AIMS Ireland response to the ‘home versus hospital birth’ debate

(Tuesday, 17 September 2013) AIMS Ireland today expressed their continued support of women making informed decisions on where and how they give birth in Ireland. In recent weeks, the media have given the topic of ‘home versus hospital birth’ extensive coverage. The conclusions drawn by most commentators is that there must be an expansion in health infrastructure to support women in making informed birth choices.

The public attention given to the landmark High Court case taken by Aja Teehan and the coverage of the recent Coroner’s inquest in the tragic death of baby Kai David Heneghan in Mayo have dominated the debate and have detracted from the real issues of: (i) Ireland’s maternity care system being almost solely obstetric led and (ii) a woman’s right to make responsible, informed choices in pregnancy and childbirth.

The HSE are currently not offering midwifery-led care options to the majority of women; either at home or in hospital. Yet we know from repeated high quality, robust research that midwifery-led care options (as opposed to midwife attended care in obstetric-led units) is the safest model of care for 85% of women. In the limited locations where such care is available the criteria for accessibility has become increasingly restrictive since the introduction of the Nurses and Midwives Act 2011. This restrictive criteria is not evidence-based and these women are denied midwifery-led care without individual assessment. For many women, a traumatic primary experience in an obstetric led unit is one of the main reasons for choosing midwifery-led care or home birth in a subsequent pregnancy. Yet the physical consequences of a an obstetric led birth often forces a woman back into the same care model irrespective of an informed choice.

In addition to the restrictive criteria, a recently published National Consent Policy document clearly states that the HSE has the authority to deny a pregnant woman her inalienable right to refuse medical treatment due to the legal uncertainty inherent in Article 40.3.3 of the Irish Constitution, whereby the life of the unborn is equal to that of the mother. Women are unaware of the fact that their basic maternal and reproductive rights are qualified by Irish law and the impact this has on their right to choose how and where they birth.

Obstetric-led care has its place in all maternity services and must be available for women who need or want this type of care. However midwifery-led and home birth care must also be provided as an option to all women in Ireland. These care options must be supported by an infrastructure which enables a seamless maternity service for women.

Failing to provide appropriate care options affects all women. Our current two tiered obstetric base system means that:

  • No choice is afforded to women who prefer to birth under a midwifery-led continuity of care model
  • Women who do not need or want obstetric-led care are using valuable resources and are taking up time and beds from women who need or want a obstetric-led care model
  • Women who choose midwifery-led care and home birth may have difficulty accessing these services in the first place, and if they do secure the service face numerous other administrative obstacles that the HSE needs to resolve..

If the maternity services are to be more equitable, there has to be more weight given to what women and families want in their maternity services. Many women are satisfied with the care they are receiving but this does not, and should not, silence the many women who are extremely unhappy with their maternity experience. These women’s voices are integral to the development of a fair and equitable maternity service that listens to and collaborates with women on their birth choices.

AIMS Ireland believes that maternity services should be based on robust and up-to-date medical evidence that provides women and families with choices in how and where they give birth. The safety and health of both mother and baby are always the priority, however, good governance should never replace the right to informed consent and informed refusal of any consumer of the health services in Ireland.


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