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

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

3. 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

4. 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

5. 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

6. NPEC Clinical Audit

7. 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

8. 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

9. 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 (%)

10. 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.

11. 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

12. 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

13. 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

14. 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

15. 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)

16. 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

17. 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

18. 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

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

20. 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.