HSE proposal on limiting home births ‘irresponsible and dangerous’

A HSE proposal to limit home births to women who live within 30 minutes of a maternity hospital has been described as “not evidence based”, “irresponsible” and “dangerous” by Social Democrats TD Holly Cairns.

Ms Cairns has told the Dáil it would have “far-reaching consequences” for families in rural Ireland who would be “denied access to these maternity services”.

“Home birthing would be prohibited in large areas of Cork, Kerry, Clare, Galway, Mayo, Donegal, Monaghan and Wicklow,” the Cork South West TD said on Wednesday. “This will impact thousands of families.”

The HSE National Women and Infants Health Programme recommended earlier this year that “from a clinical perspective it would be safest” that all women accessing the HSE National Home Birth Service would reside 30 minutes or less blue light distance from their nearest maternity service.

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Last Sunday, women from rural areas and their partners and children were among a group of 250 people who attended a protest in Cork to register their anger at the proposed HSE recommendation.

Ms Cairns said the proposal has been met with “shock” from midwives and women and that midwives associations have “come out strongly against this plan”.

“Those who it directly impacts do not want this, the healthcare professionals who run the service do not want this,” she said.

“Why is it being proposed? Who is pushing this agenda and why? This must be a political or managerial decision because it is not evidence based.

“Home births are safe, the current systems has functioned well, they should be improved and developed, not shut down.”

Minister of State at the Department of Health Frank Feighan said the HSE’s National Home Birth Service moved from community operations to acute operations within the HSE earlier this year.

“The home birth service is now being integrated into the maternity networks in line with the National Maternity Strategy,” he said.

“As part of this transition, the HSE’s National Women and Infants Health Programme, NWIHP, was asked to provide more specific guidance at national level regarding the appropriate distance a woman should live from a maternity hospital while accessing home birth services and to make a recommendation on this issue.”

Using both obstetric and midwifery expertise, the NWIHP issued a national guidance on home births on July 14th recommending, from a clinical perspective, that it would be safest that all women accessing the HSE’s home birth services would reside 30 minutes or less blue-light distance from their nearest maternity service, he said.

Mr Feighan said the NWIHP took into account a range of factors, including the historic transfer rate into maternity units of mothers who laboured at home in the national home birth service, the primary reasons why women were transferred, the method of transfer and the need to factor in ambulance response times.

“The HSE’s recommendation addresses the balance of risk that needs to be considered for home birth services,” he said.

The junior minister said he noted the recommendation had caused concern for some and that analysis carried out indicated that coverage will remain for 83 per cent of the female population of childbearing age.

Midwives in the community say the change would have a major impact on women living outside of cities.

The protest was supported by AIMS Ireland, The Midwives Association of Ireland, Better Maternity Care, The Doula Association of Ireland and the Community Midwives Association.

AIMS chairwoman Krysia Lynch said Ireland has an extremely limited set of choices with respect to maternity care. There are no birth centres and very few midwifery-led options, unlike what you would find across the border in Northern Ireland for example, she said.

According to the CSO’s vital statistics, published on October 28th, almost all births in 2020 – 99 per cent – occurred in hospitals.

There were 314 domiciliary births, such as home births or births that take place in a location other than a hospital, in 2020, 54 more than the 260 recorded in 2019.