Weaknesses in the governance of the current home birth system creates a risk for expectant mothers and their babies, according to an internal HSE audit.
The review by the Health Service Executive found that there is no agreed maximum travel distance to the nearest maternity hospital or community midwife, and while there is evidence of local governance structures, there is no national structure in place for the home birth service.
The audit was carried out on three sites, Cork University Maternity Hospital, the Rotunda Maternity Hospital and the Coombe Maternity Hospital with notes relating to 30 home births reviewed between March 2023 and February 2024.
It found that a lack of clarity regarding national governance of home birth structures meant no agreement was reached about a standard safe maximum travel distance or time from the women's residence to the community midwife or nearest maternity hospital.
In 2022, the National Director of Acute Operations issued a recommendation that all women should reside 30 minutes or less, "blue light distance", from their nearest maternity service.
However, the National Women and Infants’ Health Programme (NWIHP) said it was unclear who had responsibility for the governance of home births in January 2024 because of a reorganisation in the HSE and no agreement had been reached on safe travel time or distance.
In February 2022, the home birth service was moved from community operations to acute operations and is now integrated into the 19 maternity services nationwide.
'Significant risk' of system missing objectives
The internal audit found weaknesses in the system of governance across all three sites reviewed, which it said created a "significant risk that the system will fail to meet its objectives".
Currently in Ireland, there is a National Domiciliary Midwifery Service available to eligible expectant mothers who wish to avail of a home birth service under the care of a Self Employed Community Midwife (SECM).
The service is provided by 23 SECMs nationally on behalf of the HSE.
In 2021, of the 429 women who registered for a home birth, 248 gave birth at home accounting for 0.4 per cent of births that year.
The National Perinatal Epidemiology Centre figures show an increase in the number of planned home births from 272 in 2019, to 345 in 2020 and 429 in 2021.
In a statement today, the HSE said "homebirth services are managed within the Health Regions, in line with all maternity services" to ensure "consistency, quality, and safety across all maternity care settings".
It said several National Midwifery Clinical Practice Guidelines are at final draft stage to replace existing 2016 guidelines and the new antenatal midwifery guideline will incorporate criteria for homebirths.
There will also be recommendations regarding travel time and distance to maternity services.
