Category Archives: Home Birth Blogs

Birthpool

Using a birth pool for labour or birth at home

Many women consider using hydrotherapy during their homebirth, or even during the early part of their labour before they go to hospital. For some women this might mean using a shower or a bath and for others it means using a birthing pool. Some women on the other hand have no inclination whatsoever to use water. As with any kind of birth there is no right or wrong way to have a baby, and choosing water to ease the intensity of labour is an entirely personal choice.

For those women who are interested in having a pool hopefully this article will help with planning it. If you’re not sure if you’d like to have one or not, it’s worthwhile to have it there and ready so that if you do feel like being in water on the day, you have it as an option. And if you find you prefer dry land you can just get out. However so many women love having it and really feel it helps with contractions. Philomena Canning (SECM) calls it the ‘natural epidural’. This article was compiled from tips submitted by members of the Homebirth  Ireland Facebook group so huge thanks to all that contributed. I used a pool on all my births. Here is me and three of my kids in an (empty ) pool!

Birthpool

Having a water birth at home

Whether or not you can birth your baby in water or use it for labour will depend on what route you are taking for your home birth. The main options are:

  1. HSE Homebirth with Self Employed Community Midwife – in this case you will need to supply your own pool (see options below) although it is possible some Self Employed Community Midwives (SECM) have one they can lend.  List of practicing home birth midwives
  2. Hospital home birth services:
    • National Maternity Hospital, Holles Street Dublin – Domino Scheme. You can labour in a pool but not give birth. You will need to supply your own pool.
    • Waterford Domino / Home Birth Service – You can labour in a pool but not give birth. You will need to supply your own pool.
    • Wexford Maternity Unit – You can have a water birth with the Wexford Domino scheme although their home birth scheme is limited at the moment due to a lack of midwives. You will need to supply your own pool.
  3. Private service provider – Neighbourhood Midwives – pool and all accessories included with all of the home-birth packages. The pool supplied is the Birth Pool in a Box.

More information on accessing home birth services around the country here:
http://homebirthireland.com/how-to-organsie/home-birth-services-2/

Having a water birth in hospital

This article is focusing on home water births however, it is possible to have a water birth in one of Ireland’s hospitals at present (Mar 2015). The Coombe have one pool and started doing water births in approximately September 2014. If the pool is available i.e. there is not a woman labouring in it or giving birth and there are staff on duty that have experience with waterbirths when you want to use it, then it is possible to labour and give birth in it. However, you will have to have signed a conset form 24 hours in advance. Some of the other hospitals have pools you can labour in but you would need to get out before the baby is born. Pools also exist in Our Lady of Lourdes and CUMH.

Where to get a pool

  • You may be able to borrow a pool – your midwife or hospital home birth service may be able to advise.
  • There are a number of travelling pools and posting a request on one of the Home Birth related Facebook groups may get what you need. Simply search  home birth ireland on facebook
  • You can purchase a pool. The following site sells two popular birth pools – La Bassine and Birth Pool in a Box, along with their relevant accessories: http://birthingmamas.ie/shop

Note: if borrowing a pool it is essential to buy a new liner and hose for the birth itself for hygiene reasons. This can be bought on birthingmamas.ie also.Just be sure to buy the correct liner for the type of pool you have.

What type of pool

Birth pool trialHere are the sites with the detailed specifications such as the size, weight and other features of the more popular pools:

  • Decide what sized pool you would like. This might depend on whether your partner will be in the pool with you and what sized pool you would feel comfortable in. Remember that a bigger pool will take longer to fill and longer to get the water warm enough depending on your water heating system and the water pressure. Check out the specs of the pools above for more details. One persons experience: “I didn’t find the round smaller one to be that small. plenty of leg room for me, I’m 5’7. I had no intention on having anyone else in the pool with me though, if I did then the oval would be better option.”

Where to have the pool

  • When deciding where to put the pool in your home, make sure the floor can support it. According to the Birth Pool in a Box website the mini pool weighs 487kg when filled. This might determine whether you can have it upstairs or not for instance.
  • Make sure the pool is near enough to a tap – the hoses sold by Birthing mamas are 15m long.

Preparing – do a trial run

The top tip when it came to water birth was to do a trial run with inflating and filling your pool in advance. This is really important so that you find out how long it takes to inflate and fill it with warm water. This will also depend on your water heating system or immersion. The pool when 80% filled is approximately 5 or 6 bath fulls. It is particularly important if you suspect it will be a quick birth. Also this way you will find out if the tap attachments you have are the correct ones or if the pool needs to be repaired (if it’s not a new one). It also means that your birth partner is spending less time on the day figuring out how to inflate and fill the pool so they have more time to spend helping you. Doing a trial run will reveal any problems ahead of time when you still have time to resolve them and means you won’t have to worry about it or even think about it on the day. Check out the rest of the tips below for some creative ways to sort out any issues.

Heating the water

berco boilerThis can be the trickiest part of having a birth pool if your labour is quick or depending on your water heating system. A pool when 80% full is 5 to 6 bath-fulls of water. Here are some good tips and creative solutions provided by the Facebook group members:

  • In the last couple of weeks when you are ‘due’, adjust the clock timer on your hot water tank to heat the water (even on ‘sink’ ) regularly every 2-3 hours so it already ready to start the filling process in early labour, and once you suspect labour has begun you can switch it to ‘on’ and ‘bath’ for the next and ongoing fills. By preparing this way hopefully you will get a head start.
  • Turn on the immersion or heating as soon as contractions start.
  • You could use the hot feed under the sink – you can buy a copper fitting in B&Q for around €6. In this case there was already a valve in place – see image.Under sink hot feed
  • If you know you do not have great tank capacity, hire other ways of heating water in addition to your water tank and boiling pots of water on your stove or cooker e.g .gas camping stove or a berco boiler. You may be able to borrow a berco boiler from a local sports club, community centre or school.
  • Try filling the pool from an electric shower. You can just disconnect the shower head and fit this to the hose with a screw-on fitting that you can buy inexpensively in any hardware shop.

Inflating the pool

  • pool accessoriesYou will need a pump in order to inflate the pool – this should come with the pool. If it doesnt you will have to buy one as it would definitely not be advisable to try to do this manually!
  • Unlike a condom, the liner has to go on when the pool is not quite erect!
  • Inflating the mini Birth pool in a Box (pictured above) takes approximately 25 minutes using the goodbirh Electric Inflate-Deflate Pump.
  • If you have the space and think you may not have much time to spare on the day you could inflate the pool ahead of time and keep it in the room where you intend to use it (or another room if it will fit through the door). However, under no circumstances should water be left in the pool for long periods of time in the run up to the birth as this is a risk for Legionnaires’ disease.

Filling the pool

  • A Phthalates free Eco hose is what is recommended by the pool companies as there are can be chemicals in the other types of hose.
  • Several mothers stated that filling the pool from the kitchen tap via the hose took 45 minutes. For another contributor it took and hour and a half. However the time needed to fill the pool will obviously vary depending on your tank capacity and water pressure and of course will depend on how quickly the water is heated – see previous section on heating the water.
  • Fill the pool earlier than you think – especially if it is your second or subsequent baby. So for instance, begin filling it as soon as you feel contractions start. However if the water is in the pool for more than 12 hours there is a risk ofLegionnaires’ disease so pre-filling it too much in advance is inadvisable.
  • Find the strongest / fastest flowing tap – it may not be your kitchen tap, there could be a more direct line from the immersion tank, for example the tap in your under stairs bathroom.
  • If the water pressure is an issue and you have an outside tap – this might have better pressure than an inside tap – the pressure may not be good enough to pump water up into the attic but it may be available in an outside tap.
  • If you are on good terms with next door neighbours , they might like to be able to be helpful and run a hose from their house! Two hoses = half the time.
  • Don’t feel you can’t use the pool to your advantage unless it is ‘full’ ! Even having a third full can give you comfort and once your pelvis can be immersed you can birth in it. Check the pool for the minimum capacity line.
  • Even if you miss using the pool due to it not being ready for labour or birth continue filling it and get in once your baby is born and enjoy baby and soothing warm comfort.
  • Between pool and liner put in a bean bag – you can use it to get comfortable and rest on but it also reduces the volume of water needed if your tank capacity is low. However it would be a good to test this out in your trial run as the following story shows: “We did this with ours, but the pressure of the water made the beans solidify together so there was a big hard lump in the pool! Made it super difficult for me to get comfy at first and eventually we had to cut the liner and take it out. This resulted in not enough water volume in the pool and it only just made it in time for the birth”

Keeping the water warm

  • The water should be between 32 and 38 degrees Celsius for labour.
  • Remember that is is easier to add cold water if it is a few degrees too warm than to heat it up – however check your pool specifications as it can weaken the pool if the water is too hot.
  • If topping up the pool with hot water do not add it near the sides of the pool (or near the mother!)
  • There are fitted pool covers you can buy to keep the water warm before you get into it or some alternatives are tarpaulin, a roll of bubble wrap on its own or with blankets or a duvet on top, a sleeping bag or foil shock blankets marathon runners use.
  • Obviously keeping the room itself warm will help.

Preparing area around the pool

  • You might like to have some covers on the floor so that it protects the floor from any spillages and also so that it is not cold and slippery if you are getting in and out. Here are a few ideas:
    • Tarpaulin (available in Woodies or any hardware shops) underneath to protect the floor and prevent it being slippy – see picture in the section on doing a trial run above.
    • Builders grade plastic (available in Woodies)
    • A piece of flannel with waterproof backing – like what you would use as a liner for a bed for children.
    • Old towels
  • The pools have an air filled floor but you could have a duvet or sleeping bag underneath the pool for extra comfort and heat retention particularly if it is a hard or cold floor.
  • Have a table and chair near the pool so the midwife can do their paperwork/note-taking and be nearby.
  • A toddler step would be useful for getting in or out of the pool.

Emptying the pool

  • You can use a water pump to do this.
  • If there is at least a small slope from the pool to a drain outside, you can simply use a hose and let gravity do the work to empty most of the pool.
  • Rinse the liner and hose with Milton to clean/sterilize them.

Other tips

  • If your pool needs repair, Sugru works – bicycle repair kit does not! Definitely something you do not need to find out on the day so do that trial run!

Irish Birth stories where the mother laboured in water

  • Click here for a list of Irish birth stories where the mother laboured, and sometimes birthed, in water.

 Useful links

This post was complied by Roseanne Dolan and edited by Krysia Lynch based on contributions from many home birth mothers on the Home Birth Community of Ireland  closed facebook group. It was originally posted in the HBA newsletter in 2014

siobhan and conor

How many home births in Ireland?

This is such a frequently asked question that I decided to write a blog on it. Why is it not a number that can easily and simply be looked up? The answer lies in the fact that there are so many care providers offering a home birth service and that all their data are stored in different locations. That doesn’t sound as if it can be true right? So many home birth providers? In Ireland? Really? Read on . . .

The main home birth service  is operated under the auspices of  the HSE and known as the  National Home Birth Scheme. This is run on behalf of the HSE by Self Employed Community Midwives (SECMS), and since 2012 the service has been  audited each year by the National Perinatal Epidemiology Centre (NPEC) in Cork. This service embodied what used to be the independent midwives and the Cork and Kerry Home Birth Scheme  until September 2008.

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NPEC report on planned home births provided by Self Employed Community Midwives

The total number of births from this service will also be listed in the total number of births collated as part of the National Perinatal Statistics Report now coordinated by the Health Pricing Office (HPO). The HPO figures for home births are always a little higher than the NPEC figures as they include all home births whether midwives were present or not, and whether they were working as SECMS or not.

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Perinatal Statistics for Ireland 2013

The second provider from  which we have published data is the DOMINO home birth service coming out of the National Maternity Hospital (NMH). This home birth service has been running since 1999 and is part of the very successful community midwifery care provided from the hospital.

The third provider is Waterford General Hospital. They have had a community midwifery service in place for a number of years and at one point were facilitating many home births a year.

The fourth provider is Wexford General Hospital, They also have a community midwifery service in place and offer a DOMINO service. Again at one point they facilitated many home births each year.

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Community Midwives in NMH Image Courtesy of www.nmh.ie

Last but not least is the private service provider UK Birth Centres. This UK based company provides a private home birth service through its sister marketing company in Ireland Neighbourhood Midwives and has been offering home births since August 2014. Its first home birth in the Republic was on 11th October 2014.

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Siobhan and baby Conor born at home with UKBC

So five different providers, but not one unified figure that encompasses all of the data from all of the services. The HPO provide data from Part Three of the Birth Notification Forms filled out by all home birth midwives and NPEC provide a detailed audit on the National Home Birth Service run by the HSE whilst the  NMH in turn provide data from their own home birth service. HOWEVER these data are not linked together in any way. Instead, the NMH home birth data are produced as part of the overall hospital report, and so an interested observer would need to be able to search the NMH annual report, and know to search it in order to find the NMH figure to add to the HPO/NPEC figure.

There are no publicly available figures from Waterford and Wexford, and finding out how many home births are facilitated there requires calling the appropriate DMOs (Designated Midwifery Officers) or requesting the information through an FOI request or asking the Department of Health.

There are also no publicly available audits from UK Birth Centres at present.  Even though Neighbourhood Midwives, the Irish sister company would be aware of the figures, they are not able to publicly release any  audits  as they do not technically own the data. However, the basic data of total numbers are available through the Department of Health and Children (DoHC) and in future years one assumes they will be reported by HPO via the Birth Notification Form that every home birth midwife has to fill in.

So now maybe its becoming clearer , , , all these different sources need to be identified individually and then collated in some way.

For 2013 the NMH data and the SECM data have both been released, for 2014  the NMH data have been released and for 2014/2015 the UK Birth Centre data have been estimated. It is therefore possible to make a guesstimate as to the total number of home births in Ireland from the most up to date data available.

  2013 2014 2014/15 Source
HSE National Home Birth Scheme 155 - - NPEC
Birth Notification 7 - - HSE/HPO
NMH 55 40 - NMH
Waterford - 0 - DoHC
Wexford - 0 - DoHC
UK Birth Centres - - 60 DoHC

 

A composite total figure would be 277 if the NMH figures from 2013 are used,  or 262 if the if the NMH figures from 2014 are used. The average of these two figures is 270.

Whilst not exactly an absolute accurate figure, it is fair to assume that based on the most recently available data, an average of 270 babies are annually born at home in Ireland, which is nearly DOUBLE that which is regularly quoted by the press, academia the HSE and the DoHC alike. This also means that instead of home births accounting for 0.2% of the total number of births in Ireland, home births actually account for more like 0.4% of the total number of births in Ireland.

If more resources could be provided for Wexford General Maternity there is no doubt that these figures would be greater again. And lets not forget that in the recent AIMSI Survey #WMTY2014, with 2832 respondents found that 43.6% of respondents would choose community midwifery care (home birth with an SECM or hospital scheme) if it were available to them, so do not believe the stories that no one has a home birth or that no one wants to have on either!

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Result of AIMSI #WMTY2014 showing that nearly 43 of those surveyed would avail of community midwifery care if it were available (in blue)

Note: The extra 7 births recorded by the HSE/HPO  via Part 3 of the Birth Notification Form are probably accounted for by planned unassisted/free births.

 More statistics from NPEC on planned home births in Ireland

More statistics from the NMH home birth service

More statistics from HPO/HSE Perinatal Statistics from 2013

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Philomena Canning

The Philomena Canning case a year on.

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Philomena Canning

This day last year; 12th September 2015 Self Employed Community Midwife Philomena had not long delivered a baby and had some 29 women in her care. Some of those women were about to give birth, some had simply booked her for their births that were over six months away and others were receiving postnatal care for themselves and their babies.

At 5pm on the 12th September 2014 Philomena Canning  was instructed by the HSE that she was no longer to continue care of her clients as her state clinical indemnity had been revoked and she was to hand over all of their files immediately to the HSE. Initially Philomena assumed there had been a misunderstanding and she would be reunited with her clients within the week, but this didnt happen.

Court appearances

On the 24th September and then on the 29th September she went to the High Court to seek an injunction against the revoking of her indemnity, but she was unsuccessful. In return for the indemnity the HSE wanted her to be supervised and work with a second midwife. Philomena rejected this offer and the suspension of her indemnity continued until she lodged an appeal. The appeal was heard at the High Court on the 27th February and and on the basis of testimonies of expert witnesses provided both by the HSE’s and Philomena s legal team the injunction was granted with full costs.

investigations
Placards on the gates of the Four Couts

Everyone  thought this would mean that Philomena would return to practice. But this was not the case. The HSE  were running a second investigation in parallel with the one that had just been discredited.

Many women and midwives came to support Philomena at the court acourt appearances and they were understandably frustrated and angry, A lot of questions were left unanswered also. Women wrote to th TDs to Leo Varadkar and to their local councillors. and yet the situation remains that Philomena has still not returned to practice.

hse bulies
Student midwives supporting Philomena

Philomena remains keen to return to work. However,  despite being reinstated by the HSE back in February 2015, she continues to be unable to return to practice as long as the second  HSE report (promised in March 2015, relating to the “incidents” at the centre of her suspension), remains unforthcoming. Even though independent expert witnesses have  fully supported every aspect of Philomena s practice in both cases,  the HSE are persisting with this report. It would be professionally compromising for her to return to work. until the HSE’s systems analysis report is complete.

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Shame on the HSE

In July The Philomena Canning campaign made the following statement “We are concerned at this report delay, most especially given the very real impact for clients seeking a home birth that her absence creates, with particular concern for women seeking it through the public health system.”

The Philomena Canning Campaign continued  “We urge supporters to now contact their local TDs requesting they place parliamentary questions to Minister Varadkar when the Dáil resumes, as to the cause of the delay in the HSE investigation report. We’d also encourage those seeking home births to request information from their DMOs and to email HSE investigation head joseph.ruane@hse.ie to seek information on when the report publication is expected, as this is the single obstacle in the way of Philomena’s return. She can not be in as position that leaves her clients open to further compromise after the immense difficulties faced in the aftermath of her suspension in finding replacement midwives, not least due to the HSE’s handling of it for the clients affected.”

 What did Philomena’s removal from practice mean for women booked with her?

One woman was due to give birth over that first weekend when Philomena was suspended.. No carer was put in place for her. Others were due to give birth over the next couple of weeks and no carers were made available for them either. The women were anxious frightened and apprehensive. Mostly they were also without antenatal care, which is not best practice, especially at term.

lucy 29 mums and babies
Mothers and babies abandoned by the HSE

Some of the women were able to find other midwives to take them on within the national home birth scheme, others had to birth in a hospital setting, some were able to birth with the NMH home birth scheme and some were fortunate enough to be able to access private midwifery care. The last of the 29 women booked in with Philomena gave birth with the Community Midwives at the NMH in April this year.

The manner in which women had their carer removed from them without any alternative care being provided still remains an appallingly dangerous and callous act on behalf of the HSE.

mums and babies
Some of the women who Philomena would have cared for and their babies

What did this mean for other women seeking home birth in the areas that Philomena  served?

Since Philomena’s removal from practice women in the areas of South County Dublin, Wicklow, parts of Wexford, Kildare, Meath and Louth have been without a free homebirth service with full continuity of care. Women in these areas have been able to access a private home birth service, but this is not an option for all women. In particular women on a medical card who fall outside the administrative catchment area of the NMH’s home birth service have been particularly badly affected. Philomena’s suspension has further served to highlighted the inequity of care in term of maternity choices and service provision in Ireland today.

phil and legals
Philomena and her legal team

 

Have any of the questions surrounding Philomena’s case been answered?

No answers have been forthcoming, and meanwhile the HSE’s continued refusal to produce the systems analysis report further delays the process and continues to cost the taxpayer a ridiculous amount of money in legal fees. Only the Minister and the Department of Health and Children can reign the HSE in on this one, When we think of the lack of services  available in our maternity system and the desperate shortages of capital and staff, squandering public money by dragging out this case any further is particularly abhorrent.

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Philomena answering questions about her case

 Read more about the Philomena Canning case here

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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 http://www.nmh.ie/_fileupload/Community%20Midwives/NMHCommunityMidwiferyServiceBrochure.pdf

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).

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The NMH Community Midwifery Team 2008. Taken from http://www.nmh.ie/maternity-care-options/community-midwives.220.html

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

LINKS
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
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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!

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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.

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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.

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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!

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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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Links

Home Birth After Cesarean (HBAC) in Ireland

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Home Birth After Caesarean (HBAC) in Ireland

The window for Home Birth after Caesarean (HBAC) in Ireland has opened again for some women

Prior to the Memorandum of Understanding (MOU) between self employed midwives and the HSE (which was drawn up in 2008 for the national homebirth service), women routinely availed of home births following a caesarean section, subject to an individual assessment by an independent midwife. The MOU stated that HBACs are too risky based on the HSE’s internal risk assessment and that all VBAC attempts should take place in a hospital setting.

The HSE’s risk assessment on VBAC in the community in turn informs the State’s Clinical Indemnity Scheme (CIS), which will not offer indemnity to self employed community midwives working in the community to attend HBACs. However, the  self employed community midwives  who carry out home birth care on behalf of the HSE are required by legislation (The Nurses and Midwives Act of 2012) to be fully indemnified in order to offer care in the community Currently, the only available indemnity for a self employed community midwife is that offered by the CIS. Self employed midwives are therefore prevented from taking women on who have had a previous caesarean birth, even if they have successfully birthed at home before. Therefore in Ireland as of 2008, there have been no indemnified HBACs  attended by self employed community midwives.

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Rachel Singleton who travelled to the UK to avail of her HBAC

Instead women travelled outside the jurisdiction to avail of a HBAC, or they birthed alone without professional medical attendance. Read Rachel Singleton s  journey to the UK to have her HBAC here.

In 2013, Aja Teehan took a landmark high profile case against the HSE testing her right to individual assessment for a HBAC. http://www.ajateehan.com/2013/06/aja-teehan-vs-hse-and-minister-for-health/

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Aja Teehan who challenged the HSE’s refusal to give her an individual assessment for a HBAC

She lost that high court case, and went on to have her baby in the UK.

Aja ‘s case threw into the limelight the issues surrounding the safety of VBAC and also the VBAC rates in Ireland. Until March 2014, there were no VBAC rates released by the HSE. However last year the HSE released its VBAC rates to AIMSI

The figures show that VBAC rates are very low, although AIMSI issued a caveat with the data saying that it was possible that some of the hospitals with a 0% VBAC rate may have had problems with data coding. The highest rate for VBAC in Ireland is in the National Maternity Hospital with a rate of 33%. Some hospitals however, have a very low rate indeed of less than 5%. Coupled with a high primary cesarean rate, these figures are understandably worrying for mothers who are hoping for a normal delivery on their first baby or for a VBAC on a subsequent baby in hospital. A point also worth bearing in mind with respect to the interpretation of published VBAC rates  is whether the VBAC rate is based on all women with a previous cesarean, who birthed in that hospital or whether the rate quoted is just based on those women with a previous caesarean who have already been pre selected for a trial of labour in that hospital. So, a maternity unit might have a high rate of repeat cesarean and only allow a very small number of low risk women to attempt a VBAC and so that hospital may then achieve a high VBAC “rate.”

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HSE figures of VBAC in Ireland in 2012; released under FOI to AIMSIreland in March 2014

Why are the VBAC rates in Irish Maternity units so low? Part of the reason is our heavily medicalised approach to birth, but also partly because of the fear that health care professionals have of uterine rupture. However, the quoted rates of uterine rupture are often erroneous. It is often routinely quoted as 1 in 200 (0.5%). However, the research indicates that it is nowhere near that high in large maternity hospitals where women are properly screened. Neither of course, is it anywhere near that high at home.

“In a woman with one previous caesarean, the decision to opt for a planned elective repeat CS or a planned trial of labour may be influenced by the perceived risk of UR. National guidelines and large reviews quote different risks, for example, 0.2-1.5% (SOGC 2005), 1.0% (WHO 2005), 0.2-0.7% (RCOG 2007), 0.5-.7% (RANZCOG 2010), 0.5% (AHRQ 2010), 0.5-0.9% (ACOG 2010). In the setting of a large Irish maternity hospital with strict guidelines for a TOLAC, the UR rate was 2 per 1000 overall, and 1 per 1000 for women in spontaneous labour who did not receive oxytocin augmentation”
(Turner et al, 2006). Quoted in
http://www.hse.ie/eng/about/Who/clinical/natclinprog/obsandgynaeprogramme/guide5.pdf

In women with a previous low transverse CS, factors that have been reported to increase the risk of UR include multiple previous CS, no previous vaginal delivery, a short interpregnancy interval, one layer uterine closure, prior preterm CS, induction of labour and oxytocic augmentation
(Landon, 2010). Quoted in
http://www.hse.ie/eng/about/Who/clinical/natclinprog/obsandgynaeprogramme/guide5.pdf

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National Obstetric Guidelines for VBAC for Ireland

 

Furthermore, if  a uterine rupture should occur, the National Obstetric Guidelines Suggest that the the chances of a baby dying as a result are very low at  0.001%.

The overall rate of rupture-related death with a TOLAC is low and has been estimated as 1 in 1000 approximately (Landon et al 2004; Scott et al, 2011). One study reported no serious neonatal morbidity in 78 cases of UR when less than 17 minutes elapsed between a prolonged fetal heart rate abnormality and delivery (Leung AS et al, 1993). In a Dublin study of 4021 women undergoing TOLAC,
there were no cases of HIE or intrapartum death (Turner et al, 2006). Quoted in
http://www.hse.ie/eng/about/Who/clinical/natclinprog/obsandgynaeprogramme/guide5.pdf

It is not surprising that with the stresses and limitations placed on successful VBAC in hospital so many women are keen to have a VBAC at home; a HBAC. Many women who have previously birthed at home, but who may have been required to have a cesarean due to an isolated issue with a previous pregnancy e.g. transverse breech would also like to have a HBAC.

We already know that opting for a home birth for any woman will reduce her chances of a cesarean, so opting for a homebirth as a HBAC should be no different. It might in fact be the best treatment a  woman with a previous cesarean needs in order to avoid a repeat unwanted cesarean.

A study way back in 1997 in the UK “Home Births – The report of the 1994 Confidential Enquiry by the National Birthday Trust Fund  Edited by Geoffrey Chamberlain, Ann Wraight and Patricia Crowley
Parthenon Publishing, 1997.” looked at the safety of home births and part of the study included looking at the outcomes of a small number of HBAC mothers (53). The study found that 72% of them gave birth at home without incident and 28% transferred into hospital care (antenatally or during labour) where some of them went on to have a VBAC in hospital.

The primary risks associated with uterine rupture are unlikely to occur at home, for example there will be no oxytocic drugs used, there will be no induction of labour, there will be no CTG, and there will be no labouring by the clock. Equally as important, the mother will not be left on her own, but will be closely observed throughout her labour by a midwife who knows her and her baby, and who has given her and her baby full continuity of care, and as in a hospital setting she will have been screened as suitable for a HBAC.  However, in the unlikely event that a mother having a VBAC should have a uterine rupture; hospital would definitely be the safer place to have one, due to potential issues with transfer times from a community setting.

There is also no getting around the fact that  a woman with a previous cesarean is of a higher risk than a woman without one. Mary Cronk, MBE, independent midwife and breech presentation expert once commented at a HBA conference that a breech presentation was a “normal” presentation, but a woman with a previous cesarean  was not. A previous cesarean is a risk factor that will follow the woman antenatally in all of her labours, so does this make birthing at home less safe than hospital for women with a previous cesarean? That we don’t know. We do however have data from Ina May’s birth centre The Farm, where she has carried out 2100 births with no uterine rupture and a section rate of 4%. And more importantly what we do know is that women should have the choice to birth where they feel most safe and most supported, and what we do know is that women should be entitled to an individual assessment.

Also recent research reported in the ICAN website (March 2014) suggests that the success rate for HBAC is higher than might previously have been thought.

“The Midwives Alliance of North America (MANA) recently published data from a large and well-tracked series of planned home births, the result of a home birth registry program that was initiated in 2004 . The data set included nearly 17,000 planned home births attended by a mix of midwives including CPMs (79%), CNMs (15%), and other unlicensed midwives. Within this cohort were 1054 women with a history of cesarean section who were planning a  . . . “HBAC” . . . Within this subgroup, 87% had successful vaginal births, with 94% of those births occurring at home and the remaining 6% occurring after a transfer to a local hospital. This success rate is substantially higher than the 60-80% success rate reported across other large hospital-based cohorts and likely reflects the high level of commitment to and support of natural birth, both from the mothers and their care providers.”
http://blog.ican-online.org/2014/02/28/new-survey-shows-high-success-rate-for-vbacs-at-home/

Amy Haas in an article for Midwifery Today  identified the following risk factors for HBAC
1. Previous infection of uterine scar site (weakens scar)
2. Pregnancy less than 18–24 months after previous c-section (causes greater stress on scar)
3. Induction of any kind (causes stress on scar)
4. Placenta covering uterine scar (cause physical stress on scar)
5. 42 weeks+ gestation (associated with greater risk of cesarean) 
6. More than one previous cesarean (if no previous vaginal birth)

She also identified the following low risk factors
1. General health (if a woman is in good health then her chances of a successful HBAC are high)
2. Reproductive history 
3. Number of previous c-sections(the fewer the previous sections the greater her chance of achieving a successful HBAC)
4. Previous vaginal births (the greater number of previous vaginal births the greater the chance of achieving a successful HBAC)
5. Time since last c-section (More than 24 months since a previous section will enhance a woman’s chance of a successful HBAC)
6. Infection experience (no previous scar infections will increase a woman s chance of a successful HBAC)
http://www.midwiferytoday.com/articles/HomebirthAfterCesarean.asp

This blogger agrees that HBACs are on the whole safe but suggests two potential risks for HBAC

The other two main risks of HBAC are the family’s distance from a hospital, and the abilities of their care provider to support normal birth, to detect signs of problems and to address them in a timely, competent way. So, it is wise to carefully select HBAC assistance; most of the information you need is the same information about midwives that all families need with respect to a midwife’s training, knowledge, and usual routines. You should also ask about each available midwife’s knowledge and experience with HBAC.
https://womynwisespeaks.wordpress.com/informed-choice/hbac/

For a few months in the late summer last year (2014) a private midwifery company, UK Birth Centres/Neighbourhood Midwives had clinical indemnity to offer HBAC as an option to women in a few locations in Ireland, and then out of the blue this indemnity was unexpectedly withdrawn. A couple of mothers managed to have a HBAC with the company, but many HBAC clients hoping for care in the community  were devastated at the thought of having to go into hospital care and face into our medicalised maternity services with their low hospital VBAC rates.

However, today there is hope for HBAC women again as the clinical indemnity enabling UK Birth Centres/Neighbourhood Midwives  to provide an individual assessment process for a HBAC service to women with a previous cesarean section is in place again.

“Neighbourhood Midwives are delighted to announce that our partner UK Birth Centres are now able to offer even more homebirth choices to families in Ireland, including mothers with a previous caesarean birth (VBAC). As always, the safety of our clients is our paramount responsibility and we will continue to offer individualised assessment to all our potential clients. Mothers with a more complex history, such as a previous caesarean birth, should be assessed by a specialist and fortunately we can now offer that service if needed. We intend to roll out our new choices cautiously to help maintain our 100% safety record, so mothers with more than one previous caesarean births will be offered support in hospital or private birth suite options when available in their areas.”
UK Birth Centres/Neighbourhood Midwives

At present the company are only offering individual assessment for HBAC to women with one previous cesarean. Women hoping for a HBACx2 are currently not eligible for the service, however, hopefully this will change with time, and women looking for HBACx2 will also be able to avail for the individual assessment process.

Our national guidelines on VBAC(2)  state that  it should be supported when the head is engaged, the cervix is favourable, when there is a history of prior vaginal birth and when the onset of labour is  spontaneous. So all women hoping for a HBAC(2) should be aware of these during their negotiations in a hospital settings.

“Evidence for VBAC2 has shown that women choosing VBAC vs VBAC2 have similar rates of uncomplicated vaginal birth. The rate of major complications is slightly higher if you have had more than one previous Caesarean Section. However, while the risk of major complications is higher for women with 2 previous Caesarean Sections, when compared to the risks for elective Caesarean Section, the absolute risks of major complications are quite low.”

AJOG quoted in http://42weeks.ie/2013/07/10/did-you-know-the-national-obstetric-guidelines-for-ireland-include-vbac2/

Women planning a VBAC in hospital settings, find that their birth choices are routinely  held to ransom by the HSE’s National Consent Policy  which cites the 8th Amendment to the Irish Constitution, (and therefore the safety of the unborn  as defined by obstetricians and other HCPs rather than by the mother herself).  Sometimes women are even  threatened with high court actions. These women, will now be able to exercise autonomy in their birth choices and will hopefully have the option of a HBAC with UKBC/NM.

Obviously, this is only a choice for those who can afford it as it is a private service  and so many women without insurance or women that are medical card holders may be priced out of the market. Hopefully by demonstrating safe outcomes, this private service might encourage the HSE;s public homebirth services to look more favourably at restoring a public HBAC service.

Links

http://42weeks.ie/2013/07/10/did-you-know-the-national-obstetric-guidelines-for-ireland-include-vbac2/

http://www.hse.ie/eng/about/Who/clinical/natclinprog/obsandgynaeprogramme/guide5.pdf

http://vbacfacts.com/13-myths-about-vbac/

Home birth service providers in Ireland

Pathways to home birth services in Ireland

Home birth services in Ireland

Home Birth Mums at the Annual La Leche League Conference

Glanbia and breastfeeding in Ireland

Glanbia announced that their new €235 million nutritional ingredients plant in Belview, Co Kilkenny will be opened by Enda Kenny today. This is the largest dairy investment in the history of the State. The purpose of the plant is to focus on exports. Ireland currently supplies 10% of the global infant milk formula. Yes our tiny little country manages to feed 10% of  the children of the world with artificial milk. Targeted marketing has been focused on mainland China in the last year resulting in the volume of these exports to mainland China doubling. Glanbia anticipates huge growth in the area. I am sure they do, given the support they are getting from the agriculture lobby in the Dail.

Meanwhile, in January we heard from robust research that Ireland has the lowest breastfeeding rate in the world. Yes you read that right, not in Europe, not in comparison with other OECD countries, but in the WORLD. (Growing Up in Ireland: Maternal Health Behaviours and Child Growth in Infancy , Layte, Richard / McCrory, Cathal (TCD)  Infant Cohort Report No. 4, Chapter 4)

Not only do we have the lowest rate after discharge (primarily measured as discharge from hospital), but we also have a worrying early weaning rate, with half of Irish born babies being put onto solid food and follow on milks at four months. Evidence based best practice, and the official HSE and Dept of Health guideline is that  exclusive breastfeeding should continue until 6 months, and then continue as part of a mixed diet until two years or beyond. Our rates at 6 months are only 6%. This type of early weaning can result in rapid weight gain which Co – Author of the ESRI Report, Prof Layte  warned can lead to “metabolic disorders later in life.”

Understaffed postnatal units do their best to follow baby friendly guidelines and to give mothers  information on the normality of breastfeeding and the important role it plays in early nutrition, early development, bonding and immunology not to mention life long immunity it naturally offers to certain diseases.

The national breastfeeding coordinator, the fabulous Siobhan Hourigan, who does a fantastic job in promoting the normality and health benefits of breastfeeding has a minimalistic budget.

It is estimated that the total spend on promoting breastfeeding  by the government is less than €100,000, whilst the annual cost invested by the HSE and Department of Health in treating  acute infections in infants nationally stands at around €12m to €15m each year; conditions which can be limited by breastfeeding .

Unpaid and voluntary groups such as la Leche League, Friends of Breastfeeding and Cuidiu do their utmost to encourage breastfeeding in the community and to support mothers in their local areas with a local network of support and information.

Yes, midwives, mothers, babies, volunteers, health promotion officers and researchers all work incredibly hard to support the health of our future nation by encouraging the normal process of breastfeeding, but how can they ever be successful and have access to much needed funding when agricultural lobby groups hold such sway?

There are obvious conflicting agendas in Leinster House; agriculture and exports vs health. and at the moment the favour appears to rest with agriculture at the expense of everything else.

Tomorrow marks the start of the annual La Leche League Conference, which would normally offer an annual opportunity to promote breastfeeding in Ireland in the media. I doubt that Enda Kenny will be opening the conference, and I wonder at the timing of the grand opening of the Glanbia plant.

Home birth breastfeeding rates on discharge are 96%

On the day of discharge from the care of the SECM, 96% of mothers who birthed at home were breastfeeding exclusively. These mothers were twice as likely to be breastfeeding exclusively as on day of discharge compared to all women who gave birth (96% versus 47%). (NPEC, 2012).

Home birth midwives support breastfeeding 100% and many are trained lactation consultants. Independent home birth midwife Philomena Canning was awarded Midwife of the Year in 2012 by the Maternity and Infant Awards; an award she refused to accept on ethical grounds as the awards were sponsored by SMA infant nutrition.

LINKS

La Leche League Annual COnference 7-8th March 2015

https://www.lalecheleagueireland.com/event/la-leche-league-of-ireland-conference-2015/

NPEC Audit on Planned Home Births 2012

http://www.ucc.ie/en/media/research/nationalperinatalepidemiologycentre/NPECHomeBirths261113AnnualReportWebReady.pdf

Growing Up in Ireland: Maternal Health Behaviours and Child Growth in Infancy , Layte, Richard / McCrory, Cathal (TCD) Infant Cohort Report No. 4, Chapter 4

https://www.esri.ie/UserFiles/publications/BKMNEXT286/BKMNEXT286.pdf

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Questions re the Philomena Canning case

Philomena Canning’s clinical indemnity is re instated.

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Philomena Canning after her re instatement outside the High Court 27th Feb 2015

I am delighted. But now I want my questions answered. Why was her indemnity removed in the first place? Why were certain factions within the HSE effectively enabled to extend what appears to be their personal opinions of Ms Canning and her practice into a public destruction of her livelihood and her good name? Why did the Minister of Health insist that there had been “serious concerns” in PQs to Clare Daly TD, when the evidence now shows that there was none? I noted at the time that he did not use the term “alleged specific and serious concerns”, but opted for the more convincing “specific and serious concerns” He is of course protected from defamation proceedings by Dail privilege, but surely this privilege brings with it an extra responsibility not to reiterate potentially defamatory statements that might be made by others?

Minister Varadkar : ‘With regard to this case, I understand from the HSE that her indemnity has been suspended temporarily due to specific and serious concerns expressed by other clinical staff about patient safety. When the HSE suspends an individual as precautionary measure subject to a review/investigation, it does not do so lightly.’

The only way for Philomena to fully regain her exemplary reputation back is for Minister Varadkar to issue a public apology. I would like to know when the Minister plans to issue such an apology?

The HSE removed Philomena from practice  without providing  immediate substitute care for the women on her books.

Pholomena with some of the women who were at term or near term when she lost her indemnity

She was phoned on a Friday evening and no substitute care was available all weekend. Why was the HSE allowed to leave these 29 women without care? This was surely not best practice and might have endangered the lives of both mothers and babies. Two of the women were at term and they were left with no home birth care provider to turn to if they went into labour. As time went on, the HSE found substitute home birth care for a few women, but others were effectively abandoned or forced to engage private services from their own savings. Why was the burden of finding care not fully shouldered by the HSE? Why were women abandoned? Why were some of the 29 women never contacted by the HSE at all? Why did Minister Varadkar not intervene?

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Philomena s clients demand justice, an independent inquiry and answers

The removal of Philomena from her home birth practice left vast swaths of the Greater Dublin area without a National Home Birth Service, as only Philomena covered these areas. For medical card holders living outside the NMH’s catchment area this left them with no home birth option at all. Why, if the HSE are committed to a National Home Birth Service was a substitute midwife not put in place before the suspension to ensure continuity of service? Furthermore, why were the majority of the 29 women never found any substitute care? Why did many of them, whilst heavily pregnant have to try and seek basic antenatal care for themselves and their unborn babies?

The manner in which the suspension of Philomena was carried out left other home birth midwives in the Greater Dublin area unwilling to take on clients who lived in the area presided over by the Designated Midwifery Officer who had been involved in Philomena’s suspension. The National Home Birth Service in South County Dublin, Kildare, Wexford and Wicklow came under serious threat and still is under threat  How could the HSE allow  the National Home Birth Service be de constructed in this way?

And last but not least, why did all this come to light just as Philomena was about to open her to free standing birth centres?

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I am going to hand out some counting blocks now and you can start putting two and two together.

Unlike pretty much every other country in Europe, or OECD countries, there are no free standing birth centres in Ireland. The recent Birthplace Study in the UK showed that free standing birth centres were a safer place for mother and baby than a hospital setting as mothers were subjected to fewer interventions there. Many women in Ireland do not want to avail of obstetric care and neither do they feel comfortable with home birth. They are looking for something in the middle; they are looking for free standing birth centres. The initial results of AIMSI s WMTY 2014 survey of nearly 3,000 women and their maternity care experiences indicate that this is the missing link in our maternity services. Why is there such opposition to free standing birth centres in Ireland? Who are the vested interests that are most vocal in that opposition, and what sway do they hold over the HSE?

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The HSE are never going to answer any of these questions, only an independent inquiry can do that, and if we are ever to find out the answers to these questions that is what is required.

© February 2015

Links

https://www.kildarestreet.com/debates/?id=2014-09-30a.414

http://www.hse.ie/eng/services/list/3/maternity/homebirth.html

https://www.npeu.ox.ac.uk/birthplace/results

http://aimsireland.ie/what-matters-to-you-survey-2015/

www.philomenacanningcampaign.com

https://www.facebook.com/philomenacanningcampaign

Follow the Philomena Canning campaign on Twitter #isupportphilomenacanning

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Home Birth After Caesarean (HBAC) – Update

The window for Home Birth after Caesarean in Ireland has closed again for now. For a few weeks, UK Birth Centres/Neighbourhood Midwives had clinical indemnity to offer this option to women in a few locations in the country. However, the clinical indemnity enabling them to do so has been withdrawn preventing them from offering this option in the UK, NI and the Republic.

Two women were able to have a home birth after a caesarean with this model of care during the last month.Women with previous caesarean currently on the company’s books and availing of continuity of care throughout their pregnancy will be assessed on an individual basis to continue care. Women who were planning only 5- 6 weeks care with the company at the end of their pregnancy and are not yet receiving care will not be able to continue with their planed model of care, but will have to attend hospital services.

The company’s indemnity for other home birth clients remains in place and they state that they plan to continue to offer care to women who fall outside the HSE s rigid MOU criteria.

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Home Birth Services in Ireland

Home birth in Ireland is offered by :

(1) The HSE under the National Home birth Scheme,

(2) The HSE in selected hospitals 

(3) A private midwifery company.

Women seeking care from the HSE need to source a midwife, or a hospital based home birth scheme and then be assessed for eligibility. Only women with low risk pregnancies are considered suitable for home birth by the HSE in Ireland. Once accepted on the National Home Birth Scheme or on a hospital scheme women are visited at home during their pregnancy or they visit a midwives clinic.

Women seeking private midwifery care, will need to contact the private midwifery company  and be assessed for eligibility. Eligibility criteria are less strict than those set out by the HSE, and allow for more individualised assessment. Once accepted, women will need to arrange a payment plan and negotiate a date when private care with the company  will start. Until that time women will need to receive care from other sources; either public (GP or hospital), semi-private( hospital care) or private (hospital care).

In all cases women must also book in with a maternity unit or a maternity hospital so that their midwife can refer them in for more specialised care should the need arise. This will also be the unit that will take over the woman’s care should she or her baby require it. HSE patients are automatically treated as public patients in hospital care and codes of governance exist between the hospital and HSE home birth providers. Private midwifery patients can also choose to book in as public patients in the hospital.

The National Home Birth Service is a public service and consists of 10 visits with a midwife (taken during the antenatal and postnatal period) and the birth itself. The duration of care lasts from booking to 2 weeks postpartum. Extra visits during the pregnancy are taken with the GP  and are free of charge as they are covered under the Maternity and Infant Scheme. However, women may chose to avail of more visits with their midwife antenatally or in the postpartum via a private arrangement with their midwife. Many women, for example, wish to extend their care until 6 weeks postpartum when breastfeeding is more established. The service includes an anomaly scan taken at about 20 weeks and many midwives ask their clients to take a dating scan at about 12 weeks

When labour starts a woman will be attended by her midwife and by a second midwife if one is available. Most midwives offer the option of a waterbirth.  If you need to transfer to hospital care during labour your midwife may be able to continue care for you in a hospital setting, but equally may not be; it will depend on what local governance arrangements have been put in place.

After the baby is born the midwife will come and visit you for a period of two weeks. During this time you will also be required to have your baby checked by a GP or a paediatrician and you will also be offered the opportunity to have your baby’s hearing screened at a local hospital.

More information including a full list of practising midwives can be found on the HSE s home birth page  or here

Hospital home birth schemes are public services and are available via The National Maternity Hospital, Dublin, Waterford General Hospital and Wexford General. The service consists of  routine antenatal visits once a month until week 34, when visits for first time mothers may then be every two weeks (36 and 38 weeks). After 38 weeks women are seen weekly. The duration of care lasts from booking to 2 weeks postpartum. Extra visits during the pregnancy are taken with the GP  and are free of charge as they are covered under the Maternity and Infant Scheme. The service also includes an anomaly scan at 20 weeks and other early scans such as dating scans and nuchal scans if required.

When labour starts you will be attended in your home by two midwives. If you require transfer to hospital your midwives will continue to attend you and transfer with you. Hospital schemes do not tend to offer waterbirths, but do offer the option of labouring in water. After your baby is born, you will be attended at home for about 10 days, and you will have access to free hospital postnatal services such as lactation consultants, physiotherapy and baby massage classes.

Dublin (National Maternity Hospital, Holles Street) Domino Scheme, Phone 01 6373100

Waterford Domino/Home Birth Service Phone Janet Murphy 087 9243538

Wexford Maternity Unit Phone Sue Ryan 053 9153000

A newly founded private midwifery company, Private Midwives Ireland  offers home birth to women in some areas of the Republic, notably Dublin, the North East at present. Their fees vary depending on when you start care and how many antenatal  and postnatal visits you decide to take on. They charge approximately €6,000 for a full midwifery service from early booking to 6 weeks postpartum. However, starting care at 20 weeks can reduce the fee to around  €5,000 and starting care at 35 weeks can cost as little as €3,500. This is a fully privatised service and women receive all their antenatal care at home or with their GP. Women can book in for an anomaly scan at about 20 weeks with their local unit, or arrange one privately.

Women can opt for this service having taken care in a hospital setting previously (usually publicly).

When labour starts you ill be attended at home by a midwife and a second midwife. Most midwives offer the option of waterbirth. If you need to transfer your care to hospital care during labour your midwife will not be able to continue care for you in a hospital setting but may by prior arrangement attend as your doula.

More information on Private Midwives Ireland can be found here 

Other home birth services may be offered locally. For more information contact the following.

Carlow/Kilkenny/South Tipperary  Phone Eithne Coen 056 7785619

Downpatrick Area Phone Assumpta Morgan / Alison McDaid 02844 616995