New an­te­na­tal care clinic de­scribed as a ‘game-changer’

Evie Clinic is a one-stop shop for high-end scanning and pre-natal screen­ing, plus ex­pert ad­vice on diet, ex­er­cise and men­tal health

The Irish Times - Tuesday - Health - - Parenting Pregnancy - Sheila Way­man

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’

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 Seán 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 an­te­na­tal 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.

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 mul­ti­dis­ci­plinary, wrap­around 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 well­be­ing, 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 an­te­na­tal 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.”

All about the baby

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 an­te­na­tal 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 in Ire­land – 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 ( 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.”


Ob­ste­tri­cian Prof Seán Daly, who has founded a new, mul­ti­dis­ci­plinary “well­be­ing” preg­nancy care ser­vice in Sandy­ford, Co Dublin.

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