A ‘game-changer’ in ante-natal care

The individual framed photographs of the Evie Clinic’s team are all the same size and hang in strict alphabetical order on the wall of the entrance lobby.

It's something obstetrician and gynaecologist Prof Sean Daly is keen to point out as being symbolic of the equality of the medical and non-medical personnel that he has gathered together to provide what he describes as "a game-changer" in ante-natal care.

The name Evie was chosen because it is the Hebrew word for life.

"There is nothing like this, I think, in the world," he says about the new venture, which also involves the current Master of the Rotunda, Prof Fergal Malone, and five other consultants.

I vowed never to do that again, so what the hell am I doing?

---

Study shows children raised by same-sex parents do as well as those raised by heterosexual parents

---

‘Fruit juice may be as bad or worse than soft drinks’

---

Seated on a small couch in a consulting room at Evie, which is housed in the glass and tiled edifice of Beacon Hall in the Dublin suburb of Sandyford, the grey-haired Daly grins with boyish enthusiasm as he talks about what they are doing and why.

He believes it’s the cohesive nature of the multi-disciplinary, wrap-around care that Evie offers, ranging from the consultants, the high-end scanning and pre-natal screening, to expert advice on diet, exercise and mental health, which sets it apart. A one-stop shop, so to speak, with a big emphasis on psychological well-being, which is “something that is missing”, he says, from the general maternity system.

Medical and non-medical elements don’t always cohabit so happily and sometimes it seems as if practitioners have two separate agendas.

“They shouldn’t be competing – everybody has a role to play and I genuinely don’t think mine is any more important than anybody else’s,” he says.

During almost 30 years in obstetrics, including a stint as Master of the Coombe Hospital from 1999 to 2005, Daly has seen the lifestyle, knowledge and mindset of couples having babies change hugely, while the system of ante-natal care hasn’t.  “We haven’t made the effort to keep up,” he remarks.

A significant departure from the norm in Evie is postponing the post-natal care sign-off from six weeks to three months. “I think six weeks is too early to say ‘goodbye, good luck, see you next time’,” says Daly, himself a father of four children, aged between 22 and 16.

“When I think of my own situation – and my wife [Carmen Regan] is also an obstetrician – when we first had our baby, everything changed. One day you can just decide to go to the movies, the next day, although it is wonderful, it is a total change.”

One-third of women in Ireland don't get any scan at all during pregnancy

After the birth, the first two weeks are all about the baby, he points out. “This little eight-pound bundle takes over your whole life in a way that is inexplicable.” Over the next four weeks, couples are only beginning to find their feet as parents.

“I think by three months if you are still really struggling, we need to know about that because occasionally couples are still really struggling and then they need a whole different level of support.”

While Evie has been designed with what he regards as today’s very discerning women in mind, the complete package is only for those who want, and can afford, private, consultant-centred maternity care. However, there are also stand-alone services, such as scanning and non-invasive prenatal screening, that can be used on a once-off basis.

All expectant mothers in Ireland are entitled to free maternity care – covering antenatal visits, labour, delivery and postnatal care. But those signing up with a consultant here can expect to pay between €3,000 and €3,900, depending on who they choose, and those fees are not covered by health insurance, unlike the cost of private accommodation in the hospital around the time of the birth.

Evie patients still need to register at the Dublin maternity hospital to which their consultant is attached and this involves a booking visit at that hospital, but the rest of their ante-natal care and post-natal care will be in Sandyford. However, it is not any more expensive to attend Daly or any of his colleagues as a private patient at Evie than it is to go to their private clinics in the Coombe or the Rotunda.

At present, there is no consultant from the National Maternity Hospital on the team but he hopes that won’t be the case for much longer.  When setting up, Daly spoke to every private obstetric and gynaecological consultant in Dublin and he believes the lack of interest shown by those at Holles Street was because the part of the hospital that houses the private clinics had been recently refurbished.

“So they felt, I think, that they have it. I don’t think they do, because they don’t have all the other bits. But there is somebody in Holles Street who is considering coming out here.”

Currently, Evie is offering any pregnant woman, whether she intends to go public or private, a viability scan between seven and 12 weeks, free of charge.  Yes, this is to encourage them to step in the door and see what Evie is about, agrees Daly candidly, but “I actually think it is very important from a medical, obstetric point of view”, he stresses.

“You can see the foetal heart from seven weeks and reassure them. Women are understandably nervous – getting that first scan and seeing that everything is okay is incredibly important.”

Yet a third of women in Ireland don’t get any scan at all during pregnancy – an issue on which Daly spoke to the Joint Oireachtas committee on Health in May this year. He pointed out that there is a huge geographical variation in the care offered to pregnant women in Ireland:

“If one is lucky enough to live in Dublin every woman, irrespective of her income, will have at least one anomaly scan. However, that is not the case throughout the rest of the country.”

He told the committee the lack of a foetal anomaly scan was a “tragedy”, which “can result in tragic consequences for the baby, if it is born with a significant abnormality and born in the wrong place”,  ie in a hospital without the facilities and trained staff to deal with the ensuing emergency.

Daly is glad to say that in the Coombe, where his public practice is all high-risk pregnancies, every woman gets an early scan and an anomaly scan, “no matter who you are”. At Evie, patients will get a scan on every visit, including three formal scans – an early one, an anomaly scan at 21 weeks and a growth one at 36 weeks.

The origins of Evie lie in the Irish Maternal Foetal Foundation, which Daly and Malone, both specialists in maternal foetal medicine, set up in Beacon Hall 10 years ago to offer the most precise diagnostic tests available. After Daly went to work in Mount Carmel, just five months before it closed in 2014, he found it suited his private south Dublin patients better to see him in Sandyford, rather than in the Coombe.

“What couples want is somewhere that they can get reassurance; somewhere that is easy to get to, is accessible, that they don’t have to worry how they are going to park their car and all that additional stress.”

In looking at developing and rebranding the clinic, the message that came back from focus groups was “everybody loves their consultant”, says Daly, “but actually women want more than that. They want a midwife involved, they want lactation consultants; women want to have reliable experts to advise them on what exercise to do – mindfulness, physiotherapy, dietetics . . .”

He reckoned they should be able to provide that and he started to hand-pick a team of individuals with the right expertise, be it in mindfulness, yoga, Pilates, healthy eating, when it came to pregnancy matters. They speak at free education evenings but are also available for one-on-one consultations at reduced rates.

Take, for instance, the question of exercise. “Most women before they get pregnant are in the gym, or doing something, and then they get pregnant and they want to know can they continue to do it? And to be totally honest, they probably can’t – to the same intensity, do the same exercise,” says Daly.

“So, you do need people who understand pregnancy to advise people on what they shouldn’t do.”

We know anxiety is on the increase – particularly, it seems, when it comes to pregnancy and parenting – so Daly sees the value of reassurance.  Patients have to know only one telephone number – connecting to office manager Monica Hembrecht – to locate the advice or service they might need at any stage.

Every patient having time with the same midwife on every visit to the clinic is another key part of relationship building. “Because Annette [Mulhern] isn’t a doctor and is a very warm individual, I think people open up to her in a different way than people might open up to me,” he says.

Having one person that you can contact when you really feel under pressure is something that is missing from the maternity system, he suggests. That feeling of being overwhelmed can happen before the baby is born but, he thinks, is more common afterwards.

Couples sharing the same due month are invited to join a What’s App group for friendship and peer support. Mulhern is a member of each of those groups, ready to chip in with her expert advice if the need arises.

Although he is endeavouring to offer a more holistic approach to private patients, Daly believes mothers and babies are generally served well by the public maternity system – at least in the Coombe, which, he stresses, is the only hospital he can speak for.

“Consultants show up to their clinics and give good care; there are a lot of sub-speciality clinics in the Coombe – medical disorders, preterm birth, rhesus – so everybody who has potentially high-risk elements is seen separately by teams of consultants.

“Is the public service financed to provide Pilates and the like? It’s not,” he continues. “Should it be? Well maybe it should be but currently it’s not.”

When Evie patients will, for labour and delivery, be going through the same system as any other pregnant woman – albeit with their consultant in attendance at the birth – would Daly say this new service increases the chances of a healthy baby?

He pauses before choosing his words: “Do I believe it does? Yes, I do, to be honest.”

Why? “Because people are watching you so carefully. Things get missed sometimes – for a variety of reasons. If you have a woman with a BMI of 60, then you might miss the size of her foetus.

“If you are looking at babies all the time, if you are scanning it, if you are on top of it, then you are much less likely to miss things. I am not saying people do miss things but in a service such as we are providing, I think you are less likely to miss things.”

Although only currently available to a privileged few, if this Evie (evie.ie) model of a pregnancy care hub proves successful, then people will take notice, says Daly.

"Michael Turner is head of obstetrics in the HSE and I am sure he would love to be able to offer this to every woman in Ireland," he adds. "He is a caring doctor and I think this is the way to go."