Background
The National Maternity Hospital first opened on the 17th March 1894. The hospital’s founding philosophy was to offer expert maternity care to working class Dublin women living between the two canals. The paucity of good maternity care along with the ravages of poverty and disease had at the time resulted in very high rates of maternity related infant and maternal deaths. Since then, over 400,000 babies have come into the world with the help of the midwives and doctors working in the hospital.
Today the hospital is recognised as one of Europe’s centres of excellence for maternity, neonatal and gynaecological care within a catchment area that spans Dublin, Meath, Kildare and Wicklow (East coast of Ireland) as well as providing tertiary referral services for the whole country.
The hospital’s philosophy is to provide the highest quality medical, midwifery and nursing care to mothers, babies and their families regardless of their social, economic, religious or ethnic background. The values of human dignity, equity, compassion, justice and advocacy underpin all aspects of our service. As a university tertiary referral hospital we continuously strive to achieve excellence in a caring and healing environment, which values the contribution of each member of staff.
It is the aim of the hospital to cultivate an environment that supports the highest quality of teaching, at both undergraduate and post-graduate level, for midwives, nurses and doctors. As a teaching hospital we foster the development of high quality research in all aspects of female and child health with the aim of improving the maternal and child health of the community, through prevention, health promotion and treatment programmes.
Active Management of Labour
The NMH is internationally renowned for the “philosophy of active management of labour”. Many midwives who have been educated in different jurisdictions and institutions may not be familiar with this concept so it is important to be informed about what this philosophy entails. Several references for relevant papers outlining the principles of Active Management are included on page 8.
Increase in Hospital Activity
The National Maternity Hospital has experienced a significant increase in deliveries since 1994. The number of mothers delivered has increased from 6,244 in 1994 to over 8,500 in 2008. The percentage of first time mothers increased to 45% in 2006. The high percentage of first time mothers has a significant impact on the midwifery service often resulting in longer labours and a longer stay in the postnatal ward.
What is Special about Working in NMH
Continuing Professional Development
The Hospital has an international reputation for education and teaching of midwives and neonatal nurses. We offer excellent opportunities to avail of continuing professional development and we have an active clinical practice development department supporting practice development. Study leave and financial support is facilitated for midwives and nurses pursuing further education.
National Tertiary Referral Centre.
The Fetal Assessment Unit receives admissions from all over the country for management of particular conditions in fetal medicine such as rhesus isoimmunisation disease, multiple pregnancies and prenatal diagnosis of congenital anomalies.
The Neonatal Intensive Care Unit has 35 cots and over 60 nurses work in this unit. In addition to neonates hospital patients admissions of sick neonates from all over the country and participates in the national neonatal transport service.
Gynaecology services are also nationally acclaimed, including colposcopy, urodynamics and cervical screening services which are supported by the gynaecology nursing and medical team and clinical nurse specialists.
Community Midwifery Developments
On the 1st January 1999 eight midwives were assigned to a pilot midwife-led hospital Outreach Home Birth and DOMINO Community service in Community Care Areas 1 & 2 in South Dublin. This was an important new initiative, the aim of which was to offer greater choice to women attending the hospital. This service is midwife managed and is provided by a team of experienced midwives and has been expanded to include Community Area 3.
The women who choose the option of a home birth have all of their antenatal, intranatal and postnatal care in their own homes. For the women who choose the DOMINO option (abbreviated from ‘Domiciliary In and Out’, necessitating shorter hospital stays), their antenatal care is provided by the community midwives in a designated clinic in the hospital, in outlying clinics and / or in the woman’s own home. They have a planned low intervention hospital birth and are discharged 6-24 hours later with postnatal follow-up at home by the community midwives. Antenatal education classes are provided in the evenings to facilitate the women and their partners. The team assisted 292 women to give birth in 2006.
The National Maternity Hospital established an Early Transfer Home Programme (E.T.H.P.) in December 2001 to facilitate newly delivered mothers who wish to leave hospital within the first forty-eight hours. Midwifery care is subsequently provided in the home for the first five days, by a team of experienced community midwives. This service is available for mothers and babies (following an uncomplicated birth) living in Community Care Areas 1, 2 and 3 of South Dublin who choose the Early Transfer Home option.
The E.T.H.P. is organized by a team of four midwives: one full-time, hospital based co-ordinator and three part-time, community based midwives. The midwives also provide antenatal care in St. Michaels Hospital, Dun Laoghaire for the women who opt for community based antenatal care. The team assisted 801 women in this service in 2006.
All these initiatives are being developed in response to requests from women who wish to avail of midwifery models of care and would like to give birth with less medical intervention when possible. These demands are growing and are being met by midwives. At the same time it is necessary to plan for the care of high numbers of women who choose the traditional model of active management of labour and epidural pain relief in labour, that accounts for over 60% of first time mothers.
In-Service Education
The midwifery department now has the support of a Clinical Practice Development Team including a Clinical Practice Development Coordinator and Clinical Skills Facilitators. These midwives have been appointed within the last year. One of their functions includes assisting new midwives in adjusting to the new environment and developing orientation programmes and continuing education lectures and programmes to keep staff up to date with new developments.
Journal Club
This is a monthly meeting organised by the midwives to disseminate newly published research articles. All midwives are encouraged to participate and contribute by presenting occasionally.
Information for New Midwives working in the N.M.H.
Number of Midwives and Nurses employed Full & part-time - 400 approx.
Student midwives - 66
Number of Births in 2007 Approx 8400 births
Number of Beds
Antenatal (A/N) - 24
Postnatal (P/N) - 66
Private P/N - 13
Delivery Unit - 9
Neonatal Unit Cots – 35
Midwifery Management Structure - Titles and Explanation of Roles
Director of Midwifery & Nursing –
Assistant Director of Midwifery & Nursing (ADOM&N)
Clinical Practice Development Co-ordinators (CPDC)
Clinical Midwifery Manager 3 (Unit managers in charge of large departments)
The CMM3 post exists in some departments where there are larger numbers of staff and other promotional grades, e.g. Neonatal Unit, Delivery Unit, Postnatal Services, Fetal Assessment, Community Midwifery services, Operating Theatres.
Clinical Midwifery Manager 2 (Ward Sisters) are appointed to manage individual departments and wards throughout the hospital.
Clinical Midwifery Manager 1
The role of the CMM1 involves assisting the CMM 2 in the day to day management of the ward or unit, including taking responsibility for looking after new members of staff and student midwives and acting as shift leaders in the absence of the CMM 2
Staff Midwife
Midwives at ward level take responsibility for the provision of midwifery care to women and babies in their charge and to undertake duties assigned to them by the CMM in charge of the unit.
Hours of Employment = 39 hours x week
The hours per day vary depending on the particular ward the midwife is allocated to. Some of the units have rosters based on long days while smaller units/wards have shorter shifts:
Day Duty
3 long days – 8am to 9pm over 7 days 4th long day every 4th week
or
5 shifts – example 8am -2pm, 2-9pm, 8am -9pm, 2-9pm, 8-2( 2 days off)
Night Duty 7 nights x 9pm-8am 7 nights off
Duty rosters
The ‘off duty rosters’ are organised at ward level by the Sister/ Ward manager and requests for time off and annual leave are made directly to that person.
Salary
Pay scales for midwives are attached for your information
The average first year salary is €30,339 (Gross), Tax rates are at 20% when gross pay is below €33,000. Deductions also include PRSI and Pension
Example of calculation of net pay (January 2008)
Gross salary per yr €30,339
Tax 20% (-allowance) € 3,139
PRSI (social insurance) € 1,900
Pension (refundable within 2 yrs) € 1,500
Net Pay per year (approx) € 23,800
€233 (before tax) monthly midwifery qualification allowance
Annual leave entitlement
Midwife with 0-5 years experience = 24 days (4weeks 4 days) 9 bank holidays
5-10years = 25 days (5 weeks) 9 bank holidays
Note: Holidays are calculated based on an 8 hour (not 13 hours) working day over 52 weeks of year
Holidays
should not be pre-booked until the ward manager has agreed the time off with the staff member and it is not possible to book more than 2 consecutive weeks holidays at peak holiday times (e.g. Summer months June July August or over the Christmas period) as this may limit other staff from availing of holidays
Sick leave
This is not paid for the first six months. All sick leave must be certified if more than 2 days taken.
Accommodation
It can be difficult and expensive to find accommodation in or near the city centre. For this reason the hospital attempts to facilitate new staff by providing short term accommodation near public transport connections to the hospital. This is provided on the basis of shared rooms in most cases. The costs per person are approx €325 for a shared room and €440 for single room if this is available but generally the rooms have twin beds and must be shared. An additional cost of €50 is charged to cover utilities bills. When more familiar with surroundings, many midwives and nurses will find their own accommodation if shared arrangements do not suit.
Uniforms
The hospital will provide uniforms, (2 tunics & 2 trousers) in accordance with Hospital specification. The costs of the uniform is then paid out of the midwives salary at a rate €25 per month over 4 months. Midwives are requested to wear the correct and complete uniform at all times while on duty. Midwifery and nursing uniforms consists of WHITE TUNIC with NAVY trim, NAVY trousers and NAVY shoes. Changing rooms are available in the basement of the hospital and we kindly ask staff not to wear their uniform outside of the hospital.
Medical Indemnity (Insurance cover)
When a midwife or nurse is employed to work in NMH, he or she is automatically insured by the hospital indemnity scheme. This means that if there were legal issues in relation to a particular case involving the staff member, the hospital would take financial responsibility for providing cover and legal assistance.
Health Insurance
All E.U. nationals are covered for health insurance by EU legislation (E111 health insurance forms). If not intending to stay in Ireland permanently, it is not necessary to buy private health insurance policies such as V.H.I. or BUPA as these policies require contributions for a minimum of six months before any claims can be made.
Transport
There is no car parking facility within the hospital as there is a long waiting list for staff. If on night duty, staff may use the small car park. It is advisable to purchase ‘rambler’ tickets from the local train station for use on trains, DART services, LUAS or buses for approx €55 per month.
Crèche Facilities
There is a crèche in the grounds of the hospital with availability of places for children at a cost of approx €140 per week.
Canteen Facilities
Subsidised meals are available in the hospital canteen.
Bank Account
The hospital will assist new staff in opening a bank account in a nearby branch of Bank of Ireland. Salaries are lodged directly into the bank on the 28th of each month.
Occupational Health
When a new staff member is employed in the hospital, the medical screening includes assessing immunity to Hepatitis B, Rubella and Varicella (chicken pox). If a prospective employee knows his or her status and has documentation of immune status, it may not be necessary to repeat these tests. All new employees are requested to complete a health questionnaire.
Useful Web Addresses
Hospital Website – www.nmh.ie (useful links to many health related sites)
An Bord Altranais – www.nursingboard.ie
Dept of Health and Children – www.doh.ie
Irish Times – www.ireland.com
Aer Lingus Airline- www.aerlingus.com
Ryanair – www.ryanair.com
Accommodation Websites
Active Management of Labour - References
Turner,M.J, Rasmussen M.J.& Stronge J.M.(1991) Active management of labour. Fetal Medicine Review 3, 67-72.
O’Driscoll K. Meagher d, & Boylan P., (1993) Active management of labour, Mosby, London.
Stronge J. &Keane D. (1996) The First Birth: A Unique Experience. The Diplomate Review 13- 17.
In-Service Education
The midwifery department now has the support of a Clinical Practice
