AIMSI Statement on HSE Suspension of Waterbirth

10th November 2020

AIMSI Statement on HSE Suspension of Waterbirth

Pregnant people planning a waterbirth have contacted AIMS having been informed by their healthcare providers that waterbirth is no longer an option offered by the HSE. They have communicated both shock and disappointment at this decision, as according to international research and evidence waterbirth carries many benefits for birthing people in comparison to land births.

Research has found waterbirth can result in less pain, less chance of an epidural, shorter first stage of labour and less use of syntocinon (1). Research also shows the outcomes for babies born at home are no different to those born on land (2). AIMS understands that home birth midwives within the HSE s National Home Birth service were informed by operational management late last week that they were to stop enabling waterbirth. Instead they were to encourage women who had laboured in water to stand up out of the pool when birth was imminent. This transforms the undisturbed nature of waterbirth into a managed situation. The rationale for the move appears to be an adverse incident in September.

AIMS would like to empathise with those affected by this adverse incident. Adverse incidents happen in all maternity care settings, including hospitals (3 ). AIMS understands that the normal response to adverse incidents in maternity care settings is not to immediately pull services, unless there is ample evidence to show that service is unsafe. Depending on the nature of the incident, services generally remain in situ whilst a review takes place. We saw this for example with CTG monitoring in the aftermath of the 2017 review of MRH in Portlaoise (4). We cannot understand why the HSE have treated waterbirth in a completely different way to the many adverse hospital based incidents of the past.

Furthermore, it is completely unacceptable to enforce such a non evidenced based decision without any consultation with service users, given the extraordinarily high satisfaction ratings homebirth and waterbirth had in the recent HIQA Maternity Experience Survey last month (5).

The AIMS Ireland Chair added “It appears that the HSE have suspended birthing in water, but are still insuring midwives and doctors to enable immersion in water. The available international evidence indicates that any ban on waterbirth is not evidence based.”

“What is hard to understand” she continued, “ is that if the HSE were so concerned for the safety of mothers and babies why did they make a decision confirming this move on the 5th October, but not enact it until an entire month later on the 5th November. Either waterbirth puts mothers and babies at risk and therefore the HSE let an unsafe practice continue for a whole month before withdrawing it, or the practice is not unsafe in which case the HSE has reacted disproportionally and unjustifiably, and is denying pregnant people a safe model of maternity care that has significant benefits for both them and their baby.”

AIMS Ireland calls on HSE to reinstate waterbirth services with immediate effect. Waterbirth and Homebirth services are the most highly rated services as defined by the recent HIQA Maternity Experience Survey (6). Denying people the option of waterbirth is denying people an evidence based source of pain relief during labour and birth.

AIMS Chair Krysia Lynch concluded by saying that “Women have the right to informed refusal, if getting out of the pool at the point of a baby’s head crowning is not possible for them.” (7).

1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6494420/
2 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4210671/
3 IMIS National Report 2019
4 https://www.hse.ie/eng/services/publications/hospitals/hse-maternity-clinical-complaints-review-may-2017.pdf
5 https://www.hiqa.ie/hiqa-news-updates/results-new-national-survey-show-most-women-have-positive-experience-irelands
6 See previous reference
7 https://evidencebasedbirth.com/waterbirth/

For further information or to arrange an interview please contact AIMS Chair Krysia Lynch on 087-7543751 or contact Emily McElarney AIMS PRO on 086-385-6225

Notes for editors:
AIMS Ireland is a consumer-led voluntary organisation that was formed in early 2007 by women, following their own experiences in the Irish maternity system. This year in 2020, we are celebrating almost 14 years supporting women in the Irish Maternity System. Our mission is to inform the public on models of care, birth practices and settings, which are supported by evidence-based research and international best practices, and to identify areas of excellence within the Irish Maternity System and
to advocate for their extension. Our mission is also to speak on behalf of the service user experience in Ireland as to where evidence based practices are lacking, as to where care is unsafe and as to where new investment and services are needed. We also campaign for recognition of maternal
autonomy and issues surrounding informed choice and informed refusal for women in all aspects of the maternity services. In addition we offer support to people who have been adversely affected by their experience of the Irish Maternity System via our support team and our support network.