Unassisted birth: Four cases illustrating the inadequacy of homebirth provision in Ireland

Background The Irish Health Service Executive provides a very restricted home birth service to fewer than 250 women each year. The home birth association report a higher demand and, anecdotally, an increase in professionally... [ view full abstract ]

Background
The Irish Health Service Executive provides a very restricted home birth service to fewer than 250 women each year. The home birth association report a higher demand and, anecdotally, an increase in professionally unattended home birth. There is no research on this phenomenon in Ireland.
Aim
To explore the experience of deliberate unassisted birth in Ireland.
Method
In an extension to a small exploratory online survey about home birth in Ireland, women who had birthed without midwifery attendance were invited to participate in interviews exploring their experiences. Ethics approval was granted Trinity College Dublin, Faculty of Health. Four women volunteered; their responses were analysed and coded thematically.
Findings
These women were all multiparous. Their prior experience actively drove some from hospital birth. All felt that their personal experience gave them belief in their power and agency to birth alone.
They had all wanted but were unable to access a midwife attended home birth and so they considered free-birth. They were aware of the discourse of risk in relation to birth and heard it from family and from professional contacts.
They reported feeling they had to hide even their consideration of birthing without a midwife. They often reported deferring the ‘final’ decision to remain at home until too late in labour, explaining how this removed the potential culpability of ‘deliberate’ free-birth.They also seemed unclear as to the legality of their decision to free-birth and about the attendance of others at their birth and so were reluctant to share these details with others.
Conclusion and implications
The failure of the HSE to provide the choice of home birth, to all or even most women leaves some to consider unassisted birth. It is still not known how common deliberate unassisted birth is in Ireland. The potential risks of unattended birth means the incidence and reasons for its reported increase should be explored further. Some women might choose to free-birth even if home birth were easily accessible. We now know however that unassisted birth in Ireland is, at least in part, a direct result of women’s inability to access a home birth.