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National Maternity Hospital Home Birth Figures for 2014

The National Maternity Hospital at Holles St (NMH) has been offering a home birth service since 1999  to low risk women living within Community Care Areas 1, 2 and 3 in South County Dublin.

nmh catchment
National Maternity Hospital Home Birth DOMINO area. Home birth catchment is area 1, 2 and 3. Taken from

Last week they released their home birth figures for 2014.

In the period January to December the NMH Community Midwives team facilitated 40 home births. These can be broken up into first time mother births (nulliparous) and second time mother or subsequent births (multiparous).

Seven first time mothers gave birth within the scheme and thirty three second or subsequent time mothers, totalling 40 home births in all.

The number of mothers who planned to have a home birth and booked in with the scheme stating their intention to have a homebirth was 60 (20 first time mothers and 40 second and subsequent birthing mothers). Women transferred out of the scheme for a variety of reasons; some were antenatal (eg post dates), others were during labour (eg slow progress, others were due to maternal request for pain relief or meconium staining in the liquor). There were no transfers due to fetal compromise following birth.

The overall rate of transfer to hospital care in 2014 was 33%. This can be divided into first time mothers and other mothers as follows; in 2014 the percentage of first time mothers who signed up for a home birth and who achieved one was 35%, (65% did not) and the percentage of second or subsequent mothers who signed up for a home birth and achieved one was 83% (17% did not).

The NMH Community Midwifery Team 2008. Taken from

In 1999 – 2011, of the women that booked for a home birth, the percentage of first time mothers who achieved a home birth was 46% and the percentage of second and subsequent mothers who achieved a homebirth was 83%.

The figures for 2014 match this percentage of achieving a home birth for multiparous women (83%). but a significantly lower number of first time mothers achieved a home birth as planned than in the time period 1999-2011 (35% compared to 46%). This could be due to a number of factors. Since the total population of first time mothers planning a home birth is so small (20), individual variations can have a large statistical impact.

Since the criteria for risk assessment has remained the same throughout the scheme, and the criteria of transfer have also remained the same it is hard to identify particular reasons. It is possible that as with other aspects of the Maternity Services, the Community Midwives in the NMH are under greater pressure with more and more ETH (Early transfer Home) clients and tighter schedules. Could this affect the transfer rate of first time mothers? It has also been noted that the NMH is not currently in a position to extend or expand the home birth service, so perhaps more emphasis is being placed on recruiting first time mothers for the less labour intensive DOMINO scheme rather than the home birth scheme. Hopefully, it is an anomaly that will be redressed in this year s figures!

brothers-457234_1280In 1999 – 2011 taking the total number of births into account, the ratio of first to second (and subsequent time mothers) achieving a home birth with the scheme was 17%  to 83%, This is repeated with minimal deviation  in 2014, with the ratio being 17.5% to 82.5%.

The figures from the National Home Birth Scheme as presented by the HPO have not yet been released for 2014, so we cannot say what proportion of home births nationally  the NM home birth scheme accounts for. However, the figures from 2013 for the National Home Birth Service were released by the HPO recently. and the number of home births attended by independent midwives on behalf of the HSE totalled 162 births. Assuming these figures are relatively consistent for 2014 it is reasonable to assume that the NMH home birth service accounted for some 20% of home births in Ireland. (Note there were some private home births carried out during 2014 by a private midwifery company but no figures are available on these yet, and since the service only started in the final quarter of 2014 the figures are not yet likely to be large enough to alter a 20% odd share held by the NMH)

file0001174312433The home birth service provided by the NMH is a public service run through the HSE. Its main appeals quoted by mothers are that it is free, that there is continuity of care should there be a need for transfer to the hospital, that ambulances are put on standby when the mother goes into active labour, that distances to the hospital are no more than 20 minutes in rush hour traffic, that the risk criteria are not as tight as those used in the MOU, e.g. a higher BMI is acceptable, and women over the age of 40 are routinely accepted onto the scheme and that hospital services are very easily accessed antenatally and postnatally.

The downsides to the service quoted by mothers is that not many of the visits occur at home, that there is a team of midwives so there is no guarantee as to which of them will be with you in labour, that since the scheme is run from a hospital that prides itself in active management, some of this ethos might pervade the community midwifery team and finally that even though the scheme supports women labouring in water, it does not support water birth itself, and women are asked to stand up out of the pool or get out of the pool for the birth if they have been labouring in water prior to the birth.

The Community midwives at NMH can be contacted at (01) 637 3177

Second time mum’s  home birth story birthing with the community midwives in the NMH
More information on the Community Midwives(Home birth DOMINO and ETH at the NMH
More information on the home birth service from the Community Midwives at the NMH
Community Midwives Labour and Birth tips preparation and information
Booking form for the Community Midwives at the NMH for a home birth
Other Home Birth Services in Ireland

Going to the UK to birth William; a HBAC

In this guest blog Home Birth Mother Rachel Singleton shares her birth story.

For my first birth I had an emergency c/section due to a breech presentation. In order to secure a HBAC (Home Birth After Cesarean) for this my second baby, I had to birth in the UK. I was due to sit my midwifery final exams in TCD in Dublin in early December 2013 and William was due at the end of December. I was studying away the week before the exams when my daughter became very ill and couldn’t go to crèche. I was petrified of having to give birth in a hospital if I went into labour before I got to England. The stress of the whole situation caused my body to give off signs that labour was imminent and we made the decision to travel to the UK early – just in case – especially since my little girl had arrived at 37 weeks. This was December 3rd 2013.

Days and weeks passed and nothing happened, my due date came and went, the birth pool which had sat in the living room was now hidden under the bed upstairs well out of sight. My husband had to return to Ireland for a meeting on the 3rd of January. After all this time waiting we didn’t think William was going to show up at all!!! I got up at 6am on the 3rd of Jan 2014 and dropped Mark to the airport and came home for a nap.

I awoke feeling slightly odd; seeing as Mark was in Ireland I thought I would check to see if my cervix had started to dilate, I was shocked and horrified to find that I was 4cm dilated, after a NAP!! Then the contractions started!!

The reality of birthing in a home that isn’t really your home is that you can find yourself alone. That’s exactly the reality I faced. I was alone – well I had my 22 month old daughter for company, but essentially I was alone.

I rang Mark and told him to come back to England ASAP. Alone with my daughter, I brought her downstairs for breakfast. NOW contractions had started coming regularly and hard. I had to lie on the floor each time one took over my body, my daughter would stand over me rubbing my head asking “K mommie?”

The next task was the pool. I had stored it out of sight under the bed up stairs, I went up and dragged it out – between contractions – pulled it down the stairs and set about trying to blow up the pool up. First the seat, then the two lower sections. Then, on my own and alone I had to fit the cover, Finally I blew up the last section of the pool.

Contractions had started about 11am and this was now about 1pm.
I did call my midwife and my mother in-law and both were trying to get to me.

Pool finally up and now the contractions were very powerful and all-consuming; my poor daughter was toddling around the room entertaining herself while I tried to fit the hose to the tap in the kitchen to fill the pool in the living room.

Finally fitted I dragged the hose from the kitchen into the living room. I went back to the kitchen and turned on the tap – back to the living room – too cold, back to the kitchen turn up the hot, back to the living room, too hot now – and so on until I had the temp right.
Mark called, there were no flights till 3pm or 8pm; we were in real danger of him missing the birth and of me being alone the whole time. My daughter is the only real witness to my labour. By now I was in the pool and in a world of my own as she watched on. Finally, my mother in-law arrived, she took Lottie and left me to it. Alone, but in my own lovely labour space, and in a way I was exactly where I wanted, and needed to be.

I was alone for most of the actual labour, which I quite liked, but this was a tough labour, with my daughter’s labour I had felt no pain with contractions, but this time around it was so intense I remember thinking I would like to have the forceps, or at least an epidural. Each contraction I worked through I had to talk myself into staying where I was. I just wanted a break from the contractions!! Being alone was though, and as I was finding the contractions hard work I would tense up with each one and breath heavily, trying to contain or control each powerful wave, and that was using a lot of energy. The powerful feeling inside me was so strong, it felt like my body was trying to take off and I was trying to hold myself onto the ground.

At 2pm I check myself again and I was fully dilated and still alone. Mark was in Dublin airport waiting for his now delayed flight. By 15:15 a midwife was with me and Mark was still in Dublin!


With the midwife by my side now she told me to try and relax with each contraction instead of tensing, so with the next one I let my body relax and go floppy; I just gave into the power of the contraction. This was birth scary and empowering. Relaxing didn’t make it less intense but it helped me give into labour and let go. I had to succumb to the power of what was going on in my body and give up trying to contain it.

Soon after 3pm I began pushing, pushing removed all the pain of the contractions but it was hard work and I was exhausted, I have never pushed so hard in my life and each time a contraction came I had to work hard to do it. If I pushed there was no pain, but I was also too tired to push, so I made a deal with myself, push with every second contraction, take the pain on the others, Mark STILL wasn’t with me.
Asking where he was and waiting for him, kept me in the here and now and prevented me entering that relaxed detached state where you let labour take over. I had to stay present and worry about where Mark was and when, or if, he would make it. I pushed for what seemed like hours and got, I felt, nowhere. The reality was that I had been pushing for almost two hours. At this point I was declining fetal heart monitoring as I couldn’t stand to be touched and I knew my baby was OK. It seems ridiculous now, but I was talking to him and we were working together to complete his birth. Having someone put a Doppler to my stomach every 5min was only disrupting this delicate process.

In the UK two midwives are always present for a birth and as it appeared that Mark would miss the birth, I asked that the second midwife to start photographing the birth, once she started she kept going until he was born and we have ended up with a lovely record of the birth.


When I really felt I could no longer push any more Mark finally arrived. It was now 5:15. I had been desperately missing him to pull on, his strength helped me push and I needed him to ground me and give me renewed strength.


Now I pushed in earnest. It felt like forever, then the midwife said the head had crowned but wasn’t fully extended, The head felt massive and I was scared to push it out completely but had no choice. Then I felt a massive “pop” and the head was out, I remember saying to the midwife “Oh no, I think I ripped”. Then the contractions stopped and I had a rest, my son had decided to come as a compound presentation with his hand right up by his face. This was part of the reason that pushing took so long and so much effort. After a while I heard the midwife say to Mark, “If the baby doesn’t come with the next contraction I’ll need her out of the pool”, I started to panic, thinking I was going to have a shoulder dystocia. The next contraction came and the midwife pulled William’s hand straight to assist him out. When he was finally born I physically couldn’t pull him up from under the water due to a combination of my exhaustion and his sheer size, we later found out he was a 4,1kg or 9.3 lb baby; a massive size for a first vaginal delivery with a compound presentation!

Then we all sat in shock, amazement and thanks. We were all here to see Williams first peaceful breath in (almost), our own home!

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Home Birth After Cesarean (HBAC) in Ireland