinic provides support for women who have experienced recurrent pregnancy loss. Recurrent pregnancy loss is defined as two or more recurrent first trimester pregnancy losses.  The clinic provides support for women up to 12 weeks of pregnancy. To attend the TLC clinic, you must have attended The Recurrent Miscarriage Clinic in The National Maternity Hospital or had an appointment to attend, but have become pregnant in the interim.

The TLC clinic is led by Consultant Obstetrician, Dr Cathy Allen and facilitated by a senior midwife, Valerie Seymour.  

At the TLC clinic you will be seen by a senior midwife who will discuss your history and how you are feeling. You will also have an ultrasound scan. This scan is to check the baby’s heartbeat for your reassurance. If the midwife has any concerns, she will contact a doctor. They will then arrange your next appointment in 1 to 2 weeks.  The TLC clinic offers weekly appointments from approximately 8 to 12 weeks’ gestation.

After 12 weeks’ you can attend your chosen antenatal clinic, or one that has been recommended to you based on your medical history. You can book public, semi private or private care.

Booking

To book an appointment with the TLC clinic contact the bereavement midwives by phone (01) 6373225 or by emailing  bereavement@nmh.ie.  Please give your full name, date of birth and the first day of your last period. The bereavement midwives will review your history and arrange your first ultrasound scan for you. Prior to attending the TLC clinic, you will have an ultrasound scan in the ultrasound department at 7 weeks. If this scan is normal you will be sent an appointment for the TLC clinic. Sometimes you may need more than one scan in the ultrasound department before attending the TLC clinic. There is no need to contact the Bereavement midwives following your scan, your appointment for the TLC clinic will be sent automatically.

The TLC Clinic takes place every Friday morning.

Referral

Referral is through the bereavement midwives as above in ‘booking’.