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65 Maternity and Obstetrics NMH Annual Rep t | 2020 Eimear O'Connor, Community Midwife. Domino/ETHP Postnatal Care The team combined the DOMINO and the ETHP visits in 2020, with the aim to providing equity within both services. For a period of six weeks, the hospital took the decision to offer the ETHP service to all women irrespective of care pathway during the height of the COVID-19 pandemic. This proved incredibly challenging to the team from a workforce planning viewpoint. The visits were challenging as we had to phone the women before entering the house to ensure they and the family members were asymptomatic of COVID-19. The families were exceptionally appreciative of this care. It is interesting to note that within the ETHP service there was a 23% overall increase in the numbers of visits completed as more women were choosing to use this service. In addition, women are requiring more visits due to the additional stresses and lack of external supports due to COVID-19 pandemic. The average number of visits per woman was 3.3. The PHNs and GPs in some areas were unable to provide postnatal care. External Clinics The ETHP team continued to provide clinics weekly in both Ballinteer and St. Michael's Hospital in Dun Laoghaire. The midwives continue to refer women back into The National Maternity Hospital if they need a consultant review. In addition, they women used their private health insurance and attended either semi-private or private care. 2. The 7% who did not return for delivery sited their move home due to the COVID-19 pandemic. 3. We had 39 homebirths in 2020. 6% of women who booked with our service during their pregnancy changed care giver to a Self-Employed Community Midwife or to attend the private midwives. The factors influencing their decision were that they fell outside our eligibility guidelines, they wanted an individual caregiver, or they were not in our catchment area for a homebirth. Intrapartum Care Of the 184 nulliparous women who birthed with the Community Midwifery Team, it is interesting to note that 27% required induction of labour. The indications for induction are the same as per The National Maternity Hospital Policy with the main reason for induction being Prolonged Spontaneous Rupture of Membranes (PSROM), advanced maternal age and postdates. It is also interesting to note that Group 1 of the Robson Ten Groups Classification of Caesarean Section was 7% with the overall Spontaneous Vaginal Delivery rate for nulliparous women at 60%. The only reason for the elective caesarean section for nulliparous was breech presentation. The multiparous outcomes can be seen in the tables. Once again, the induction rate appears high, but the team followed the NMH Induction Policy. 91% were SVDs with 4% elective LSCSs, once again for breech presentation. The epidural rate for our nulliparous women is 47% and 9% for multiparous women irrespective of pathway of delivery. We are excited with the installation of the hydrotherapy pool and suspect this will have a positive effect on the epidural rates by facilitating a greater choice for women. While the 32% episiotomy rate for nulliparous looks high, it falls to 18% of the women who had a spontaneous vaginal birth. Another interesting fact is the equal 3 rd -degree tear rate in both multiparous and nulliparous. Four women had a blood loss of >1000ml and the average blood loss was 400ml in both nulliparous and multiparous. The largest baby born was 4.95kg and the smallest was 2.78kg (induced for being small for gestational age). Breastfeeding One of the key success indicators is the rate of women feeding on discharge from the service which are given in the tables.