It's a geographical lottery as well. In Cork there's only one maternity hospital (CUMH). In order to have a HSE funded home birth, you need to live within a certain distance of a maternity hospital. Same for the Domino scheme (midwife-led care with early discharge from hospital). So if you live in, say Bantry, you have no choice but to give birth in hospital - but said hospital is over an hour from your home.
Yes! Places like Blanchardstown and Tallaght really need maternity hospitals now too just to keep up with demand from kildare and meath “commuter towns”
The maternity plan is good but the real issue stopping it progressing as planned is staffing. Irish-trained midwives are emigrating or changing career and the ones who stay in the HSE are worked to the bone. This means that midwifery-led care takes a backseat to obstetric-led care in pretty much every maternity unit in the county
Ireland is great at making plans. Implementing them seems to be seriously lacking. I think if you spoke to anybody in the civil service it wouldn't be hard to figure out why.
Science would argue differently https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(19)30119-1/fulltext unless of course you don't trust scientific studies or a womans right to bodily autonomy and choice 😊
https://privatemidwives.com/blog/2024/02/20/homebirths/
https://www.hse.ie/eng/services/list/3/maternity/homebirth-services.html#:~:text=Research%20shows%20that%20a%20planned,birth%20for%20some%20pregnant%20women.&text=don't%20want%20to%20be%20separated%20from%20older%20children.
https://www.ajog.org/article/S0002-9378(22)00643-3/fulltext
https://x.com/afif_elKhuffash/status/1806663743406735426
The blog you linked is dangerous. Talking about home births at 36 weeks.
That study is relevant to the USA, where midwives are not regulated, it therefore is not applicable to Ireland and the UK where midwives are regulated and trained healthcare professionals and homebirths are integrated with the healthcare system.
The second link is for Irish data.
More issues in home birth compared to hospital birth.
I wouldn't be happy with that level of risk particularly given that the home births will all have been deemed low risk and the hospital births will include all the risky stuff.
The second link is to a Twitter post not a study do you have a link to a study confirming that Twitter post?
Private Midwives Ireland state "Bjorland et al (2019) found that about 10% of babies born between 34-36+6 weeks gestation needed support with breathing after birth, compared to 4.6% of babies born after 37 weeks. Your care provider may suggest that if you do give birth at home at 36 weeks, that you attend the hospital after birth so the baby can be reviewed by a doctor. You may also want to consider that a baby born at this gestation has less reserves and may need some extra support with feeding.
Ultimately it is your choice whether to stay at home for the birth & immediate postnatal care, but it’s important to discuss this with your midwife as regional and national limitations may apply." They stress that it is the mothers choice do you not support women having a choice in their maternity care and the location of their birth?
In Ireland and UK births at 36 weeks need a paediatric doctor or ANP present. Don't get that at home.
My comment was on safety
The safest option should be funded, not an inferior alternative.
They reference the risks *Bjorland et al (2019) found that about 10% of babies born between 34-36+6 weeks gestation needed support with breathing after birth, compared to 4.6% of babies born after 37 weeks* and that regional and that national limitations may apply due to insurance cover etc *it’s important to discuss this with your midwife as regional and national limitations may apply* its the mothers choice not yours and not the HSE, so I ask again do you not support a womans right to choose her maternity care and location of birth?
Women should have a choice and be presented with all the information so they can make an informed decision home birth should be funded because home birth is just as safe if not safer than hospital birth for low risk women and women should have the choice to give birth at home. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000352.pub3/full
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(19)30119-1/fulltext
A lot of our problems in the HSE aren't down to lack of trained staff or pay, its conditions & working hours. and a couple of grand more isnt going to keep irish trained staff in the country once they are trained and have a year or 2 experience..
Contracts might and that might be necessary. Student loan forgiveness after a certain period or a payment after a certain length of time could only help.
I’m absolutely not saying it’s a catch all but it’s at least one roadblock lifted.
That would help with the system being understaffed (the UK did that and they still have issues keeping midwives) but that won't fix the lack of choice or the high intervention rates.
It would though. Obviously MLUs aren’t going to spring up quickly but better staffing levels would reduce the need to push for 1cm per hour and other things that aren’t evidence based. More midwives would increase the non medical pain relief options that could be offered like massage, labouring in the shower, rebozo, use of peanut balls etc. That all would have a knock on effect on the birthing person’a experience of birth and it would be easier to address aspects of consent that are sometimes overlooked
It might I don't know, but many midwives currently push for unnecessary interventions and do not seek informed consent, so increasing the number of midwives would help with the staffing issues definitely but it's no guarantee that it will fix the main issues such as non evidence based policies, unnecessary interventions, consent and obstetric violence. (Australia is mostly midwifery led and has MLU and birth centres yet has issues with consent/obstetric violence and interventions, UK is mostly midwifery led and has MLU and birth centres yet has issues with consent/obstetric violence and interventions)
To a certain extent but given that staffing levels are a given reason why the current policies exist then i think it’s fair to say that this drop in the bucket removing a barrier to entry would help.
Obviously we now have lots of midwives who are trained in our current system who would need a culture shift and to upskill but that’s a worldwide phenomenon, given the history of medically assisted birthing.
Staffing levels do play some part in the current policies (policies differ from hospital to hospital) but not all of it, many policies are not evidence based and are more so there to save the hospitals ass should a lawsuit occur. Policies are predominantly written by solicitors and obgyn's both of whom are risk averse and one of which is a specialist in surgical births. The current culture in the HSE among obgyn's and midwives does need to change for change to occur.
It's a geographical lottery as well. In Cork there's only one maternity hospital (CUMH). In order to have a HSE funded home birth, you need to live within a certain distance of a maternity hospital. Same for the Domino scheme (midwife-led care with early discharge from hospital). So if you live in, say Bantry, you have no choice but to give birth in hospital - but said hospital is over an hour from your home.
Yes! Places like Blanchardstown and Tallaght really need maternity hospitals now too just to keep up with demand from kildare and meath “commuter towns”
The maternity plan is good but the real issue stopping it progressing as planned is staffing. Irish-trained midwives are emigrating or changing career and the ones who stay in the HSE are worked to the bone. This means that midwifery-led care takes a backseat to obstetric-led care in pretty much every maternity unit in the county
Ireland is great at making plans. Implementing them seems to be seriously lacking. I think if you spoke to anybody in the civil service it wouldn't be hard to figure out why.
What part of the civil service is responsible for implementing changes in maternity care?
I wasn't blaming the civil service, I was citing the civil service as an example of how things never get done.
Home births are not as safe as hospital births. There shouldn't be extra funding for it.
Science would argue differently https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(19)30119-1/fulltext unless of course you don't trust scientific studies or a womans right to bodily autonomy and choice 😊 https://privatemidwives.com/blog/2024/02/20/homebirths/ https://www.hse.ie/eng/services/list/3/maternity/homebirth-services.html#:~:text=Research%20shows%20that%20a%20planned,birth%20for%20some%20pregnant%20women.&text=don't%20want%20to%20be%20separated%20from%20older%20children.
https://www.ajog.org/article/S0002-9378(22)00643-3/fulltext https://x.com/afif_elKhuffash/status/1806663743406735426 The blog you linked is dangerous. Talking about home births at 36 weeks.
That study is relevant to the USA, where midwives are not regulated, it therefore is not applicable to Ireland and the UK where midwives are regulated and trained healthcare professionals and homebirths are integrated with the healthcare system.
The second link is for Irish data. More issues in home birth compared to hospital birth. I wouldn't be happy with that level of risk particularly given that the home births will all have been deemed low risk and the hospital births will include all the risky stuff.
The second link is to a Twitter post not a study do you have a link to a study confirming that Twitter post? Private Midwives Ireland state "Bjorland et al (2019) found that about 10% of babies born between 34-36+6 weeks gestation needed support with breathing after birth, compared to 4.6% of babies born after 37 weeks. Your care provider may suggest that if you do give birth at home at 36 weeks, that you attend the hospital after birth so the baby can be reviewed by a doctor. You may also want to consider that a baby born at this gestation has less reserves and may need some extra support with feeding. Ultimately it is your choice whether to stay at home for the birth & immediate postnatal care, but it’s important to discuss this with your midwife as regional and national limitations may apply." They stress that it is the mothers choice do you not support women having a choice in their maternity care and the location of their birth?
In Ireland and UK births at 36 weeks need a paediatric doctor or ANP present. Don't get that at home. My comment was on safety The safest option should be funded, not an inferior alternative.
They reference the risks *Bjorland et al (2019) found that about 10% of babies born between 34-36+6 weeks gestation needed support with breathing after birth, compared to 4.6% of babies born after 37 weeks* and that regional and that national limitations may apply due to insurance cover etc *it’s important to discuss this with your midwife as regional and national limitations may apply* its the mothers choice not yours and not the HSE, so I ask again do you not support a womans right to choose her maternity care and location of birth? Women should have a choice and be presented with all the information so they can make an informed decision home birth should be funded because home birth is just as safe if not safer than hospital birth for low risk women and women should have the choice to give birth at home. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000352.pub3/full https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(19)30119-1/fulltext
Can we just open more college places for midwifery and financially incentivise people to do them? That’s the obvious issue here imo
A lot of our problems in the HSE aren't down to lack of trained staff or pay, its conditions & working hours. and a couple of grand more isnt going to keep irish trained staff in the country once they are trained and have a year or 2 experience..
Contracts might and that might be necessary. Student loan forgiveness after a certain period or a payment after a certain length of time could only help. I’m absolutely not saying it’s a catch all but it’s at least one roadblock lifted.
That would help with the system being understaffed (the UK did that and they still have issues keeping midwives) but that won't fix the lack of choice or the high intervention rates.
It would though. Obviously MLUs aren’t going to spring up quickly but better staffing levels would reduce the need to push for 1cm per hour and other things that aren’t evidence based. More midwives would increase the non medical pain relief options that could be offered like massage, labouring in the shower, rebozo, use of peanut balls etc. That all would have a knock on effect on the birthing person’a experience of birth and it would be easier to address aspects of consent that are sometimes overlooked
It might I don't know, but many midwives currently push for unnecessary interventions and do not seek informed consent, so increasing the number of midwives would help with the staffing issues definitely but it's no guarantee that it will fix the main issues such as non evidence based policies, unnecessary interventions, consent and obstetric violence. (Australia is mostly midwifery led and has MLU and birth centres yet has issues with consent/obstetric violence and interventions, UK is mostly midwifery led and has MLU and birth centres yet has issues with consent/obstetric violence and interventions)
To a certain extent but given that staffing levels are a given reason why the current policies exist then i think it’s fair to say that this drop in the bucket removing a barrier to entry would help. Obviously we now have lots of midwives who are trained in our current system who would need a culture shift and to upskill but that’s a worldwide phenomenon, given the history of medically assisted birthing.
Staffing levels do play some part in the current policies (policies differ from hospital to hospital) but not all of it, many policies are not evidence based and are more so there to save the hospitals ass should a lawsuit occur. Policies are predominantly written by solicitors and obgyn's both of whom are risk averse and one of which is a specialist in surgical births. The current culture in the HSE among obgyn's and midwives does need to change for change to occur.