Labour pains: Surge in homebirths as women seek alternative options
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Of the 58,443 babies born in Ireland in 2021, almost 650 of those were homebirths, across both public and private services.
While 650 out of 58,443 might not seem like many, it represented a 53% increase for the public homebirth service, compared with 2019.
With maternity restrictions in place during the pandemic, many women started looking for alternative options for giving birth, some learning about the possibility of homebirth for the first time.
The majority of homebirths take place in counties Cork and Kerry and late last year a proposal was made to limit public homebirth services in those two counties, to women living within a 30-minute drive of a maternity hospital. The proposal caused protests, both in Cork and Dublin, and led to an intervention by the Irish Nurses and Midwives Organisation (INMO).
A key issue was that no evidence to support the proposal was either published or presented to the HSE Home Birth Oversight and Steering Committee.
In early December, the proposal to limit homebirths in Cork and Kerry to people within a 30-minute drive to a maternity hospital was put on hold.
We speak with three women, all of whom experienced hospital births as well as homebirths, to see how their experiences compared.
For Cork woman and nurse Sharon Russell, a hospital is where she felt "safest" for the birth of her first baby, Sadie, in November 2019.
"I know lots of girls who have had home births and when I was pregnant with Sadie, my friend, who had had a homebirth and whose sister had had a homebirth, was trying to encourage me to use the HSE homebirth service because it was so incredible in her experience," she says.
"I was so slow to, as I wanted to give birth in the hospital as I'm a nurse, and I just believed that it was safer in hospital and I just wanted to be in the hospital," says Sharon.
She describes her hospital birth in Cork University Maternity Hospital as a "really incredible experience" with no interventions.
"So I guess because I had such an incredible and positive birthing experience in the hospital it helped me to trust my body and baby more the next time around at home," says Sharon.
She gave birth to her second child, Ben, in August last year, at home, after undertaking research and professional training in the intervening three years.
"I'm well aware of what can happen but I guess I did my research. Home birth is a safe option for healthy women," she says.
"The evidence shows that there is no statistically significant difference in infant mortality between the two settings, home or hospital, and that women are three times more likely to have a normal vaginal birth planning a homebirth than planning a hospital birth," says Sharon, referring to research published in , a medical journal, in 2018, by multiple professors of midwifery.
Spurred on by her research, Sharon decided to set up her own business in the area.
"I even took a break from nursing and opened a business in June 2021, a little venture in Clonakilty called GROW and it’s a centre for yoga, yoga for pregnancy and birth preparation, baby massage classes, and then parent and baby meet-ups.
"I went out on my own doing that so I learned so much about pregnancy, about labour and birth, and all of that," says Sharon.
By the time the birth of her second child came around she firmly believed in the possibility of a homebirth.
"All that learning and education instilled that confidence that I could birth my second baby at home with two midwives and my husband in attendance through the HSE home birth scheme," says Sharon.
The difference between the two births for Sharon was her ability to prepare her own birth space long in advance, and not having "that question over my head of 'when do we leave the house?'".
Alongside her main homebirth midwife Caroline Corcoran, Sharon had her 'affirmations', and a pool she did not end up using.
There was no gas and air on this birth; instead, she relied on GentleBirth hypnobirthing and her yoga.
Sharon ended up giving birth during the heatwave last August but in spite of the heat, she had a "beautiful" experience.
"My friend had held a mother 'blessingway' for me on the beach a couple of weeks previous where a few friends attended and brought some markers and paper and they did out some birth affirmations for me.
"So they were all hung around the room on a string of fairy lights with lots of Sadie's art and lots of my own things as well, like the ultrasound scan of the baby that was about to be born.
"I had an essential oil diffuser on the whole time as well, with some of my favourite oils. I had a birth playlist on too, from Sadie's birth, and some new tracks for Ben," says Sharon.
"The entire day, because it was summer, the sun was splitting the stones, so I was in the garden a lot, and I knew labour was progressing. My waters had broken in the morning, I was progressing slowly but I knew it was progressing. I was having lunch and lying on the grass and doing some yoga under the parasol because it was so hot," she adds.
As the sun set and it started to get darker, things ramped up and after two hours and 55 minutes of active labour "little Ben was beautifully born".
In the following weeks, she had the support of her postpartum doula Mindy Simpson.
"She brought these broths, and healthy treats and freshly-baked breads and she really respected our newborn cocoon," says Sharon.
With wraparound support from her husband, her family, her midwives Caroline Corcoran and Elke Hasner, her postpartum doula Mindy, and Shelly O'Halloran, with whom she and her partner did their GentleBirth workshop, there was no hesitation going into her homebirth.
"I felt really really safe because my midwife said: 'We don't work with grey areas Sharon; everything we do is guided by policy and best practice, it's black and white. So if we see anything that we are worried about or warrants transferring, we won't be hesitating and we won't be arguing with you, we'll be just getting you in an ambulance well in advance," says Sharon.
"I don't think anyone having a homebirth goes into it blindly.
"I always say the opposite; we go in eyes wide open, we've done the research, the reading, we're doing it for a reason and it's because we feel safest," she adds.
- See @growsupportandwellness on Instagram
Both of Lucianne Hughes' pregnancies were so-called "geriatric", in that she was aged 37 giving birth to her first girl, Daisy, and 40 giving birth to her second girl, Poppy.
Her first birth was in the National Maternity Hospital, Holles St, in Dublin, something she describes as a "positive experience" with no medical interventions whatsoever. This experience planted a seed about the possibility of a homebirth if there was to be another baby. Both the baby and the idea became a reality.
"I had a really nice experience with the Domino midwives on my first baby in Holles St," says Lucianne of her midwife-led care and hospital birth.
She laboured at home all day, with a visit from a midwife and then day-long support over the phone. However, when the time came to get into the car for the short journey from Blackrock into Holles St, it took her three attempts.
"I didn't want to leave because I felt I was going to give birth in the car or get sick; there was a fear in me about leaving the house and the intensity of the contractions too," explains Lucianne.
She and her husband eventually made it to Holles St about 6pm on a November evening, and her baby Daisy was born less than three hours later.
In the hospital she relied on a balance ball, a shower, gas and air, a specific music playlist, and the dimming of lights.
When her midwife checked to see how far dilated she was, Lucianne's waters came, and so did her baby.
"My midwife caught her. She came so quickly so she wasn't breathing initially from the shock of the impact of coming out that quickly. She gave me the baby, hit the bell, cut the cord, and they resuscitated her," says Lucianne.
All was well minutes later, with Daisy even doing the breast crawl up to her mother's chest for her first feed. Lucianne and her baby girl were discharged the next morning with a clear bill of health and not a stitch in sight.
"The midwife said: 'Next time Lucianne you have to have a homebirth, you were amazing'. It planted a seed, as I had toyed with the idea on the first one, but I wasn't confident on it.
"When we started talking about getting pregnant a second time it was a definite in my mind. That feeling of leaving the house, I didn't want to go through that again," says Lucianne.
As soon as she found out she was pregnant she rang all of the public and private services. She no longer qualified for the Domino scheme as she had moved to Greystones, Wicklow, however the HSE homebirth service was an option, as was Private Midwives. She chose the latter.
Care included home visits from 26 weeks' pregnant, and postpartum care, and the cost was largely covered by her health insurance.
"Any worry or concern you go through with them, they tell you everything that can happen. Liz, my midwife had been through all of those scenarios, and successfully so," says Lucianne.
The day of labour progressed in an almost "carbon copy" of her first, and when things intensified her husband filled the birthing pool.
"What if something goes wrong is always the fear," says Lucianne, "but you have to remember as soon as you're in active labour your midwife calls the local ambulance service so you're on a list".
She describes getting into the pool as "incredible", like being "wrapped in arms". She had gas and air on hand, the support of her husband, midwife — and some bunting.
"A neighbour gave me this bunting, she owns a gym and had had a homebirth and it had been handed through a few women who had had a homebirth, each putting their own affirmation on. I put up my affirmation on it and hung up the bunting over the birth pool.
"When it got really intense I remember thinking: 'I don't just have my husband and midwife here I have all these women too, who have done this before me'," says Lucianne.
"I am strong, my baby is strong, we are strongest together," says Lucianne, explaining that "it was, after all, the two of us together through the labour".
Her baby was born in the pool, in a "slow and peaceful" way, again with not a tear in sight.
"I would describe both my births as positive, just one was more positive than the other, and I know it's not for everyone but it was quite amazing," says Lucianne.
It was on this second pregnancy that she did a career pivot and retrained as a postpartum doula, after a "fire was ignited" on her first birth.
"I became obsessed with how amazing women are and how amazing their bodies are and the support they need but don't get and I wanted to support women," says Lucianne.
While she had both birth experiences she firmly believes that the best option is "whatever is right for you".
"If you're in a hospital it's still your birth, not their birth; you should have autonomy over your labour," she says.
- See: @thesunshine_doula
Pam Davis became pregnant with her third baby Rosie at the height of the pandemic, a birth she was planning to have at home "after much research", following hospital births with her two other children.
"After much research and going through the risks and benefits I chose to have a homebirth on my third pregnancy in the height of the pandemic, but sadly I lost Rosie at 18 weeks' gestation, so I booked the same midwife for my fourth pregnancy and third baby," says Pam.
Living in Wicklow, she had tried to book in with the HSE homebirth service, which has the highest satisfaction rate in the country, but she was considered too high risk.
"Age and a diagnosis of diet and exercise-controlled gestational diabetes ruled me out, so I looked into Private Midwives Ireland; we did a call and discussed any concerns my husband and I had and booked her immediately. We live 50 mins from our nearest maternity unit," says Pam.
Having already had two hospital births, she describes the first as one that many first-time mothers can relate to, and her second as "positive".
"For my first birth in hospital I had an experience many first-time mums experience, one I have now come to believe is easier for the hospital to 'manage': Induction, for non-evidence-based reasons, epidural, episiotomy, and my baby was pulled out with a vacuum.
"There was shoulder dystocia, my baby’s cord was clamped, and he was checked and weighed and I had my cut-turned-tear repaired, and I tried to feed," says Pam.
Her second hospital birth was much different, and "positive", having arrived "very much in labour" knowing the previous interventions would be less likely if this was the case.
"I moved freely, I had a bath in the hospital, the unit was extremely busy so I was left to my own devices. I felt the urge to push, was moved to the birth room and he came very quickly. The cord was delayed but not optimal, he fed very well, and there was no mental health issues the second time," says Pam.
Her third delivery, the homebirth, however, she describes using words such as "beautiful", "calm" and "elation".
Tightenings became contractions, which became regular contractions, but they were such that Pam was able to go back to sleep during them initially.
She then used her Tens machine, little pads placed on the back that relieve the intense sensation of contractions via a mild electrical current. She called her midwife and her husband prepared the birthing pool.
"I walked around, danced a bit, moved and swayed; my husband supported me with hip squeezes which were a godsend. I used breath, movement, and the Tens until I felt I needed something more," she says.
"I then used gas and air and the birth pool that was blown up in my sitting room," says Pam.
However, doubt crept in at the crucial stage between full dilation and delivery.
"In the later stages of labour, during transition, the self-doubt crept in and I said many times: 'How did I think I could do this?'
"I was reminded by my husband, midwife, and doula that I was doing it, once I leaned into this stage I went through it much quicker," says Pam.
Even with suspected shoulder dystocia, Pam, with the aid of her midwife, moved into a specific position to facilitate delivery.
"I had a suspected shoulder dystocia so was asked to get into a runners start and he came fairly quick after that. The feeling of joy, relief... pregnancy after loss is not an easy journey... elation and total empowerment," says Pam.
She then stayed attached to her new baby for an hour before the umbilical cord was cut, surrounded by family and sitting on her sitting-room floor enjoying "unlimited skin-to-skin".
"If I had discovered homebirth on my first I’d probably have more children, it was the most amazing experience of our lives, myself, my husband our two older boys, our dog, our doula and two midwives witnessed the calm entry of our baby boy Earthside," says Pam.
- Pam is on Instagram @pamjdpilates