The current home-birth system in Ireland creates a “risk to patient safety”, an internal health audit has found.
The Health Service Executive (HSE) audit reached this finding as there is no agreed maximum safe travel time to the nearest maternity unit or self-employed community midwife (SECM).
In February 2022, the home-birth service was moved from community operations to acute operations and is now integrated into the 19 maternity services nationwide.
In light of this, the HSE conducted an audit to establish the “adequacy and effectiveness of governance and risk management” of the home-birth service.
READ MORE
The auditors examined three sites – Cork University Maternity Hospital, Rotunda Maternity Hospital and the Coombe Maternity Hospital – and reviewed 30 midwifery notes relating to home births that occurred from March 1st, 2023, until February 29th, 2024.
It found weaknesses in the system of governance across all three sites that the audit said created a “significant risk that the system will fail to meet its objectives”.
According to the audit report, there is “no national governance structure in place” for home births as acute operations no longer has oversight due to the reorganisation of the HSE into the six health regions.
In 2022, the national director of acute operations issued a recommendation that all women should reside 30 minutes or less “blue light distance” from their nearest maternity service.
However, the National Women and Infants’ Health Programme (NWIHP) said it was “unclear who had responsibility for the governance” of home births due to the HSE’s reorganisation and no agreement had been reached on safe travel time or distance.
[ Homebirth experiences more positive than hospital births, study findsOpens in new window ]
There is a “risk to patient safety where there is no agreed standard maximum safe travel time or distance from the mother’s residence to the SECMs and nearest maternity unit”, the audit report added.
While risk eligibility and suitability assessments were completed with the expectant mother at booking there was no evidence of regular update of this throughout the pregnancy, it added.
In 2022, the most recent year for which figures are available, there were 432 women registered for home birth. The number has been rising quite significantly in recent years.
A spokesman for the HSE said that going forward home birth services will be operated within HSE health regions, reporting to the regional executive officer “in alignment with all other maternity services” which will ensure “consistency, quality and safety”.
Separately, the HSE also published an audit into consultant doctors, who are not on the specialist register.
Under current legislation, doctors must be registered on the specialist division register (SDR) of the Irish Medical Council to be eligible for consultant posts.
However, there is a protocol in place that allows a consultant post to be filled by a doctor not on the SDR in “the most exceptional circumstances” when all options to recruit a suitable candidate has been exhausted.
According to the audit, despite the legal and professional requirements, the total number of consultant doctors employed by the HSE who were not listed on the SDR increased from 100 in 2021 to 133 in 2024. This number reduced to 112 by March last.
Some 21 per cent of that 112 have been employed for over five years.
The audit highlighted a number of risks in relation to this, including that it could “compromise standards of patient care and safety, the HSE’s duty of care and undermines safe clinical governance”.
The audit also cautioned that this situation could impact the quality of training to more junior staff, and warned that any adverse event may fall out of the clinical indemnity scheme, which covers services provided by appropriately trained staff.
A spokesman for the HSE said the measures within the protocol are designed to “ensure appropriate governance and supervision arrangements are in place when such an appointment occurs”.
