Home birth can be a safe option for low risk healthy women. Research shows that a planned home birth is an acceptable and safe alternative to a planned hospital birth for some pregnant women.
Women may wish to have a home birth because they
- want to feel more in control
- feel safer at home
- want to avoid intervention
- dislike being in hospital
- don’t want to be separated from older children.
The expectant mother in consultation with her midwife and other Medical advisors of her choice will decide whether home birth is a safe option for her and her baby.
Currently in Ireland there is a National Domiciliary Midwifery service available to eligible expectant mothers (Eligibility criteria for the HSE Home Birth Service is available here) who wish to avail of a home birth service under the care of a self employed community midwife (SECM) (list of SECM names and contact details, Appendix 2). This service is provided by the SECM on behalf of the HSE who signs the Agreement with the Health Services Executive (HSE).
Medical Malpractice Indemnity
Click here for the Clinical Indemnity Scheme for Self Employed Community Midwives (Appendix 3)
Applying to the HSE for a Home Birth Service
Since September 2008 the HSE no longer pays a grant to the expectant mother, but now pays the SECM directly for the home birth service provided as outlined in the Agreement. The Home Birth Service provided by the HSE therefore is free of charge to the mother. The service extends from the date the application form has been approved by the HSE until the child is aged 14 days of age only. The midwife’s indemnity insurance cover and payment by the HSE for services provided under the terms of the Home Birth Service, is confined to this period.
The pathway of care is outlined in Appendix 4.
As per the National Guidelines for Home Births you are advised to register with a GP for the Maternity and Infant Care Scheme and to book at a Maternity Hospital of your choice. Some maternity hospitals have a home birth liaison consultants & it would be a matter for your GP to make the appropriate arrangements. Risk assessment is an ongoing process throughout pregnancy and should circumstances arise contraindicating a home confinement you may be told that your eligibility for this service has ceased and that, in your own and your unborn infant’s best interests, you are advised to transfer to hospital based care.
Private Home Birth Agreements
Should an expectant mother and her nominated SECM proceed with a Home Birth outside the terms of the Agreement or without applying to the HSE for domiciliary midwifery services, then this midwife will not have the benefit and protection of CIS cover in respect of any subsequent medical malpractice claim or inquest.
Therefore if an expectant mother enters into a private arrangement with an SECM for a home birth it is the responsibility of the midwife to have alternative insurance cover and the expectant mother should satisfy herself that alternative insurance cover is in place.
Pathway of Care
- When the expectant mother contacts HSE, Local Health Office, enquiring about having a home birth, she is put through to the Designated Official who is a suitable qualified midwifery professional.
- Information package sent to the expectant mother including information sheet informing her of the possible risks involved and the reasons that may require a transfer to hospital care.
- The expectant mother contacts the self employed community midwife. The expectant mother and self employed midwife discuss criteria for Home Births and agree regarding the safety of a home birth.
- The Self employed community midwife having regard to “Risk factors that identify those women who may be at risk for a home Birth” as per appended tables one to five, considers whether the expectant mother is a suitable candidate for a Home Birth and if satisfied undertakes to provide midwifery services for a Home Birth on his/her own professional judgement and responsibility. Tables 1 and 2 would render an applicant too great a risk for inclusion in a home birth service. With regard to tables 3 and 4 it is considered that where the specified factors exist a woman should only be included in a home birth service following assessment by a consultant obstetrician who would advise on the suitability of a home birth in the particular case.
- The Self employed community midwife must advise the expectant mother to
- Register for antenatal services with a maternity hospital.
- Be registered or register with a GP.
- Avail of the Maternity and infant care scheme.
- The Midwife will be the prime carer for the mother and child up to the age of 14 days
- An application form for services under the scheme is completed by mother and midwife and transmitted to the Designated official who will assess eligibility for the service.
- On acceptance of the application the Designated Official writes to:
1. Director of Public Health Nursing
2. Local Public Health Nurse
3. Expectant mothers GP,-indicating that his/her patient intends to be confined at home and that the HSE will provide a Birth Pack (see letter no 1)
4. Administration Dept of the HSE, LHO Office informing them about the forthcoming homebirth, the expected date of confinement and any significant details about the client.
5. The expectant mother, confirming receipt of her application, informing her how to contact her local PHN and arrangements for provision of a Home Birth Pack. (see letter no 2)
- Directions to the home of all planned Home Births are sent in advance to Ambulance Control using “Ambulance Standard Procedures” as appended, so as to expedite transfer to hospital in the event of an emergency.
- Following the birth the midwife informs the hospital, GP and ambulance control of the outcome; and the mother/midwife make appropriate arrangements for routine medical examination of the new born.
- Neonatal Metabolic Screening is carried out by the Midwife
- With Rh negative mothers, maternal and cord blood taken by midwife and delivered to the Blood Bank. Anti D given within 72 hrs if required
- Mother and Baby discharged to care of the PHN at 14 days.
On completion of the service Midwifery notes are sent to the Designated Official together with a request for payment. Designated Official reviews notes, copies same and arranges payment through administration. Details from notes are transferred to database for statistics and Notes returned to SECM.