BIRTH EXPERTS ARE warning of an increasing prevalence of women having babies at home without medical assistance.
Given the nature of unattended ‘free births’, data is unavailable on numbers opting for this, but those providing maternity services in the community told Noteworthy that they were coming across more year-on-year.
Aisling Dixon, community midlife in Ballinasloe and chairperson of the Community Midwives Association, said that she “noticed in the last 10-15 years that many more women are choosing home births because of a traumatic hospital experience”.
This contrasts to women’s reasons for homebirth in the early 2000s, when most opted for it for philosophical reasons as “they aligned to that pathway”, Dixon said.
This is significant as for some women, “their experience has meant that going back to hospital is too traumatic for them”.
In the absence of a home birth service, they are choosing to free birth.
Women need to meet strict criteria to avail of the HSE’s home birth service. Data from 2018-2020 shows over a quarter of women who wanted a home birth were referred back to a maternity unit and gave birth in a hospital. This does not include women transferred during labour.
Home births provided by the HSE have stricter criteria than other countries, such as the UK, or private home births for those able to afford the option of private midwives in Ireland. It is also limited to certain parts of Ireland due to the low number of available community midwives.
Free births were raised as a potential consequence of the controversial 30-minute ‘blue light’ ambulance distance limit recommended by the National Women and Infants Health Programme (NWIHP) last year. As part of this series, we reported that this controversial guidance “remains in place”, according to the HSE.
Minutes of the HSE Homebirth Oversight & Integration Steering Committee in October last year, obtained by Noteworthy though a Freedom of Information (FOI) request, noted that “concerns were raised that removal of the homebirth service would cause women to seek alternatives such as free birthing”.
We asked the HSE if an increasing number of free births was a concern. A spokesperson said that “the NWIHP is not aware of any formal reporting or data which evidences an increasing number of free births”.
“However, free births are acknowledged as an area of concern in general, given that ordinarily these births are unassisted and unattended by healthcare professionals,” they added.
Dilemma facing doulas
Doulas, trained birth companions who offer non-clinical support, have noted a marked increase in this practice over the past year.
Anita Petry, chairperson of the Doula Association of Ireland, said that though they knew of this happening abroad, their association never had any interactions in relation to it.
“And last year it started,” said Petry. “I got a letter from one hospital, then I got a letter from another. Then a letter from a midwife.”
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The Doula Association of Ireland always “discouraged doulas from attending free births as we felt the line between our scope of practice was quite thin and very easy to cross over”. This is because doulas are not midwives and do not offer medical advice or support.
However, Petry said that “in recent times, we have changed” as “it is also fundamental to the work of the doula to support women’s choice”.
“As long as the doula knows that their clients are well informed and understand the risks and benefits of the choice they are making, that doula will support them.” She clarified this by saying that she would not attend a free birth if she believed people were doing something harmful.
This week, she said, there is a doula, a member of the association, whose client was “dropped by her midwife and has extreme anxiety” about hospital care. The doula never had any intention of attending a free birth but now her client might refuse to go to hospital.
“We know that there’s emotional or psychological injuries and there’s a lot of women who really don’t want to go into hospital,” said Petry, also referring to the trauma that a lot of people in this position have experienced during a previous birth or births.
If they’re not given the option to stay at home, they might just do it themselves.
Research recommends expansion of services
The observations of Petry and Dixon are backed by international research findings. Prior experience of trauma in maternity care as well as poor provision of maternity options were common themes across studies of free births.
Research from 2020 in Australia recommended “systematic improvements” to prioritise humanising maternity care as well as “the expansion of birth options” with midwifery-led care available for women of all risk profiles.
“It’s really difficult” to know how many women do this, said Dixon, as some stay in touch with maternity care teams but others don’t engage in any antenatal or other maternity care.
For those in the system, “once the baby is born, they’ll say the labour was quick and come into hospital”.
Because free births are becoming more common in Ireland, Petry is planning to organise a workshop for doulas and midwives. She hopes that this will increase the understanding of healthcare workers and also address some of the associated stigma.
When the association or doulas are contacted about free births by hospital staff, “there’s a lot that think that the doula is somehow acting like a midwife which she absolutely couldn’t do”.
Why does the Irish health service offer so little choice for expectant mothers?
By Maria Delaney of Noteworthy
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