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HandsOnBellyIn the main it is Self Employed Community Midwives (SCEMs) who are registered with the HSE (Health Service Executive) but who practice independently and are self-employed who provide a home birth service in Ireland.

Some hospitals operate a limited home birth service, the largest being that run by the Domino service in Holles Street Maternity Hospital in Dublin.

There are differences between these two home birth services, some more profound than others, but the more immediate one is that individual SECMs attend all the women who engage their services whereas hospital-employed midwives work as a team and, working shifts, share their caseload.

Another difference, not always immediately noticeable, is that midwives employed by the hospitals unlike SECMs are ultimately under the supervision of the hospital obstetricians. For some women, this makes SECMs their first choice as they are employing midwives who practice in full freedom and in full utilization of their expertise.

These women do not choose home birth under hospital schemes because they suspect that obstetrics will influence the midwives and conflict with the type of midwife-led care they desire. Yet for others it is this very arrangement in the hospital run home birth schemes, which reassures them greatly, and they believe that the hospital home birth service provides them with the best of both worlds.

Self Employed Community Midwives

They are professionals in their own right and qualified to practice independently in providing all services to those who opt for home birth. As midwives they are the only professionals whose training is concerned solely with maternity care and they are specialists in normal maternity care (obstetrics is the study of abnormal pregnancy and labour). The SECM can provide full antenatal care; labour and delivery; and postnatal care up to and including a six week check up. She may also conduct the regular paediatric newborn checks and the P.K.U. (heel prick test) on the baby. When it comes to establishing breast-feeding, she will provide the best of encouragement and support. SECMs provide a very personalised service and will answer any questions you have about the services they offer. Fortunately, there are a number of SECMs in Ireland (see list). Most of the 200 home births per year in Ireland are attended by them. You contact them privately – if there isn´t a midwife near you, you should write to the HSE and insist that you are determined to go ahead with your plans for a home birth. Remember that the service provided by each SECM might vary, both in number of visits and to some degree in practices. For example, some SECMs practice shared antenatal care with a local maternity hospital. When you meet your midwife you should ask her to describe the service she will provide and ensure that you clarify any questions you might have. Equally you should make sure to supply the midwife with full health details.

Doctors

Nowadays very few General Practitioners attend births; because of this they do not have the skills which would be required to attend domiciliary births safely: As a result doctors are no longer insured to attend births. However, some doctors will share the antenatal care with your midwife or team of midwives under the combined care scheme and most doctors will offer the baby a three day check (necessary if you are part of a hospital scheme) and also offer you and the baby the six/ten week check post partum..However, don’t be surprised if your G.P. is not supportive of home birth and is adamant that home birth is not safe: many are not well informed about home birth and it is important to remember that they are not experts in maternity care. The Home Birth Association and our regional contacts may have information about supportive doctors in your area Alternatively, you may feel that it is not your responsibility to persuade your G.P. about the wisdom of your decision.

Combined Care

A few women are fortunate enough to have the combined care of both an enthusiastic G.P. and a skilled midwife who will work together in providing complementary domiciliary services. This system would be akin to the District community midwifery services, which sadly, were phased out from the 1950s through to the 1970s. Some HSE Regions insist that a doctor must be involved, knowing that very few will agree to do so. There is no statutory requirement for a doctor to be present at a birth, at home or in hospital.

Hospital Home Birth Schemes

For those women lucky enough to be able to participate in one of the Home Birth Schemes, they will be cared for by a team of community midwives, and should ask about the scheme at the hospital booking clinic, at the GP’s surgery, at the local Health Centre or by phoning the hospital directly.

Other Hospital services

Blood tests and scans will be available in your local hospital when required. Most SECMs will suggest that you register at your local maternity hospital in case you need to transfer into hospital care either before, during, or after you have your baby.

Unassisted Births

While we can appreciate the frustration felt by parents who want to have their babies born at home, we in the Home Birth Association cannot support a woman’s/couple’s decision to go ahead with the delivery without trained medical attendants present.

While we can appreciate the frustration felt by parents who want to have their babies born at home, we in the Home Birth Association cannot support a woman’s/couple’s decision to go ahead with the delivery without trained medical attendants present.