Women from rural areas attend protest against proposed HSE recommendation to limit homebirths

Women from rural areas and their partners and children were among a group of 250 people who attended a protest in Cork today to register their anger at a proposed HSE recommendation to limit homebirths nationally to women living within a half an hour of maternity units.

Midwives in the community say the change would have a major impact on women living outside of cities.

Patrice and Pepi Mara from Ballydehob in West Cork were among those who protested outside Cork University Maternity Hospital (CUMH) this afternoon.

Patrice gave birth to their two children Juno (3) and Tilly May (5) at home and says that it is “ridiculous” to even consider restricting the home birth service to people who live within thirty minutes of a maternity unit.

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“It is not safe to have people having births on the side of the road (in an ambulance) or at home unassisted if they can’t make it to the hospital.

There is safe professional midwives to support you at home. We have had two children at home. And we can’t speak highly enough of it and the people behind the service the professional midwives.

I believe that between 50 and 80 percent of the people who currently use the service wouldn’t be eligible anymore. It is making the service unavailable to people like us and it is also putting wonderful professionals out of work because they can’t operate with 20 percent of the capacity they would normally.”

Patrice says that her home births went very well.

“It is completely vetted. Risk assessed the whole way along. It is not a suitable option for everyone but if you are a low risk pregnancy and it appeals to you there is no reason why you need to be in hospital.

Pepi said that the option for a home birth “needs to be there” for women wherever they live.

“No birthing option is risk free if you are in a hospital or not. Our experience of home birth was low stress. We felt like it was a good thing for us and a good thing for other people who want to choose it.”

Amelia McNamara, mother to six month old Grace who born at home in Ballincollig, Co Cork in April said that her “fantastic” birth involved her being back in her own bed two and a half hours after delivery.

“There is a place for hospital but it is a choice you should have. They don’t take any risks. If there is any inkling something might go wrong you are straight in to hospital,” she said.

“I had an easy pregnancy and straightforward birth. Just because I live in Ballincollig (which is within 30 minutes of CUMH) shouldn’t determine whether I have a home birth or not. That choice shouldn’t be taken from other women. "

Caroline Cumming from Ballydehob had a home birth with her third child after the birth of her second baby involved “a very dramatic high speed ambulance ride.”

“So it was a much safer option to stay where I was for my third and to have two experienced midwives come to me and tend to me. I had a very fast labours. The (third) baby was born within an hour and a half so I wouldn’t have made it to the hospital. It was the most beautiful experience you could ever ask for.”

Mary Cronin a community midwife, with 28 years experience in Ireland, said that she was previously employed in the UK as a community and private midwife. Having seen women have “lots of choice " in England she returned to a very different Ireland in 1994. “I came back to Cork in ‘94 and the word midwife wasn’t even a thing. Seven years of meetings and we set up the service we have now. The service has gone from strength to strength. We have twenty years of data backing up the safety.”

Mary emphasises that women have to pass very strict criteria in order to qualify for a home birth.

“All our women go through our own consultant who sanctions the home birth. Your midwife will know if that risk changes and we have a protocol for transfer to hospital.

“We do our emergency drill changing with the doctors and nurses in CUMH. We carry emergency drugs. We carry oxygen. We carry IV fluids. We have the ambulance on standby for every single birth. They have their Eircode from 36 weeks of pregnancy.

Meanwhile, community midwife, Elke Hasner says that all 11 applicants on her books from now until April 2023 will be denied home births should this recommendation be implemented, whereas Mary personally knows four pregnant women who could be impacted.

Organiser of the protest, Kara Spratt, who had four of her five children at home says the homebirth service is statistically speaking the safest operating unit of the maternity service in Ireland.

Kara, who is a member of Births Rights Alliance Ireland, says that a postcode lottery could now dictate access to choice in maternity care.

“Homebirth has long been established as a safe and important choice for families and satisfaction ratings with the service are consistently excellent. Reduced travel time to a maternity unit does not improve outcomes for mothers and babies,” she said,

“This speaks to the heart of women’s autonomy in their healthcare decisions. We have a long and exhausting history of women’s agency being removed in healthcare settings and this cannot remain a feature of Irish society.”

The protest was supported by AIMS Ireland, The Midwives Association of Ireland, Better Maternity Care, The Doula Association of Ireland and the Community Midwives Association.

AIMS Chair, Krysia Lynch, said Ireland has an extremely limited set of choices with respect to maternity care. There are no birth centres and very few midwifery-led options, unlike what you would find across the border in Northern Ireland for example.

“Homebirth is the primary alternative to medicalised childbirth for the majority of rural people,” she said.

In a statement the HSE said that the Homebirth Service is delivered by self employed community midwives in accordance with a range of clinical guidelines and within scope of practice and compliance requirements as provided by the HSE.

“In February 2022, the HSE Home Birth Service moved from Community Operations to Acute Operations and is now being integrated into the maternity networks, which are part of the six hospital groups, in line with the strategic objectives of the National Maternity Strategy.

The National Women and Infants Health Programme (NWIHP) was requested to provide advice to Acute Operations on the appropriate distance a woman should live from a maternity hospital (where she could be transferred to an obstetric unit, if the need arose during her labour at home). In undertaking this exercise, NWIHP took into account a range of issues and factors, including the historic transfer rate into maternity unit of mothers who commenced labouring at home, the primary reasons why women were transferred, the method of transfer, ambulance response times, the time needed to transfer the woman into the ambulance and the time until assessed upon arrival at maternity unit.”

The HSE says further to its consideration, NWIHP recommended to the Oversight Steering Committee that all women accessing the National HSE Homebirth Service would reside 30 minutes or less blue light distance from their nearest maternity service.

“This recommendation is designed both to ensure the best possible chance of getting to a maternity hospital in a timely manner so as to ensure the best outcome for mother and baby, and to ensure that the clinical determination of the Community Midwife is acted upon in a safe and timely manner by the wider HSE services including ambulance and maternity services.”