Free births in Ireland

[Thetroutofnocraic1]

I was particularly saddened and shocked to hear of the recent death of a young woman who had a free birth at home in Louth. It makes me wonder how common free births are in Ireland and what leads women to make the decision to have a free birth instead of going into hospital. I wonder if people have lost faith in maternity services in Ireland to go to such extremes. Also makes me wonder about doulas and how this practice is regulated. Just curious if anyone else has any thoughts on this issue.

Is a free birth totally unassisted or is there a midwife present?

A friend had three attempted home births with a midwife but each time ended up in hospital due to complications. That was rough for her as she specifically didn't want hospital, she wanted the comforts and familiarity of home (own bed, family around, no medication, etc).

Oh I just looked it up, how sad..it was risky to do a home vaginal delivery after previous c-sections without a medical professional. The doula is a birthing assistant, not a medical professional.

Apparently this woman gave birth with no medical professionals present. She had applied for a home birth (with midwives) but her application was declined as she was deemed high risk. She had 2 previous c sections. A doula (with no medical qualifications) was present. After the birth she was sent to Drogheda hospital by ambulance but they were unable to save her due to post partum bleeding.

@ThatLovingTurtle agree it was so risky. I think there is so much pressure these days for women to have a “natural birth”. I am not even sure where this pressure is coming from. It really is so sad.

I don't know why people make this choice. Reading up on this case I've seen a lot of comments insisting that women should be "allowed" whatever type of birth they want, but I find it difficult to accept that a hospital consultant should be forced into overseeing a situation that they would advise against, that is hugely high risk and leaves their career/reputation/medical Council registration on the line.

Tragic case regardless. Those poor babies.

They don't have responsibility over the care/risk their registration etc.
if a woman is counselled and makes her choice that's that. As long as they have been given the right information then the consultant has no liability.
The sad thing is that this woman has died because she has been refused care. Tragic and outrageous in equal measures.

It's very unlikely that she was refused care. She may have refused the care that was offered though.

From what I can see she was denied midwifery care at home. Which is disgusting.

She was denied at home midwifery care because it was too high risk, as unfortunately was proven.
She would have had all the care available if she gave birth in hospital. There's now two small children who are left without a mother. It's desperately sad, but in no way the medical teams fault.

I don't agree it was disgusting at all, it was the right decision - but she chose to ignore medical advice.

Of course it's not disgusting. Midwifery care is the most appropriate option for many women with normal risk pregnancies. This particular lady did not have a normal risk pregnancy, so that would've placed her outside the remit of midwifery care. Even within a hospital she wouldn't have been a candidate for midwifery led care

The medical professionals identified this was highly unlikely to be a safe birth for home. Tragically they made the decision to continue with the home birth over medical settings.

midwives are, subject to staffing and a clear outlook happy to support a home birth. Of the 80 odd women I work with who have given birth only three went the home birth approach. So I don't think it's that common.

I can see why she was denied midwives for a home birth. It's awful and her kids have to grow up without a mum but she decided to against advice. According to an article she would have been supported with a vbac in a hospital setting.

She shouldn't have been denied midwifery care and actually there is a duty of care to attend.
Lots of high risk women plan home births and are supported by midwives.
Denying them midwifery care will make it much more dangerous for them and their baby. If she haemorrhaged a midwife at home has lots of options to treat which are potentially lifesaving before arrival at hospital.

I don't think it is disgusting.

VBacs are more risky due to the chance of the scar rupturing. That's why VBacs are consultant led.

A midwife shouldn't be forced to perform a home birth with those risks.

That poor girl was most likely informed of this.

I completely disagree with you. Why should the midwives go along with a decision made by a pregnant woman when they know she is high risk. Had a midwife been present they would have unfairly got all the blame if the outcome had been the same. That lady was taking her life in her hands with this decision, she was made aware how risky it was and she still chose to ignore the professionals. It's a very sad story and I feel so bad for her precious children, partner and family. I can't understand why she wouldn't just go to the safest place (hospital)
Ive had 4 straight forward births and I would never dream of a home birth. We live too far from a hospital if something were to go wrong. I wouldn't risk it all just to prove a point. No way.

A tragic, needless death.

I can't believe people are suggesting midwives should be forced to attend high risk births in unsafe circumstances. Clearly a VBAC home birth is not safe.

Don't be silly. Of course there's no duty of care from a midwife to a women having a homebirth after 2 previous sections. It's not even within the scope of midwifery! The HSE wouldn't provide insurance in such a situation.
I find it hard to believe that "lots" of women in Ireland have high risk deliveries at home given that there are very few home births in Ireland, and very few home birth midwives available. There might be some exceptions in the Cork/Kerry area, where there is a homebirth service due to the difficulty in accessing hospital services

I'm not sure a midwife could handle a postpartum hemorrhage at home. Surely they need immediate surgical attention and blood transfusion, etc?

What a sad sad thing to happen. It is very difficult to read about a death that could have been prevented if this woman had given birth in hospital. My heart aches for everyone who has been involved in this.

I am a birth and post natal doula, not in the UK or Ireland and indeed, there are ethical and moral considerations in the work that we do. We are there to support women, encourage them to become informed and to assess the risks associated with the choices that they make, primarily we are there to support them. We do our best, not to come with our own agendas and we often reflect with our supervisors and colleagues, when we are faced with difficult situations - which I might add, are rare, but do happen. We all approach our work in different ways, but we are very clear, that we are not medical professionals and cannot give medical advice.

In a week, where three women have died in Ireland, shortly after giving birth, it is a stark reminder that women and babies do die in childbirth. Despite those deaths, childbirth is safe in Ireland for the vast majority of women and babies.

It is impossible to predict the outcome for individual women, but we do know that interventions, including previous cesareans, increase the risks of PPH and uterine rupture.

I often refer people to Sara Wickham, who offers perspectives on evidence. https://www.sarawickham.com/research-updates/hbac/#:~:text=Home%20birth%20after%20caesarean%20(or,of%20successful%2C%20safe%20vaginal%20birth.

A home birth, in the presence of qualified midwife with access to hospital resources, might have been safe for this woman, but it would have required a professional to be comfortable with that decision. We do not know the details of this woman's health history and the exact reason why she was advised not to have a home birth. Syntocinon is routinely administered to women after delivery in hospitals and if indicated, at home births, this was not available in this case, whether it would have prevented death in this case .... we do not know.

I am sure, this will be a topic of discussion at many doula gatherings over the coming months.

That is ridiculous, you want a professional who states in their trained professional opinion that home birth is not likely to end in a good situ for baby and or mother - to be forced to attend? And exactly how on earth would that work - no insurance to cover the individual for indemnity. The midwife knowing likely loss of one or both patient? really?

There are c. 650 planned home births according to the HSE. This woman wasn't within the criteria that the professionally trained qualified people adhere to. The midwife in the case of a first time birth can take some steps in controlling a haemorrhage - they have drugs/massage tummy etc, but ultimately it is about getting an ambulance and transfer to hospital.

I am pretty sure the community midwives group in Holles street offer a choice of homebirth or hospital birth. Maybe other hospitals in Dublin or other areas also have such a service.

It's very tricky. Perhaps if a midwife had attended they would have spotted the difficulty, persuaded transfer to hospital and all would have been well.

In the UK midwives can be made to attend a home birth they disagree with:

"Yes. The Nursing and Midwifery Council’s Code says that midwives must put your interests first and make your safety their main concern. This is their professional duty.
Midwives should respect your decision to give birth outside the hospital. They should attend you at home if you ask for this, even if they don’t agree with your decision."

As a home birth midwife, I can tell you we attend 'high risk' home births all the time.
We are insured, we are trained, and we do have a duty of care.

We certainly can handle haemorrhaging at home and have a decent amount of drugs and equipment.
We don't know her individual circumstances but the majority of haemorrhages post birth would be significantly safer with a midwife at home.

https://www.rcm.org.uk/media/5941/careoutsidee_guidance.pdf

You keep saying she was denied midwifery care @Caitlynandthecat, but she wasn't. She was refused a home birth because it wasn't deemed safe.
Also you've linked a UK website - Ireland is a whole DIFFERENT COUNTRY!