Home births and human rights

An Cailín Rua

WOMEN’S CHOICE The popularity of home births has risen in Ireland since the pandemic.

An Cailín Rua
Anne-Marie Flynn

The future of home births in Ireland is uncertain, following a recent recommendation by the HSE National Women and Infants Health Programme that women using the HSE National Home Birth Service must live a maximum of 30 minutes ‘blue-light distance’ from their nearest maternity unit.
The recommended restriction, the HSE stated, is designed to ensure the best possible chance of getting to a maternity hospital on time should a risk to mother or baby be identified by the midwife.
Currently, women with low-risk pregnancies may choose home births, but the national service, offered under the care of community midwives is only available in certain parts of the country, due partially to a midwife shortage.
The statement followed the death of Laura Liston, who died in June in Limerick after giving birth at home, leading to a temporary suspension of HSE home birth services in the Midwest.
The new restrictions would potentially affect one-fifth of pregnant women, effectively denying them the option of delivering their baby at home, with rural areas like Mayo disproportionately affected. But while the safety of women and babies must be a priority, where is the evidence to suggest that planned home births are any more dangerous than hospital births?
Home birth is not the cultural norm in Ireland. Fewer than 1 per cent of women give birth at home, but its popularity has grown since the pandemic, with a 53 per cent increase in home births recorded in 2020 following the introduction of highly restrictive Covid measures in maternity units.
Accounts from women who have delivered at home describe a familiar, calm, stress-free environment as empowering, liberating and convenient, citing a sense of being in control of their own birth experience and having built relationships over time with their midwives. Midwives alert the closest hospital and ambulance service in advance of births, and recent data shows that just one in five women who started labouring at home under the national service were transferred to hospital maternity units – mostly for pain relief.
The evidence for restrictions does not stack up. A 2019 review in medical journal The Lancet, involving around 5 million intended home births found that among low-risk women, there was no difference between the risk of perinatal or neonatal mortality regardless of whether birth was intended at home or in hospital.
Other research suggests a lower incidence of interventions like C-Section and assisted vaginal delivery, even if the woman ends up in hospital. A study in the Journal of Midwifery and Women’s Health (2016) involving 12,000 individuals in Canada – where a strong tradition of home-birthing exists, despite the isolation of many inhabitants – found no increased risk of adverse neonatal outcomes for births planned to occur more than 30 minutes from a hospital. And a separate study (International Journal of Obstetrics and Gynaecology,  2015) found no increased risk of adverse perinatal outcomes for planned home births among low-risk women, with the disclaimer that their results may only apply to regions where home births are well integrated into the maternity care system.
Home birthing works well in countries with networks of highly trained midwives in the community, and indeed, in Ireland, the National Maternity Strategy in 2016 recommended that women should have the option of funded home births, with community midwives integrated into the maternity networks. Yet, the National Home Birth Service is moving from community care to integration within acute hospitals, a move that feels counterintuitive.
Water births have also been banned in Ireland since 2020 following two adverse incidents, despite follow-up HSE investigations finding no link with birthing in water.
Cork TD Holly Cairns last week called upon the Minister for Health to urgently intervene and ensure continued access to home-birth services for women living in rural communities, including Mayo, but stated that she had ‘no confidence’ that Stephen Donnelly will stand up for women – a justified statement, given his abject failure to address pandemic restrictions.
Nothing in life is risk free, including pregnancy and childbirth, but those risks are not exclusive to home or water births, and the Community Midwives Association argues these restrictions will infringe on women’s human rights.
The repeal of the Eighth Amendment was meant to signal a new era, supporting and empowering women to make informed decisions, but the HSE National Women and Infants Health Programme’s proposal once again proves that the patriarchal structures that led to mother and baby homes, Magdalene Laundries, symphysiotomy, contraception bans and the CervicalCheck debacle remain dominant in maternity healthcare.