'It's taking a choice away from women and families'
A midwife has said that in her experience homebirth clients, including women using the free HSE service, mainly live in rural areas.
A midwife offering homebirths in the Mid-West said a proposal by the HSE to limit homebirths to people living within 30 minutes of a hospital would remove this option from most women in the region.
A recommendation on this from the HSE’s National Women Infants Health Programme is due to be discussed by the National Oversight Group for the HSE Homebirth service, the previously reported.
The HSE has estimated the change would remove this option from 20% of women, however midwives argue this is an underestimation.
Amy Moynihan-Benson, a private midwife working with Private Midwives Ireland, said in her experience homebirth clients, including women using the free HSE service, mainly live in rural areas.
“My fear now is this 30-minute distance, that is potentially being implemented, is going to knock homebirth for so many women out of reach,” she said.
“They are definitely more than half an hour from a hospital, the majority of them anyway.”Â
The impact would be immediate for any women looking for a free homebirth service, she said.
“It really hurts my heart for women, it’s taking choice away from women and their families,” the midwife, based in Kilmallock, Co Limerick, said.
“The HSE service is publicly funded and it is a buffer that helps women who are not able to pay privately.”Â
Separately, HSE homebirths across the Mid-West were recently temporarily suspended pending a review following the death of Laura Liston in Croom, Co Limerick.
Private services are not affected by any changes in HSE policy as PMI operates as part of a British company under guidelines approved by the UK Care quality commission.
As a result Ms Moynihan-Benson has seen her workload double since this embargo began, despite the significant price difference between private and public care.
“We have been contacted by a lot of women looking for a homebirth,” she said.Â
“My manager has been inundated with women calling, and there are some that I’ve had to knock back. It’s been really hard.”Â
She is now booked through to April, and unable to take more clients.
Costs for private midwifery packages range from €5,300 to €9,250, the PMI website states.
The HSE offered further information on their position on Friday evening.
A spokeswoman said homebirths make up 0.7% of overall birthing numbers, and said: “The HSE and its National Women and Infants Health Programme recognise that it is an important pathway for women.”Â
She said, as part of the move to place governance of the homebirth services under hospitals, analysis was done at the hospitals’ request on geographic locations of mothers applying for the service.
Up to now the guidance was: “Ideally, the woman should be transferred to an obstetric unit within 30-40 minutes from the phone call to the ambulance service requesting the transfer. However it is recognised and acknowledged that for many women it commonly takes 60 minutes.”
Data feeding into this analysis includes the historic transfer rate into maternity unit of mothers who started labouring at home under the National Homebirth Service. During 2018 to 2020 this rate stood at one in five or 136 women.
“If a woman has an emergency in a maternity hospital, and a category 1 Caesarean section is called, the woman must get to theatre within 30 minutes,” she said.
“In the event of a serious risk to a mother or baby in the HSE’s Homebirth Service being identified by the relevant SECM (self-employed community midwife) this recommendation is designed both to ensure the best possible chance of getting to a maternity hospital in a timely manner so as to ensure the best outcome for mother and baby, and to ensure that the clinical determination of the SECM is acted upon in a safe and timely manner by the wider HSE services including ambulance and maternity services.”
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