Women should have home birth option, says Reilly

Tue, Jun 5, 2012, 01:00

PREGNANT WOMEN in Ireland should be offered the choice of having their babies at home, Minister for Health James Reilly has said.

The Minister said it had always been his policy to treat the patient at the lowest level of complexity in a safe, timely and efficient manner and as near to home as possible.

“Clearly home birth is as near to home as you can get,” he said.

“I would like to ensure that women expecting their baby have a choice, but that choice has to be always predicated on safety.”

Fewer than 0.5 per cent of births in Ireland are planned home deliveries, with more than 99 per cent taking place in hospitals.

Home births are largely supervised by self-employed community midwives.

A small number of hospitals, including the National Maternity Hospital at Holles Street, Dublin, offer limited home birth services to women who are considered low risk.

A spokeswoman for the Department of Health said the level of home births in Holland was about 30 per cent.

She said there was “the potential for increased home births” in Ireland, but any such development would occur only in the context of safety.

A task force set up by the Health Service Executive and chaired by Dr Chris Fitzpatrick, Master of the Coombe Women and Infants University Hospital in Dublin, was examining “the appropriate settings and conditions for maternity services”, including “the appropriate safety requirement for home births”, the spokeswoman said.

It is expected to report to the Minister at the end of the year.

Master of the Rotunda Hospital in Dublin, Dr Sam Coulter-Smith, said if a home birth service were to be run, it would have to be appropriately governed and funded.

“You cannot have a safe home birth service run by independent midwives without an appropriate governance structure,” he said.

Home birth would not be his preferred option, he said. A “home from home” experience in hospital would be preferable.

Dr Coulter-Smith said the issue of overcrowding in the State’s maternity hospitals needed to be addressed. The Rotunda was delivering 40 per cent more babies than in 2005-2006, on a reduced budget and with a reduced head count.

There wasn’t the “quality and privacy you would consider appropriate in 21st century Ireland”, he said, and overcrowding meant that controlling infection such as the winter vomiting bug was very difficult.

Dr Gerry Burke, a consultant obstetrician at the Mid-Western Regional Maternity Hospital in Limerick, said the country was “very far from a structure that would support home birth”.

Encouraging home birth would mean “a huge change in policy” and would have “very major implications in terms of reorganisation”.

“It is by no means clear that it would save money or change outcomes,” Dr Burke said.

“Mr Reilly is avoiding the issues; there has to be capital investment in the service.”

He said “fewer and fewer” women were suitable for home birth, partly because they were delaying parenthood until their mid to late 30s.

Dr Burke said he personally believed it was not a good option and home births were not mainstream, other than in the Netherlands.

Prof Fionnuala McAuliffe of the Royal College of Physicians of Ireland, who is also a consultant obstetrician at Holles Street, said the hospital had been “very supportive of community care”, but an increase in home births would require an increase in midwives.

Two senior midwives needed to be sent to every home birth as they needed to be very experienced, she said, and this would take stretched resources away from the hospital.

There was already an issue with the ratio of midwives to delivering women, and also a shortage of obstetricians.

Deliveries at the hospital had risen from 6,500 babies a year to 10,000 with no increase in size of the hospital and little increase in staff.

“There is huge pressure on staffing,” Prof McAuliffe said.

“The HSE and the Minister for Health are fully aware of that, but additional funding hasn’t come forward.”

BABY BOOM: RESOURCES SHORTAGE

THE MASTER of the Rotunda Hospital in Dublin has warned the hospital is struggling to treat women at risk of ovarian and cervical cancer because of severe pressure on the availability of operating theatres.

Dr Sam Coulter-Smith said the hospital delivers 9,500 babies a year, has nine delivery rooms, two gynaecological theatres and one theatre for caesarean sections.

A 40 per cent increase in the number of babies delivered at the hospital since 2005/2006 has meant that caesarean sections are being carried out in the gynaecological theatres. An additional theatre for caesarean sections is badly needed, Dr Coulter-Smith said.

“The level of maternal activity has increased so much it is squeezing gynaecology,” he said.

“Access to gynaecology across the north side of the city is really being hammered. We just can’t fit them in.”

He said the hospital was struggling to fit in women who were at risk of gynaecological malignancy, which includes ovarian and cervical cancer.

And women with fertility issues were waiting for routine gynaecological procedures for more than a year.

“Unless we get a facility where we can deal appropriately with a large volume of patients coming through, that list is going to get worse,” Dr Coulter-Smith warned.