Proposals Could Bring Homebirth Services to Underserved Western Ireland

Hospitals in western Ireland could be required to establish internal homebirth services under proposals aimed at addressing gaps along the country’s western seaboard.

Ireland’s national maternity strategy, which runs from 2016 to 2026, identified limited choice for expectant mothers and major geographic differences in available services. Its supported-care pathway allows women with normal-risk pregnancies to give birth at home or in hospital.

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Inconsistency of implementation

At present, homebirths operate through a Health Service Executive system that relies on self-employed community midwives. Only 23 such midwives work across the State, and some work part-time, leaving many areas without access.

Kilian McGrane, programme director of the National Women and Infants Health Programme, said the country had made significant progress over the past decade but still faced inconsistent implementation, particularly in the west. Some maternity units lack homebirth services, water-birth facilities or home-like rooms. He attributed the problem mainly to staffing and the difficulty of hiring designated midwifery officers to assess proposed homebirths and support community midwives.

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There is no homebirth service available in a number of the units. They don’t have labouring in water in a number of the units, and then there’s a few units that still don’t have home-away-from-home rooms.

Angela Dunne, the programme’s national lead midwife, said recruitment was another obstacle because many midwives did not want to work alone in the community. She said the future model could give hospitals an internal homebirth service, with their community midwives rotating between home care and the maternity unit, as happens at the National Maternity Hospital and Waterford Hospital.

“That keeps their skills up, keeps their support, and it’s a much better model,” Dunne said. She said the approach could be integrated into community midwifery services and used in areas without homebirth provision. Homebirths in the Midwest were suspended in 2022 after Laura Liston died soon after giving birth at home in Limerick. McGrane said there was an intention to resume the service, but Limerick maternity hospital faced major staffing challenges.

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That keeps their skills up, keeps their support, and it’s a much better model.