HSE Home Birth Service Clinical Professional Seminar & workshop for healthcare professionals

HSE Planned Home Birth Service; A review of three years of Audit Dr. Sarah Meaney

A Brief History Our Mission Establishment of the Centre announced in Dáil Éireann on 8th March 2006 by then Minister for Health and Children, Mary Harney T.D. On foot of recommendations from the Lourdes Hospital Inquiry Report Our Mission To collaborate with the Irish maternity services in order to translate clinical audit data and epidemiological evidence into improved maternity care for families in Ireland

Governance NPEC National Advisory Group Chair: Dr. Michael Robson Membership: 18 nationally-representative multi-speciality members nominated by their respective professional bodies including: Sheila Sugrue and Michelle Waldron Established in 2012 with the objective to provide governance to sustainable clinical audit programmes at national level in order to improve outcomes for Irish patients Closes the audit loop – formalisation of escalation procedures

A Unified National Obstetrics Chart Electronic Maternity Chart What Do We Do? A Unified National Obstetrics Chart (NMHCR) Electronic Maternity Chart (MN-CMS) Research Audit MAMS Perinatal Mortality PRAMS Severe Maternal Morbidity Caesarean Section Planned Home Births Cochrane Review Vermont Oxford Network Patient experience Maternal Death Enquiry HIPE Data Analysis

NPEC Clinical Audit

Home births in Ireland Home birth is an option for low risk women within an agreed criterion Memorandum of Understanding SECMs to partake in audit

Home Births Audit The woman identifies an SECM to plan her home birth and applies to DMO for the service Upon completion of the care under the home birth service, midwifery notes are forwarded from the SECM to the DMO DMO completes the NPEC home births data collection form after revision of the midwifery notes NPEC reviews all data and refers back to the local DMO Dissemination to various stakeholders and the public

Home Births Audit 734 Registered from 2012-2014 HSE area Home births (2012) (2013) (2014) Dublin North East 20(8.9) 40(15.5) 38(15.1) Dublin Mid Leinster 41(18.3) 50(19.4) 50(19.8) West 56(25.0) 51(19.8) 44(17.5) South 107(47.8) 117(45.3) 120(47.6) Note: Values are shown as n (%)

Women intending on a home birth Over three quarters of women were multiparous (n=560) Previous pregnancy 3% (n=19) had a previous obstetric or medical problem Current Pregnancy 10% (n=76) were reported to have an obstetric or medical problem All of the women were reviewed by a consultant obstetrician in a maternity unit.

22% referred antenatally Of those 19% return to the care of the SECM Planned Home births n=720* *14 women left the service: Miscarriage Moved away Unavailability of an SECM Antenatal referral n=156 No antenatal referral n=564 Remain under the care of the maternity hospital N=127 Return to the care of the SECM n=29 22% referred antenatally Of those 19% return to the care of the SECM

Antenatal referrals 22% (n=156) of women were referred to the MH Nulliparous women were more likely to be referred than parous (28% v 20%) Primary reasons for transfers: Breech presentation Post maturity 13% of women transferred had a CS delivery

n=127 n=593 n=110 n=237 n=483 Mothers who began labouring in hospital Mothers who began labouring at home n=127 n=593 Intralabour transfer n=110 Hospital deliveries Home birth deliveries n=237 n=483

Intrapartum Transfers Nulliparous women were more likely to transfer than parous (44% v 10%) 75% of transfers in the first stage of labour 43% were transferred by ambulance 15% of women transferred had a CS delivery Unknown for 22% of women

Dublin Mid Leinster (n=33) Home Birth Deliveries Two thirds of all women who planned a home birth delivered in the home Of the women who began labouring at home 81% gave birth in the home   2014 Overall (n=167) Dublin NE (n=24) Dublin Mid Leinster (n=33) West (n=27) South (n=83) SECM 161(96.4) 23(95.8) 31(96.9) 25(92.6) 82(98.8) Second Midwife 121(72.5) 6(25.0) 10(31.3) 24(88.9) 81(97.6) Doula 5(3.0) 1(4.2) 1(3.1) 0(0) 3(3.6) Partner 146(88.0) 19(79.2) 72(86.7) Other 24(14.5) 4(16.7) 12(37.5) 3(11.1) 5(6.0)

Babies delivered in the home 53% of the babies born at home were male Mean birth weight 3,661 grams 63% had Vitamin K administered 98% had a newborn bloodspot screen 93% examined by the GP 7% examined by a hospital paediatrician

Babies delivered in the home 6% (n=31) of babies needed resuscitation 58% (n=18) by suction only 29% (n=9) oxygen 17 babies delivered at home were transferred to the maternity hospital 14 by ambulance to the NICU Resus intermittent positive pressure ventilation warm towel stimulation

Conclusion: A lot Done National Steering Committee for Home Births Designated Midwife Officers in Region National Audit Established 3 years completed 2015 data to be published in 2017 National Office of Clinical Audit Improved communication between the services

Conclusion: More to do Data quality MN-CMS Review of the audit tool Missing data Data entry MN-CMS Review of the audit tool

Acknowledgements We would like to thank; The Self Employed Community Midwives The Designated Midwifery Officers My fellow colleagues from the NPEC who contributed to the development of the home birth audit and annual report.