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Home Birth with Self-Employed Community Midwives

Role of Self Employed Community Midwives

There are currently 17 Self Employed Community Midwives (SECM) spread geographically over the Republic of Ireland. Midwives are based in the communities where they live and provide midwifery care for women who choose home birth in Ireland. Holistic woman-centred midwifery care is provided on a one-to-one or individual basis to women in their own homes. Care is provided in pregnancy, around the birth and in the postnatal period. Each midwife assesses a woman’s suitability under the criteria of a memorandum of understanding set by the HSE. A woman needs to be ‘low risk’ to avail of home birth services. Midwives are insured through the Clinical Indeminity Scheme.

Whilst providing visits in pregnancy the midwife is able to tailor care to suit individual needs and that of the woman’s family. Midwives will provide up to date researched-based information in all aspects of midwifery care. If any problems occur at any stage of the care a woman will be referred to the medical team or consultant led team at her local hospital.

The HSE pays each SECM for providing a home birth service and some midwives may charge an additional fee for their care. Schedules of visits may differ slightly from midwife to midwife.

SECM’s may work individually or as part of a team. At some births there may be provision for two SECM’s to be present depending on geographical areas.

For more information please visit www.homebirth.ie

Birth statistics for 2009 are provided in the table below.

All mothers First time mothers 2nd & subsequent time mothers
No. of mothers booked for home birth 150 33 117
No. of mothers transferred to care of local maternity unit during pregnancy 24
No. of mothers transferred to care of local maternity unit during labour 33.0%
No. of mothers who gave birth at home 93.0% 14.0% 79.0%
No. of babies born at home 93.0% 14.0% 79.0%
Onset of Labour
% spontaneous onset of labour 100.0% 100.0% 100.0%
% labour induced
% elective caesarean birth
% pre-labour emergency caesarean birth
Mode of Birth
% spontaneous vaginal birth 100.0% 100.0% 100.0%
% ventouse/vacuum birth
% forceps birth
% total instrumental birth
% unplanned/emergency caesarean birth in labour
% all emergency caesarean birth
% total caesarean birth
In spontaneous labour (% of women who went into labour spontaneously)
% artificial rupture of membranes (ARM) 14.0% 21.4% 12.7%
% syntocinon 0.0% 0.0% 0.0%
% spontaneous vaginal birth 100.0% 100.0% 100.0%
"Normal Birth"
Spontaneous onset of labour, no artificial rupture of membranes, no augmentation, no epidural, no episiotomy, spontaneous vaginal birth.
Normal birth as % of all women attending unit 86.0% 78.6% 87.3%
Normal birth % of women who went into labour spontaneously 86.0% 78.6% 87.3%
Fetal Monitoring
Intermittent auscultation during labour
Episiotomy / Tears
% intact perineum 74.2%
% 1st degree tears 4.3%
% 2nd degree tears 18.3%
% 3rd degree tears 1.1%
% 4th degree tears 0.0%
% episiotomy – spontaneous vaginal birth 2.2%
% episiotomy - instrumental birth 0.0%
% total episiotomy 2.2%
3rd Stage
% physiological 3rd stage of labour 78.5% 50.0% 83.5%
% actively managed 3rd stage of labour 16.1% 50.0% 10.1%
Breastfeeding (% of all mothers booked for care)
% initiated breastfeeding within 1 hr of birth 94.7% 87.9% 96.6%
% exclusively breastfeeding on discharge 82.7%
Gestational age at birth (from last menstrual period date or by ultrasound scan)(% of all mothers booked for care):
≤ 370 weeks 1.3% 6.1% 0.0%
371 – 380 weeks 4.7% 3.0% 5.1%
381 – 390 weeks 6.7% 12.1% 5.1%
391 – 400 weeks 20.7% 30.3% 17.9%
401 – 410 weeks 28.0% 18.2% 30.8%
411 – 420 weeks 23.3% 33.3% 20.5%
421 – 430 weeks 12.0% 30.3% 6.8%
431 – 440 weeks 0.0% 0.0% 0.0%

All % data provided here has been calculated by 'bump2babe: The Consumer Guide to Maternity Services in Ireland'. Maternity units provided bump2babe with numbers of mothers for the various categories and we calculated the percentage rates based on the numbers of mothers who gave birth in the unit. We are not responsible for any inaccuracies in the figures given to bump2babe. The guide has highlighted and raised concerns about differences in data recording and reporting abilities in the 22 maternity units in Ireland.