Access to homebirths 'a postcode lottery' for many women, audit finds
There were 231 homebirths during 2019, rising to 272 in 2019, and 345 in 20202.
Despite a steady increase in the number of women opting for a homebirth, access to the service remains "a postcode lottery" with some regions not having any community midwives, a clinical audit has found.
The National Perinatal Epidemiology Centre audit of the public service covers the years 2018-2020 and found there were 231 homebirths during 2019, rising to 272 in 2019, and 345 in 20202.
The number had continued to increase since 2016 when there were 192 planned homebirths registered with the service.
The figures do not account for homebirths registered with private services.
The audit found: “The geographical distribution of home births is reflective of the number of SECMs (self-employed community midwives) available in each region.”
The HSE south region including Cork, Kerry and Waterford accounted for 36.8% of homebirths in 2020, reflecting the higher number of midwives there, the audit states.
The HSE south-east region, including Wexford, had 4.3% of all homebirths that year.
Numbers increased across Dublin and the mid-Leinster region during those years.
Over the three years studied 848 women registered for a homebirth.
Some 627 went on to begin labour at home, while 221 were transferred to hospital care due to complications identified during the first 40 weeks of their pregnancy.
Among those who started labour at home, 22% were transferred to hospital care, almost all during early stages of labour.
“More than 90% of intrapartum transfers occurred during the first stage of labour, potentially reflecting caution by the SECMs around the decision to transfer,” the audit found.
The audit shows over those years, three women required transfer during the third stage of labour. It states transfer figures are in line with international findings.
Overall this meant 489 babies were born at home.
The average age of homebirth mothers was 38, with range going from 18 to 44.
The majority were of white Irish ethnicity, the audit found.
“The numbers of Asian/Asian Irish (9), Black/Black Irish (2) and mixed ethnicities (15) are small and are under representative of the population for this triennial report,” it states.
“There were no Irish Traveller women who had a planned home birth for this triennial report.”
The National Perinatal Epidemiology Centre recommended all maternity units should identify a liaison obstetrician to work with their local homebirth service.
The babies’ health is also examined, with the audit saying 11 who were admitted to intensive care in hospitals were discharged “alive and well”.
On average women remained under care of a community midwife for two weeks.
Women who had a homebirth were twice as likely to be breastfeeding exclusively when discharged compared to all women who gave birth (95% versus 47%), the audit also found.
A liaison obstetrician is also available to women as part of the service. During 2018 this was available to 80% of women, to 82.6% during 2019 but only 60% during 2020.
The audit authors speculate this drop is linked to the pressures of the first year of Covid-19.
They also recommended designated midwifery officers continue expanding how data is collected.
The audit can be read at: https://www.ucc.ie/en/npec/npec-clinical-audits/plannedhomebirths/plannedhomebirthsreports/
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