Home births: rule on 30-minute distance from hospital ‘not set in stone’, says HSE

The HSE has defended new rules excluding women from its home-birth service if they live more than half an hour ambulance travel time from their local hospital.

The rules are not “set in stone” and can be interpreted flexibly, according to Cliona Murphy, clinical director of the HSE national women and infants health programme.

The recommendation to apply a 30-minute “blue light” transfer rule has been criticised by community midwives, who say it will have a significant impact on rural women.

Dr Murphy said the rule had been portrayed as a “hard limit” when it was intended as clinical guidance for hospitals. It may be “revisited” once proper governance is in place.

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One in five mothers who start labour under the home-birth service ends up being transferred to hospital — rising to one in three for first-time mothers, said Dr Murphy. Six babies born at home over recent years were transferred to hospital.

The change arose from a decision to move the HSE home-birth service from community to acute (hospital) operations, after which Dr Murphy’s programme was asked to advise on the maximum distance a woman should live from a maternity hospital in case she needs a transfer during labour.

The 30-minute rule relates to blue-light ambulance transfer from the time the ambulance arrives at the house, to arrival at the maternity hospital. It does not include the time it takes for the ambulance to arrive, and the time needed to transfer the woman into the ambulance and to be assessed on arrival at the hospital.

“This recommendation is designed both to ensure the best possible chance of getting to a maternity hospital in a timely manner in the event of an emergency so as to ensure the best outcome for mother and baby,” she said. “It is a balance of risk and choice.”

Home-birth scheme

She said limits were already in place on the distance a woman could live from a maternity hospital, though they may not have been applied consistently and “the wording was loose”.

The time threshold relates to an ambulance delivering a patient to hospital “not your average car tootling around”, Dr Murphy said. The HSE has calculated that 83 per cent of the population is covered by the rule, but acknowledges that it excludes some women from participating in the home-birth scheme.

She said that if a woman who is in labour in a maternity hospital is having difficulty, and an emergency caesarean is called, she has to get to theatre within 30 minutes. Obstetricians and paediatricians are required to live within a fixed distance from the hospitals in which they work.

Maternity care is changing with the provision of more midwifery-led clinics and more care in the community for expecting mothers, Dr Murphy said, while the wide use of water immersion and “home from home” rooms in hospitals is being explored.

Last Sunday, 250 people attended a protest in Cork to register their anger at the HSE recommendation.

There were 199 deliveries under the home-birth scheme in 2020, equivalent to 0.4 per cent of all births. Participating women lived an average of 30km from a maternity hospital.