Tag Archives: NMH

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.

planned home births in ireland
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.

perinatal report 2013
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.

community midwives nmh
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.

siobhan and conor
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!

aimsi 42
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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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