An Exploration of the Unmet Demand forHome Birth in Ireland

PURPOSE: The home birth rate in Ireland is less than 0.5%. There is no formal record of the demand for home birth; however, it is suggested that it exceeds availability by as much as tenfold. This study sought the experiences of women who had tried but were unsuccessful in securing a midwife-attended, planned home birth in Ireland in the years 2009–2013.STUDY DESIGN: An online questionnaire was made available over an 8-week period in the summer of 2013.RESULTS: Sixty-two women responded. Three main reasons were identified for refusal of home birth: “unsuitability for home birth,” “unavailability of a midwife,” and “distance from the midwife.” The Dublin regions’ high level of unmet demand is consistent with its high population density. December and other holiday periods were reported as particularly difficult times to access a midwife. Eighty percent of women eventually gave birth in a hospital setting, whereas 15% gave birth outside a hospital setting without a midwife in attendance. Five percent of women accessed a planned home birth elsewhere.DISCUSSION: Online survey is a methodology that is unable to quantify unmet demand for home birth. This exploratory study has however confirmed the inequity of the home birth service, even for those fully eligible. The choice made by some multiparous women to birth at home unattended, even in the knowledge of risk criteria, is a concern and remains unaddressed by the Irish Health Service Executive.CONCLUSION: Health Service Executive dependence on self-employed community midwives (SECMs) to deliver their “national” home birth service means that demand for home birth is greater than can be supplied. This research highlights the need for the inclusion of requests for home birth in their audit of services. Capacity building of community midwifery in Ireland is recommended, with recruitment and support of SECMs identified as a priority.