The National Maternity Hospital’s Home Birth Symposium in Numbers

The National Maternity Hospital, or Holles Street, in Dublin held a symposium on home birth in the very swanky Gibson Hotel on Monday. Organised by the hospital’s community midwives team, it was a fascinating day with a huge selection of speakers from across the Irish maternity system and it was great to get an insight into how the professionals working on the frontline feel about home birth in Ireland and maternity services in general.

There was so much discussion that I’m struggling to pick the hot topics to talk about because there were so many so I thought I might do a rundown of some numbers that came up during the day. But first let me start with two quotes from Jennifer Hollowell, an epidemiologist from the National Perinatal Epidemiology Unit in the UK who presented the data from the UK Birthplace Study published in 2011. She said:

“birth is very safe”

and

“when events are very uncommon you need a large sample size”

She was talking about the fact that out of 64,538 low risk women included in the Birthplace Study, there were adverse outcomes for 250. Let’s look at some more numbers that featured…

18,269

This is the number of women in England who planned a home birth over a 16 month period that were included in the Birthplace Study.

18,000

The approximate number of home births in Ireland in 1957

4,000

The approximate number of home births in Ireland in 1967

265

The number of home births in Ireland in 1977

224

The number of women in Ireland who planned a home birth with a self employed community midwife in 2012

161

The number of women who delivered their baby at home under the care of a self employed community midwife in 2012

0.2

The percentage of births that occurred at home in Ireland in 2012

28

The number of women who planned a home birth and began labouring at home but were transferred to a maternity hospital to deliver their baby

7

The number of women who disclosed that they had had a planned unassisted home birth in 2012 to the “unmet demand for home birth” study presented by Colm O’Boyle and Eileen Kenny of Trinity College Dublin.

20

The number of self employed community midwives currently working in Ireland

500

The approximate number of women who avail of the DOMINO scheme in the national maternity hospital (NMH) each year. This is the maximum number the community midwives can accept due to their staff allocation.

45 – 55

The average number of home births under the NMH home birth scheme each year

250

The approximate number of women availing of the relatively new DOMINO service in the Coombe

01/14

The date that Cork University Maternity Hospital will launch their new pilot DOMINO scheme for low risk women

5

The distance in miles that qualifying women for the new Cork DOMINO scheme must live within to avail of the scheme

25

The furthest distance in minutes a woman can live from Holles Street to avail of the NMH home birth scheme. It was also described as roughly as far as the Loughlinstown Roundabout.

There is no distance limit for the homebirth scheme in the Cork/Kerry region. The risks are discussed with the mother at the time of her booking a home birth and she then makes an informed choice as the whether continue with her plans or not.

3

The number of women who had a doula present at their home birth in 2012

3-6

The length of time in hours the average home birth mother laboured for in 2012

9

Out of the 157 women whose position for birth was recorded, the number of women who delivered in a position that was NOT kneeling, on all fours, standing, squatting, sitting or a lateral position. Note there is no category for “supine” or on their backs. Maybe it falls into the “other” category.

16

The average number of days a mother stayed under the care of her self employed community midwife after the birth and received an average of six postnatal visits.

98%

The percentage of home birth mothers who were breastfeeding on the day of discharge from their midwife. Worth noting is that this discharge date is day 16 after the birth rather than day 3 as in maternity hospitals

0

The number of masters of the National Maternity Hospital who showed up for the conference. Although in fairness, given the week she’d had, I wouldn’t have either. It’s a pity though because I was looking forward to hearing her thoughts on home birth.

7.65

The amount in euro I paid for a glass of wine in the Gibson Hotel bar after the conference. I nearly spat it back at them but it was too late. There’s no recession in the Gibson clearly.

Most of figures quoted come from Planned Home Births in Ireland, Annual Report 2012 published by the National Perinatal Epidemiology Centre which was launched at the symposium. You can read the full report here.

What do you make of the figures? Anything surprise you or beg more questions?

PS. It’s worth mentioning that the figures for home births that take place under the hospital schemes in the National Maternity Hospital in Dublin and Waterford Regional Hospital are not included in the data for the Annual Report 2012. It only covers home birth under the care of self employed community midwives. However, the report does say that it hopes to include these figures in future years to get a clearer picture of home birth in Ireland.

 

 

7 thoughts on “The National Maternity Hospital’s Home Birth Symposium in Numbers”

    1. We do! But hopefully we’re headed in the right direction – for maternal choice in both midwifery-led care and homebirth.

      There was a great discussion actually where both a self employed community midwife and the assistant director of midwifery in NMH said that their vision for maternity care in Ireland was a “midwifery based” model. So basically every woman would start off in midwifery-led care and would only be referred to obstetric care if there was a medical need. I think that would be brilliant.

  1. thanks for this – love seeing the figures laid out like this. especially the wine price 🙂

    When you say ‘adverse outcomes’ – what’s classified as adverse?

    1. The 250 figure in the study relates to the following adverse outcomes:

      – Stillbirth after the start of care in labour.
      – Early neonatal death (within 7 days).
      – Neonatal encephalopathy defined as either a clinical diagnosis of neonatal encephalopathy or “signs of neonatal encephalopathy‟.
      – Meconium aspiration syndrome.
      – Brachial plexus injury.
      – Fractured humerus or clavicle.

      Thought you might also be interested to hear that the conference was generally disappointed at the numbers taking up the DOMINO scheme in the Coombe. One speaker suggested it was either due to lack of maternal demand or a marketing issue. Consensus was very quickly reached that it is a marketing issue!

      Seriously, how expensive was the wine??? Nearly died. It was nice though.

  2. A friend of mine lives near the Coombe and attended last year – she loved the idea of the Domino scheme but was never told about it during any of her visits! There really is a problem with communicating the choices that we do have. I think if the way the homebirth package and Domino were explained were tweaked a little to highlight to customised one to one care, no queuing, safe outcomes, lots of postnatal support etc. it would appeal to more families. Great post! Holy Moly on the wine, I hope you licked every last bit up!

    1. I know, it’s pretty bad on the communication side. The amount of people who have said to me that they didn’t know those options existed is too high. I also wonder though – with the exception of the Coombe – do the hospitals prefer that not too many people know because they can barely cope with the numbers they have already. I know with the NMH DOMINO scheme you’re lucky to get in if you call after you’re only six weeks pregnant and you probably won’t!

  3. Thanks for reposting this, perfect timing for me as I’m aiming for a home birth sometime in the next few days. I did the reading and realised it’s the safest place for me to give birth.

What do you think?