HSE homebirth service audit finds no agreed national standard for travel time, says advocacy group

The HSE audit found there was no nationally agreed standard for the travel time between a woman’s home and the nearest maternity hospital. 

Advocacy groups have appealed for increased supports for the national homebirth service in the wake of a HSE audit finding weakness in its governance systems.

The HSE audit found there was no nationally agreed standard for the travel time between a woman’s home and the nearest maternity hospital. 

It also found "signs" of local governance, but no overall system is in place.

The audit looked at 30 homebirths linked to Cork University Maternity Hospital, the Rotunda, and Coombe Hospital in Dublin. 

Kara Spratt, from Births Rights Alliance Ireland, previously organised public demonstrations in support of homebirth services in Cork to protect its future. 

In late 2022, over 400 people protested against the proposals to limit the travel time criteria for homebirths to a 30-minute "blue light" distance  — the time an ambulance would take from the hospital to the home.

This 30-minute travel time is considered as a safety measure for homebirths, ensuring timely transfer to a hospital in case of an emergency.

Ms Spratt said the issues raised in the audit are more reflective of gaps in management approaches rather than criticism of the concept of homebirths.

“There are good and bad things about trying to standardise things nationally,” she said. 

“The problem arises when you try to apply one model to areas of varying geographical need. It doesn’t work.” 

She pointed out women travelling from West Cork to the maternity hospital in Bishopstown have “given birth on the side of the road all too often”.

This is different to women in Dublin City with three hospitals to choose from, she said.

“However, on the other hand, when you leave it up to the individual regions, you are completely dependent on the management structures there and whoever is in place at the time,” she said.

She cautioned against “bad will” about homebirth services, saying this puts barriers in women’s way.

Ms Spratt said women are "really lucky in Cork” as the service is so strong there, but she called for more support in other regions.

National service

There are 23 community midwives working with the HSE’s national homebirth service, leaving many areas without access to the home birthing option. The National Maternity Hospital in Dublin operates a separate service. 

The Private Midwives Ireland organisation closed abruptly for financial reasons in August, as did its British parent-group.

The Doula Association of Ireland, established in 2006, has also raised concerns about the audit, saying  “urgent investment” is needed. 

Chairwoman Anita Petry said: “The audit does not show that homebirth itself is unsafe. What it shows is that the HSE has failed to provide clear governance and sufficient resources. The risk lies in the system not in the choice of families."

She noted that the national maternity strategy expires next year, and she called on the Department of Health to establish a clear national governance system for homebirths.

“Since the 2022 HSE reorganisation, no single body has responsibility for homebirth oversight,” the association warned.

The service should be equally available in all regions and it should be fully funded, it added.