More and more Irish women are opting for home births, despite strong resistance from the medical profession and research that suggests a woman is four times more at risk of losing a baby born at home. Now a new pilot project at University College Hospital Galway is offering "low-risk" pregnant women the choice to have their babies at home under the supervision of a trained midwife. The 1970 Health Act stipulates that women have a right to a home birth irrespective of their medical circumstances. In Britain, it is a medical decision whether a woman has the right to home birth.
Of the 50,000 babies born in Ireland last year, 140 were home births, a small but growing minority. The fact that women are prepared to have their babies at home even without the backup support of medical services prompted the CEOs of the health boards to set up a national committee in 1977 comprising obstetricians, midwives and interested parties to examine the whole issue.
On the recommendation of this expert group, the Department of Health set up a series of home-birth pilot projects, with the task of coming up with a set of guidelines on the best way of providing a national service. The most comprehensive project is based at University College Hospital Galway; the others are at Holles Street in Dublin and University College Hospital Cork.
Clinical co-ordinator of the obstetrics/gynaecological and paediatric division at UCHG Dr Michael Mylotte, the obstetrician in charge of the home-birth project, explained that there had been a demand for home deliveries in this country for many years even though they were perceived as dangerous by the medical profession and the general public.
He explains: "In general most people fear that going back to home deliveries is a regression, a backward step. A lot of money and resources were spent setting up obstetric units in the not-so-distant past, and now some people are choosing not to have their babies in hospital on the grounds that they are more likely to be interfered with during labour."
He points out that the law in Ireland has created difficulties for the health boards because, if a woman has a right to a home birth, the health boards are responsible for providing this service. The project might recommend that this law be changed.
In the past, the Ombudsman has received complaints from woman who were not getting home-birth services from the health boards, and some women have even gone to the High Court to fight for their right to give birth at home.
Dr Mylotte says: "Doctors know home births are more dangerous, not only to the mother and baby but to themselves, and they have strongly resisted the idea over the years. Even if you choose the safest mother to have a baby at home and provide her with the best services, there has to be a greater risk to both mother and baby. I would prefer for the safety of the baby and mother if all births were in hospitals.
"Even there we can't guarantee total safety, even with all the back-up equipment and skills. If we can't achieve 100 per cent success in hospitals, how can we achieve it at home?"
The chances of a baby dying during childbirth in hospital are one in 1,600, whereas Dr Michael Mylotte says research findings from the US and Australia show that one in 400 planned home-birth babies die. About one-third of mothers planning home births end up being transferred to hospital as a result of various complications.
The home-births pilot project was set up at UCHG last November and the first "pilot" baby was born on March 9th. There are very strict criteria for women who want to join the project, covering medical, physical, psychological and social issues. At present there are eight women in the pilot but since November, there have been more than 40 inquiries from women of all ages and backgrounds, including first-time mothers.
There are three options in the scheme. The first is the home birth where the project midwife provides combined care - along with the GP - to the woman before the birth and looks after the woman during labour in her own home. Post-natal care is provided in conjunction with the GP and public health nurse.
The second option is the domino care situation, where the midwife and GP again provide ante-natal care and the midwife provides assistance at home during the early part of labour, before the woman is transferred to hospital where the midwife continues to work with her. The woman is discharged post-delivery within three to six hours - except in cases where complications arise - and the midwife continues to provide care for a few days before handing her patient over to the care of the public health nurse.
The first two options are provided to public patients only, but a third option, of early discharge within three to six hours after a hospital birth, is open to public and private patients who have had a normal birth with no problems.
Divisional nurse manager over obstetrics and gynaecology at UCHG, Mary Boyd, explains that the midwife is trained to deal with all normal deliveries, ante-natal and post-natal care and would immediately transfer the patient to the care of the obstetrician should any complications arise.
Midwife co-ordinator on the home birth project, Annemarie Staunton, explains that the project is not just about the mother-to-be, but involves the partner or husband and his feelings. Information leaflets will be distributed to hospital staff and women who are interested in the idea of a home birth.
More information on the Galway project is available from the midwife co-ordinator's office: tel 091-524222.