SECTION 1 - ALL WOMEN REGISTERED FOR A HOMEBIRTH

This section presents data on all women who registered with the HSE Home Birth Service. While 2023 is the primary focus, selected indicators are summarised over longer timeframes (e.g. 2014–2023, 2012-2022 or 2021–2023) to support consistency and enable meaningful trend analysis.

Registered Home Births refers to all women who were registered with the home birth service during the reporting period, regardless of their eventual place of birth. This includes women who commenced antenatal care under the service, those accepted onto the home birth caseload, and those who transferred between midwifery-led and hospital-led care at any stage of pregnancy, labour, or the postnatal period. It also includes women who transferred to hospital care either temporarily or permanently. This cohort represents the total service population and is used to describe overall activity and care pathway transitions.

Figure 4: Rate of women registering for a home birth among all maternities in the Republic of Ireland, 2012-2023

Note: The national number of women who gave birth in hospital based on Hospital In-Patient Enquiry (HIPE) data, with the maternities in one non-participating unit excluded for 2014 and 2015. Since 2022 data from the National Maternity Hospital home births have been collected for this audit. 

1.2 Geographical distribution

In 2023, the Dublin Mid Leinster region continued to report the highest proportion of women registering for home birth, with 181 women (46.8%). This marks a slight decrease from 2022 (43.8%) but still represents nearly half of all home birth registrations in the country (Table 1).

As in previous years, these numbers include women who registered through both self-employed community midwives and integrated hospital community services (IHCS). The majority of women (n=340, 87.9%) received their care from an SECM, while 12.1% (n=47) were cared for by an IHCM.

Table 1: Distribution of women who were registered for home birth by HSE area/year, 2021-2022

Note: Values are shown as n(%) unless otherwise stated. Frequency tables for each category are available and can be accessed through the Central Statistics Office (CSO) in Ireland. *From 2022, HSE Dublin Mid Leinster includes the Coombe Hospital and NMH registered home births.

In 2023, most homebirth registrations occurred in two units; the National Maternity Hospital (NMH) and Cork University Maternity Hospital (CUMH), each accounting for 23.3% of all registrations, though NMH saw a slight decline compared to previous years. Waterford and Wexford both saw an increase, more than doubling their 2022 figures. Despite a drop in overall registrations (from 432 in 2022 to 387 in 2023), the distribution remained geographically diverse. At the time of writing this report, the home birth service in University Maternity Hospital Limerick (UMHL) was not available.

1.3 Maternal Characteristics

Age, body mass index, ethnicity and relationship status

The age range of women who were registered for a home birth in 2023 was 17–44 years, with the average age being 33.8 years. Over three-quarters of women (76.3%) were aged between 30 and 39 years. This compares to 65.5% of all women who gave birth in Ireland[1] in 2023 falling within this age range. Body mass index (BMI) was available for 99% (n=383) of women in 2023. As in previous years, 

the BMI for 62.5% of women was in the healthy range (18.5–24.9 kg/m²), 28% were in the overweight category (25.0–29.9 kg/m²), and 8.7% were in the obese category (≥30.0 kg/m²).

The majority of women who registered for a home birth in 2023 were of white Irish ethnicity (71.8%), a figure that is broadly consistent with the general female population aged 15–49 in Ireland, where 75.4% identified as white Irish in the 2022 census.[1] Women from other white backgrounds accounted for 24.3% of home birth registrations in 2023, compared to 14.8% of the general population. Women from Asian, Black, mixed, or other ethnic backgrounds represented 3.9% of home birth registrants in 2023, slightly below the 9.8% reported in the census.

Consistent with previous years, more than half of the women registered for a home birth were married (56.1%), while 37.6% reported having a partner (not married) and 6.3% were single.

Figure 5: Maternal characteristics of women registered for a home birth, 2023

Lifestyle

Four women (1%) reported smoking at the time of booking, three of whom stated they quit during pregnancy. All women reported abstaining from alcohol at the time of booking.

Information on physical activity was available for approximately 70% of women (n=268). Among them, 85% (n=228) reported engaging in regular physical activity (i.e. more than once per week), while 14% (n=37) reported occasional activity (i.e. once every two weeks) at the time of the booking visit. While HSE advice encourages regular physical activity during pregnancy, (10) this data point does not appear to be routinely captured in all maternity areas.

Previous pregnancy

Approximately 36% of women who registered for a home birth in 2023 had not had a previous birth (n=139 of 387; 35.9%). In 2023, 64% of women had a previous birth (n=248 of 387), which is consistent with previous years (64.1% in 2022, 64.2% in 2021, 65.5% in 2020, and 69.9% in 2019), with the highest proportion recorded in 2015 (74.2%). In comparison, among all women who gave birth in Ireland in 2023, just under 42% were nulliparous (n=22,199 of 53,125; 41.8%, unknown for six women) and 58.2% had given birth previously (n=30,926). This indicates that home birth continues to be more common among women with previous birth experience, although the gap between the home birth population and the general birthing population is narrowing. As shown in the graph, the proportion of nulliparous women has gradually increased over the past decade, from 31.1% in 2014 to 35.9% in 2023. Conversely, the proportion of multiparous women has shown a steady decline over time, though they continue to represent the majority of home birth registrations.

Note: Frequency tables for each category are available and can be accessed through the Central Statistics Office (CSO) in Ireland.

Figure 6: Trends in parity among women registered for a home birth, 2014–2023

Figure 6 presents the gravida and parity distribution for 387 women who were registered for a home birth in 2023. Prior to the current pregnancy, 31.3% of women (n=121) had never been pregnant or given birth before (gravida 0, parity 0), while 68.7% (n=266) had experienced at least one prior pregnancy. Among the women who had never given birth before, 4.7% (n=18 of 139) had a previous pregnancy that resulted in miscarriage or termination of pregnancy. Meanwhile, 166 women (42.9%) had experienced only completed pregnancies, defined as live births from 24 weeks’ gestation and/or stillbirths. An additional 82 women (21.2%) had experienced a combination of completed pregnancies and early pregnancy losses, i.e., parity ≥1 and gravida > parity.

Of the 248 women who had previous births, 18.5% (n=46) had a previous home birth only; 19.8% (n=49) had given birth in both home and hospital settings, and 60.9% (n=151) had given birth exclusively in hospital. A small subset of the hospital-only group (n=2) had a previous birth before arrival (BBA).

1.4 Antepartum care

Shared Care

All women who registered for a home birth in 2023 were also registered with a maternity unit, an essential component of providing care under the home birth scheme.⁴ For all women, there was documented evidence that they were provided with a home birth information leaflet and/or that a discussion took place regarding eligibility for the service and situations requiring transfer of care. This is in line with auditable standards outlined in the Midwifery Practice Guidelines. (1) Gestational age at booking with community midwife ranged from 7 completed weeks to 39 completed weeks, with a mean of 22 weeks and a median of 23 weeks.

As outlined in the Midwifery Practice Guidelines, (1) a liaison obstetrician or other relevant healthcare professional should be available to support appropriate referral where indicated. While some maternity units do not appoint a specific home birth liaison obstetrician, a designated clinic is supported instead by a team of obstetricians instead. Data on liaison clinic availability has been available since 2021. More than half of the women who registered with the home birth service in 2023 had access to either a specific liaison obstetrician (n=197 of 386, 51%, unknown for one woman) or a specific liaison clinic (n=19, 4.9%). For the remaining 44% of women (n=170) a non-specific obstetrician was available. A steady decline of specific liaison obstetrician availability is evident throughout the last decade of the audit.

Figure 7: Shared care and liaison obstetrician access among women registered for a home birth, 2023

Most women registered for a home birth were also registered with a general practitioner (GP) (n=318 of 351, 90.6%; unknown for 36 women). However, shared care with GPs was less commonly provided. Of the women who registered with a GP, 37.3% (n=110 of 295, missing for 23 women) received full shared care. However, 62.7% (n=185 of 295) did not receive some aspects of care through their GP. Among these women, 27.1% (n=49 of 181, unknown for four women) did not receive any shared care from their GP. The most commonly missed component was antenatal care (n=88, 48.6%), followed by newborn examination at day 3 (n=75, 41.4%) and postnatal checks at weeks 2 and 6 (n=40, 22.1%).

When GPs were unable to provide shared care, midwifery-led hospital services were the most common alternative (n=105 of 183, 57.4%, unknown for two women), followed by obstetric-led hospital services (n=56, 30.6%).  A further 23.5% (n=43) of women received all of their care solely from the community midwifery services.

Estimated date of delivery and antepartum ultrasound scans

In 2023, the estimated date of delivery (EDD) was based on ultrasound scan alone for just over half of the women registered for a home birth (n=195 of 386, 50.5%; unknown for one woman). For the remainder, EDD was calculated using the last menstrual period (LMP) alone in 28.5% of cases (n=110), and a combination of ultrasound and LMP in 21% (n=81).

A booking scan before 14 weeks of gestation was reported for approximately 73% of women (n=278 of 383, 72.6%; missing for four women). However, it is worth noting that those withtout a recorded booking scan, or with missing information, may have joined the home birth service after completing early antenatal care elsewhere.

Of the 386 women who registered for a home birth in 2023, 97.4% (n=376; unknown for one woman) had an anomaly scan. Most of these scans were performed after 21 weeks of gestation (n=242 of 372, 65.1%, unknown for four women), followed by 34.9% less than 21 weeks (n=130).

Number of women requiring review at booking for medical or obstetric risk factors

Following an initial consultation by the community midwifery teams while registering a woman for the home birth service, some women are then offered an appointment with an obstetrician to confirm eligibility for the service and review any possible risk factors. Risk level is then assessed on an ongoing basis throughout the pregnancy as per the Midwifery Practice Guidelines.⁴

In 2023, 24.3% (n=94 of 387) of women who registered for a home birth had at least one reported risk factor. This continues the gradual increase in reported risk factors observed since 2014, when the proportion was just 13.4%.

Among women with a previous pregnancy, 19.5% (n=52 of 266) were reported to have had a previous obstetric condition or risk factor requiring review in 2023. This represents a decrease of 4.5% compared to 2022 (24%) and interrupts the upward trend seen in recent years. The earlier increase, particularly between 2021 and 2022, may have been partly driven by improvements in data capture following updates to the data collection form, as recommended in the triennial report. The decline in 2023 may indicate a stabilisation following these updates. Alternatively, it may reflect a real change in the clinical profile of women registering for the service.

Of the 387 women who registered for a home birth in 2023, 168 (43.4%) were reported to have developed a medical or obstetric condition during the current pregnancy. This proportion is comparable to 2022 (40.7%) and continues a notable upward trend over the past decade. As was also observed with the increase in reported previous pregnancy problems or risk factors at booking in recent years, this upward trend may reflect improved clinical detection and documentation of risk factors through enhanced data collection practices, particularly since 2021. However, it may also indicate a shift in the clinical profile of women engaging with home birth services, with a growing number of higher-risk pregnancies being considered for eligibility following obstetric consultation.

Medical history risk factors requiring review

The most commonly reported risk factor (n=94) in 2023 remained maternal age over 40 at booking (n=34, 36.2%), consistent with previous years. This was followed by mental health history (n=16, 17%), gynaecological anomalies (n=15, 16%), and endocrine disorders (n=12, 12.8%). Notably, the ‘Other’ category has increased substantially since 2021, reaching 22.3% (n=21) in 2023. This may reflect broader documentation practices or the inclusion of less common or emerging risk factors.

Previous pregnancy problems requiring review

The most commonly reported previous pregnancy problems (n=52) in 2023 were Group B streptococcus and having previously experienced three or more miscarriages, reported in 21.2% (n=11) and 17.3% (n=9) of cases, respectively. These represent a continued upward trend for Group B streptococcus in a previous pregnancy since 2018, and a slight decline for three or more miscarriages compared to its peak in 2018 (n=5 of 12, 41.7%).

This was followed by previous extensive perineal trauma (17.3%), previous post-partum haemorrhage (13.5%) and previous baby with a congenital anomaly (9.6%).

While the ‘Other’ category decreased from 37% in 2022 to 21.2% in 2023, it still remains higher than in earlier years, potentially reflecting sustained improvements in recording less common obstetric complications.

In 2023, the most commonly selected category when reporting medical or obstetric conditions during the current pregnancy (n=168) was “Other” (29.8%), which includes a variety of medical issues not individually listed, possibly reflecting increased detail in documentation or a broader range of clinical scenarios. This was followed by prolonged rupture of membranes with no signs of labour (15.5%), post-dates pregnancy (14.3%) and indication of maternal infection (8.9%).

Although the percentage of women with infection-related concerns decreased in 2023, this may be due in part to a decline in COVID-related cases, which had contributed to the 2022 peak.

1.5 Antepartum referrals

Of the 168 women who experienced a complication during their current pregnancy while under the care of the home birth service, 91.7% (n=154) were referred for an antepartum obstetric review in a maternity unit (Figure 3). The remaining 14 women were appropriately managed by the community team without the need for referral. Among the 154 women who underwent an obstetric review, 51.3% (n=79) had their care transferred antenatally to a maternity unit. An additional 22.7% (n=35) remained under the home birth service but had a planned hospital birth; for the purposes of this audit, these women were also classified as antenatal transfers. Three of the women who were transferred during their pregnancy later returned to the care of the home birth service following the review and discharge from hospital. The remaining 26% (n=40) women continued their care with the home birth service following review with the plan to give birth at home. Of these 40 women, 32 (80%) gave birth at home, seven (17.5%) were transferred during labour and gave birth in hospital, and one woman gave birth outside of the home birth service.

Furthermore, six women who did not have any complication arise were transferred antenatally at their own request. 

1.6 Antepartum transfers

In 2023, 117 of 387 women (30.2%) were transferred to a maternity hospital during their pregnancy and did not subsequently return to the care of the home birth service and therefore, their planned place of birth changed from home to hospital. This is consistent with previous findings where approximately one-third of women required an antenatal transfer. Among those transferred in the antepartum period, most gave birth in hospital (n=110, 94%), while six women (5.1%) gave birth outside of the HSE service, and one woman (0.9%) gave birth before arrival at the hospital (BBA). As in previous years, nulliparous women were more likely to transfer during pregnancy compared to multiparous women (44% vs. 23%).

Figure 8: Antepartum transfer by parity, 2014-2023

As in previous years, the most common reasons for antenatal transfers in 2023 were prolonged rupture of membranes with no signs of labour (n=16 of 117, 13.7%) and post-dates pregnancy (n=11, 9.4%). Other notable reasons included onset of gestational diabetes (n=4, 3.4%), infant measuring small for gestational age (n=4, 3.4%), and malpresentation (n=2, 1.7%).

Figure 9: Trend in most common reasons for antepartum transfers, 2014-2023

Note: Categories are not mutually exclusive. 

Among women who experienced an antepartum transfer, access to birth records has improved notably over the past three years. In 2023, the community midwives had full access to 67.5% of the clinical maternity records, compared to 36.8% in 2022 and just 20.9% in 2021. Meanwhile, the proportion with access to only some birth details declined from 61.2% in 2021 to 29.1% in 2023, and those with no access at all dropped significantly from 15.5% to 3.4%. These trends reflect a positive shift toward greater access and information sharing between the services for women whose care was transferred during pregnancy, potentially an early reflection of the ongoing integration of the home birth service with the acute hospital services.

Antepartum visits

In 2023, women who did not require an antepartum transfer and therefore continued their pregnancy under the care of the home birth service (n=270) received between one and 13 antepartum visits from the midwife. The median number of visits was six for both nulliparous (interquartile range [IQR] = 2) and multiparous women (IQR = 3).

Since 2017, the median number of antepartum visits provided by the community midwives has remained stable at approximately six visits per woman, regardless of parity. This reflects a standardised pattern of antenatal care across the home birth service in recent years which is in line with the schedule of visits as outlined in the Midwifery Practice Guidelines.⁴

1.7 Intrapartum transfers

Of the 270 women who started labour at home under the care of the HSE Home Birth Service in 2023, 17.8% (n=48) required an intrapartum transfer to hospital.

As in previous years, nulliparous women were significantly more likely to transfer during labour than multiparous women. In 2023, 44.9% of nulliparous women transferred during the intrapartum period, compared to just 6.8% of multiparous women, a nearly sevenfold difference.

This pattern aligns with previous findings, where nulliparous women consistently experienced higher intrapartum transfer rates, ranging from 33.3% to 60.9% over the past decade, while rates among multiparous women remained below 15% in all years.

_{(Click Definitions and terminology for a definition of 'women who started labour at home')} 

Figure 10: Intrapartum transfer by parity, 2014-2023

As in previous years, the leading reasons for intrapartum transfers to a maternity unit in 2023 were confirmed delay in the first or second stage of labour (n=16, 33.3%) and maternal request for medical analgesia (n=13, 27.1%) (Figure 11). Other notable reasons included the presence of meconium-stained liquor (n=6, 12.5%) and concerns with the fetal heart rate (n=5, 10.4%). These patterns are consistent with previous years, where delay in labour and request for analgesia have remained the most common causes of intrapartum transfer.

Figure 11: Trend in most common reasons for intrapartum transfer, 2014-2023

Of the women who started labour at home and had relevant documentation available (n=266), there were 29 women who had a delay in labour identified and documented as per the guidelines.⁴ Of these women, 82.8% had an intrapartum transfer (n=24), as appropriate. For the remaining 5 women, while they were not transferred to hospital, there was evidence of accurate diagnosis of delay and a plan for transfer for 4 of them, potentially indicating that the delay resolved prior to the transfer. For the remaining woman, although a delay in labour was noted, accurate diagnosis and plan for transfer was not documented. Mother and baby were well following the birth.

Among nulliparous women who experienced intrapartum transfers, 40% were transferred for this reason, consistent with 2022 (36.1%). In contrast, only 15.4% of multiparous women transferred for this reason in 2023, showing a notable decline from 24.1% the previous year.

Similarly, maternal request for medical analgesia (e.g. epidural analgesia) remained more common among nulliparous women than multiparous women in 2023 (31.4% vs. 15.4%), consistent with patterns seen in previous years.

These findings reflect a continuing divergence in labour management needs by parity, with maternal request for analgesia remaining consistently higher among nulliparous women and transfers due to confirmed delay becoming increasingly concentrated among this group.

Among women who experienced an intrapartum transfer, access to birth records has also improved markedly over the past three years. In 2023, the community midwife had full access to clinical maternity records in 85.4% of cases, up from 44.6% in 2022 and just 34.5% in 2021. The cases in which the community midwives only had access to some information fell from 58.2% in 2021 to 14.6% in 2023, while cases in which they had no access decreased from 7.3% in 2021 to 0% in 2023. These improvements reflect a significant step forward in access and communication during intrapartum transfers, ensuring better continuity of care for women and improved collaboration between community midwives and hospital-based teams.

Stage of labour at decision to transfer

In 2023, for nearly four in five women, the decision to transfer occurred during the first stage of labour (n=38 of 48, 79.2%), a proportion that has remained relatively stable over the past four years. Transfers during the second and third stage of labour were less common, affecting one in five women (n=10, 20.8%) in 2023.

Community midwives remained involved in the woman’s care following intrapartum transfer in 85.4% of cases (n=41 of 48). A small number of which only provided postnatal support or non-clinical support (n=3). Seven community midwives (14.6%) did not remain involved following the transfer.

Of the 48 women who were transferred in the intrapartum period, 91.7% (n=44) women gave birth in the hospital, three women gave birth at home but were transferred in before the 3rd stage of labour was completed, and one woman gave birth before arrival to the hospital (BBAs) (Figure 3).

Figure 12: Stage of labour at decision to transfer, 2014-2023

Note: Frequency tables by year and reason are available from the Central Statistics Office (CSO).

Community midwives remained involved in the woman’s care following intrapartum transfer in 85.4% of cases (n=41 of 48). A small number of which only provided postnatal support or non-clinical support (n=3). Seven community midwives (14.6%) did not remain involved following the transfer.

Of the 48 women who were transferred in the intrapartum period, 91.7% (n=44) women gave birth in the hospital, three women gave birth at home but were transferred in before the 3rd stage of labour was completed, and one woman gave birth before arrival to the hospital (BBAs) (Figure 3).

Intrapartum transfers times

For the purposes of this clinical audit, intrapartum transfer time is calculated based on the time the woman left her home to the time she arrived at the hospital. In 2023, it took between 10 and 95 minutes to transfer women from their homes to the hospital. The average duration of intrapartum transfers was 39.5 minutes.

Just over one-third of women (38.6%, n=17 of 44, missing for 4 women) were transferred in under 30 minutes. Approximately 43.2% (n=19) were transferred within 30 to 60 minutes, and 18.2% (n=8) experienced transfers lasting more than 61 minutes.

The majority of these women (68.8%, n=33) were transferred by ambulance, while the remaining 31.2% (n=15) travelled by private car. Among the 33 women transferred via ambulance in 2023, ambulance timing data were available for 94% (n=31). The mean time from ambulance contact to arrival at the home was 31.4 minutes (SD = 18.4; range: 9 to 90 minutes). The time from ambulance arrival at the home to arrival at the hospital was 45.8 minutes (SD = 27.0; range: 13 to 105 minutes). The total time from ambulance contact to hospital arrival was 76 minutes (SD = 40.5; range: 28 to 195 minutes).

Figure 13: Length of intrapartum transfer, 2014-2023

Note: Frequency tables by year and reason are available from the Central Statistics Office (CSO).

Pain relief and birth outcomes following intrapartum transfers

The vast majority of women used some form of pain relief (n=46 of 48; 95.8%), with 58% (n=28) opting for an epidural in the hospital setting in 2023. This aligns with the most frequently reported reason for intrapartum transfer—request for medical analgesia, as discussed earlier in this report. Additionally, over half of the women (54%) used Entonox for pain management.

Less than 2% of women experienced blood loss greater than 1500mls (unknown for 5 women), and none required a postpartum blood transfusion.

The perineum remained intact in approximately half of the cases (n=23, 49%, unknown for 1). Ten women had an episiotomy, seven sustained a first-degree tear, six a second-degree tear, and one woman experienced a third-degree tear (n=24, 51%). Suturing was performed in nearly all cases (n=20 of 24; 83.3%), with the exception of four women who had a first-degree tear.

Of the women who required an intrapartum transfer to the hospital in 2023, two infants were reported to have required some form of resuscitation, one following transfer in the first stage and one in the second stage of labour. Resuscitation methods included suction and oxygen, and one case of intermittent positive pressure ventilation (IPPV). Both infants had recorded Apgar scores of 9 and 10 recorded at 5 minutes after birth and were later discharged well.

Between 2012 and 2023, approximately 1 in 7 infants born under the home birth service required an intrapartum transfer (14.3%). Of these, fewer than 10% were reported to require resuscitation.

No cases of shoulder dystocia were recorded among women who experienced intrapartum transfer.

Mode of birth following antepartum and intrapartum transfers of care

In 2023, spontaneous vaginal birth remained the most common mode of birth following both antepartum and intrapartum transfers.

Among those who transferred during the antepartum period, 54.9% (n=61 of 111, missing for six women) had a spontaneous vaginal birth, while 31.5% (n=35) had a caesarean section. There were 12.6% ventouse births (n=14) and less than 1% requiring a forceps birth within this group.

Among women who transferred during the intrapartum period, the rate of spontaneous vaginal birth dropped to 45.8% (n=22 of 48), down from 61.7% in 2022. Meanwhile, caesarean section rates rose to 31.3% (n=15), nearly doubling from the previous year 2022 (n=10 of 60, 16.7%, unknown for five women). Instrumental births in 2023 included ventouse in 16.7% (n=8) and forceps in 6.3% (n=3).

SECTION 2 - WOMEN WHO GAVE BIRTH AT HOME

This section presents data on women who gave birth at home after registering with the HSE Home Birth Service. While 2023 is the focus, selected indicators are summarised over longer timeframes to enhance consistency and allow meaningful trend analysis.

Home Births refers to all women registered with the Home Birth Service who ultimately gave birth at home during the reporting period. This includes women who remained within the home birth pathway throughout care, as well as those who returned to home care following a temporary transfer, where the birth subsequently occurred at home. Women registered for home birth who gave birth in hospital are excluded from this cohort. This group represents the final birth outcome population and is used to report outcomes specifically relating to births occurring at home.

2.1 Uptake and provision of home birth care across HSE areas

In 2023, 223 of 387 women who registered for a home birth (57.6%) gave birth at home, this equates to 0.2% of all women who gave birth in the country in 2023 and represents a home birth rate of 4.20 per 1,000 maternities. Among these, 80.7% were multiparous and 19.3% were nulliparous. In 2023, 86.1% (n=192 of 223) of home births were attended by SECMs and 13.9% by ICHMs (n=31).

Since 2012, a total of 2,076 women gave birth at home. The proportion of women who registered and ultimately gave birth at home has slightly declined over time, from over 70% in the early years of the audit to approximately 60% in the past years. This trend appears to be driven primarily by an increase in antepartum transfers (i.e. rising from 148 per 1,000 registered home births in 2012 to over 300 in 2023).

Figure 14: Proportion of women who gave birth at home among those who registered for a home birth, 2012–2023

2.2 Labour details

Rupture of membranes and liquor colour

Among women who gave birth at home in 2023, spontaneous rupture of membranes occurred in the vast majority of cases (n=213, 97.3%), with only a small proportion requiring artificial rupture (n=6, 2.7%). In four cases, the baby was born en caul, with the membranes remaining intact at the time of birth. Clear liquor was recorded in most cases in 2023 (n=200 of 222; 90.1%, unknown for one case). Meconium-stained liquor was reported in 7.7% of cases, while 2.3% were blood-stained.

These patterns align with trends observed from 2012 to 2022, during which 97.9% of home births followed spontaneous rupture of membranes, and just 2.1% involved artificial rupture. Clear liquor was recorded for 93.4% of home births during this time period.

Present at birth

In 2023, 94.6% of home births (n=211 of 223) were attended by a primary community midwife. A second midwife was present at the time of birth in 78.5% of home births (n=175). In a further 13.9% of cases (n=31), a second midwife arrived shortly after the birth and was present for the delivery of the placenta, but was not present at the time of birth. A partner was present at 96% of births (n=214). Other types of support at birth, such as student midwives, ambulance staff, or an additional midwife, were reported in 4% (n=9) of births.

Since 2014, the woman’s primary community midwife was present in over 94% of home births and the presence of a second midwife ranged from 72% to 85%. Having a second midwife present at the birth is a necessary component of the service. (1) Partners are almost always present (>90%), while other companions (family, friends, doulas) increased slightly in recent years, but remained below 15%.

From 2021 onwards, more detailed data on times of arrival to the birth for the second midwife were collected, showing that cases where the second midwife arrived only in time for placenta delivery or postpartum remained rare (<14% and <5%, respectively).

In 2023, 12 women gave birth at home without their primary community midwife present at the time of birth. In half of these cases (n=6), a midwife arrived shortly after the birth and was present for the delivery of the placenta to continue care. For the remaining six women, it is not specified when the midwife arrived at the home; these women were supported by their partner or a doula in some instances. Most of the women were multiparous (91.7%). All mothers and babies were reported to be well, with no hospital transfers required.

Figure 15: Who was present at the home birth by year, 2014-2023

Note: Values are not mutually exclusive.

Maternal position at birth

In 2023, all fours and kneeling positions were used by 143 of 218 women who gave birth at home (65.6%, unknown for five women).

These positions remain the most commonly used among women who gave birth at home across the last decade.

Figure 16: Maternal position for birth, 2014-2023

Pain relief

As per the midwifery practice guidelines, (1) pain relief options in the home setting should be discussed with all women planning a home birth. In 2023, this discussion was documented for 88.8% of women who gave birth at home (n=198 of 223).

In 2023, 88.4% of nulliparous women (n=38 of 43) used pain relief, versus 60.6% of multiparous women (n=109 of 180). Since 2014, nulliparous women consistently reported higher use of pain relief during labour compared to multiparous women.

Figure 17: Pain relief methods used during home births, 2014-2023

For those choosing to avail of pain relief during their labour, water immersion remained the most commonly used method in 2023 (n=79 of 147, 53.7%), followed by TENS machine (n=56, 38.1%) and Entonox (49, 33.3%). For those who chose to use water immersion during their labour, water temperature was monitored frequently in 84.8% of cases (67 of 79), in line with the relevant guidelines. (1) Among those that used water during their labour in 2023, 19% (n=15 of 79) gave birth in the water.

Since 2014, water immersion has remained the most commonly used pain relief method for labour, peaking between 2015 and 2020 when more than 75% of women used it, followed by a gradual decline in recent years. In contrast, use of TENS machine and Entonox have steadily increased in the past decade.

Since 2021, the noticed increased in the use of the “Other” category can be attributed to the introduction of Winner Flow, a handheld inhalation device, which accounted for around 7–10% of all responses between 2021 and 2023.

Duration of labour

This section presents data from 2021 to 2023, during which more detailed information on labour duration was available for women who gave birth at home (n=647, unknown for 42 women). Most labours lasted between 1 and 4 hours (n=407, 62.9%), with the highest frequency recorded around the 2-hour mark. Fewer than 10% (n=58) of cases exceeded 7 hours, and only a small number lasted longer than 12 hours (n=8).

Figure 18: Duration of labour among women who gave birth at home, 2021–2023

Labour duration varied noticeably by parity among women who gave birth at home between 2021 and 2023. Multiparous women (n=520) tended to have shorter labours compared to nulliparous women (n=127). These findings align with clinical expectations and illustrate the impact of parity on labour progression in the home birth setting.

Among women who gave birth at home between 2021 and 2023, 5% (n=36 of 647) experienced a baby born before arrival (BBA) of the midwife. These women had significantly shorter labours than those who gave birth at home with midwives present.

Management of the third stage of labour

In 2023, 71.2% (n=158 of 222, one unknown) of women who gave birth at home had physiological management of the third stage of labour, and 28.8% (n=64) had active management. Among the 64 women who had active management: 49 received intramuscular syntocinon, 19 received syntometrine, one was given ergometrine and two required a syntocinon infusion; (figures not mutually exclusive).

Since 2014, a slight rise in active management has been observed. Despite this rise, physiological management remains the more common approach over the last decade.

Physiological management involves no routine uterotonics, delayed cord clamping, and placenta delivery by maternal effort. National clinical guidance recommends active management of the third stage of labour to reduce the risk of postpartum haemorrhage (11). 

Figure 19: Management of the third stage of labour for home births, 2014-2023

Perineal outcomes

In 2023, nearly half of the women (43.5%) had an intact perineum following their home birth (n=97 of 223), while 26% of women experienced a first-degree tear (n=58) and 27.4% a second-degree tear (n=61). Third-degree tears and episiotomies remained rare in 2023, reported in 2.2% (n=5) and 0.9% (n=2) of women who gave birth at home, respectively.

Since 2014, the proportion of women with an intact perineum following the birth has become less common, whereas first-degree tears have become slightly more common. 

Perineal outcomes varied by parity throughout the years. Multiparous women were consistently more likely to have an intact perineum. While episiotomies and third-degree tears were uncommon, the majority of those reported were among nulliparous women. Fourth-degree tears remained extremely rare across all years and parity groups.

Figure 20: Perineal outcomes for women who gave birth at home, 2014-2023

Estimated blood loss at birth

According to HSE guidelines, postpartum haemorrhage (PPH) is defined as a blood loss ≥500ml, a major PPH is ≥1,000ml, while major obstetric haemorrhage is defined as a blood loss ≥2,500ml (11). In 2023, the mean estimated blood loss during home birth was 304ml (SD = 170ml) and five women were reported to have had a blood loss of 1,000ml or more. Two of these women were transferred during the third stage of labour and three were transferred in postpartum period, only one of which required a blood transfusion. All women were later discharged well.

In 2023, the mean blood loss following active management of the third stage of labour was 385.2ml (SD = 260.0ml), versus 271.7ml (SD = 99.1ml) for physiological management.

Since 2014, the proportion of women with moderate loss (250–499ml) was more common in the recent years. One major obstetric haemorrhage was reported since 2014.

2.3 Postpartum complications, transfers and care

In 2023, the average number of postpartum visits by community midwives to women who gave birth at home was 5.3 and ranged from two to 11 visits. The average day of discharge from the service was 11.7 days after the birth and ranged from four to 21 days.

Since 2014, the average day of discharge has decreased, reflecting a shift toward earlier discharge from the home birth service over the past decade.

Postpartum complications and transfers

In 2023, 28 postpartum complications were reported among 223 home births (12.6%). Of these, 15 women (53.6%) required hospital transfer, while 13 (46.4%) were managed in the community. One additional woman was transferred without a recorded complication, as she accompanied her baby who required transfer, bringing the total to 16 postpartum transfers following a birth at home (7.2%). Of these, 11 were transferred by ambulance, four by private car, and one by air ambulance.

From 2014 to 2023, postpartum transfer rates remained low, with annual variation ranging between 3.2% and 8.5% across the last decade. Rates were consistently higher among nulliparous women compared to multiparous women.

Figure 21:  Postpartum transfers by parity, 2014-2023

In 2023, the most common reasons for postpartum transfer among women who gave birth at home were extensive perineal tearing (37.5%, n=6) and postpartum haemorrhage (31.3%, n=5). 

Among women transferred in the postpartum period, postpartum haemorrhage and extensive perineal tear remained the most common reasons in the last decade, with annual variation across years.

2.4 Infant outcomes

This section presents data on outcomes among infants born at home using both 2023 data and the full cohort of births between 2012 and 2023. Due to the small number of events reported annually, data are summarised across the entire period to provide a more robust and meaningful overview.

Birthweight

In 2023, the average birthweight among infants born at home was 3,655g.

Since 2012, the mean birthweight of babies born at home remained stable. Across all years, birthweight was consistently higher among multiparous women, with babies weighing on average 150–250g more than those born to nulliparous women.

Apgar scores

In 2023, 209 of 215 babies (97.2%) were reported to have had reassuring Apgar scores (7–10 at one minute and five minutes), and none had scores below 7 at five minutes. Two infants had recorded scores below 7 at one minute but improved to 8 and 9 by five minutes. This excludes eight cases with unknown scores due to BBA.

Since 2012, Apgar scores remained consistently high, with a mean of 8.9 at one minute and 9.7 at five minutes, reflecting good neonatal condition in the home birth setting.

Within the whole audit period with available data, it was reported that two babies (0.1%) who were born at home had persistently low scores at 1 and 5 minutes after the birth and required resuscitation. One of which was transferred to hospital and was later discharged well, and one baby who was sadly stillborn.

Table 3: Apgar score transitions between 1 and 5 minutes for babies born at home, 2012-2023

Resuscitation

In 2023, six of the 223 infants that were born at home (2.7%) required some form of resuscitation, one of the lowest rates reported in recent years.

Since 2012, the proportion of babies who required resuscitation at birth among women who gave birth at home remained low, ranging between 2.7% and 7.1%.

Interventions among the six babies (2.7%) who did receive resuscitation in 2023 included oxygen alone (n=3), intermittent positive pressure ventilation (IPPR) alone (n=1), and a combination of suction, oxygen, and IPPR (n=2).

Between 2012 and 2023, 93 babies required some form of resuscitation following planned home births, including six in 2023. The most commonly used interventions reported across the entire cohort of babies were suction (n=47, 50.5%) and oxygen therapy (n=39, 41.9%). More advanced support, such as intermittent positive pressure ventilation (IPPR), was used in approximately one in five cases (n=19, 20.4%), while external cardiac massage was rare (1.1%). A further 19.4% received other forms of resuscitation, most commonly simple stimulation techniques.

Between 2012 and 2023, approximately 1 in 7 infants born under the home birth service required an intrapartum transfer (14.3%). Of these, fewer than 10% were reported to require resuscitation.

Shoulder dystocia among women who gave birth at home

Among all the women who gave birth at home from 2012-2023 (data unknown for 3), 17 cases of shoulder dystocia were reported (0.8%), including one case in 2023. The average Apgar score of those babies was 8.5 at 1 minute and 9.5 at 5 minutes, 1 infant had an Apgar score <7 at 1 minute . Three infants required resuscitation.

Reported rates of shoulder dystocia vary in the literature, ranging from 1% in high-income countries to 2.7% in a large U.S. study of a low-risk cohort. (12,13)

Newborn examination and screening

In 2023, one in 11 infants born at home (n=20 of 223; 9%) had a condition identified at the first head-to-toe newborn check by the midwife following the birth. The most commonly reported finding was tongue tie (n=15, 75%).

Between 2012 and 2023, one in 25 infants (4%) had a condition identified at first check (n=83 of 2,065; unknown for 11 infants). The most frequent findings were tongue tie (42.7%), positional talipes (11.7%) and other non-fatal anomalies (11.7%)

These findings reflect routine postnatal screening outcomes and align with expectations in a low-risk birth cohort.

In 2023, a day 3 newborn medical examination was completed in 98.7% of cases (n=220 of 223). Most examinations were carried out by hospital paediatricians (n=153, 69.5%), followed by midwives trained in newborn examination (n=47, 21.4%) and general practitioners (GPs) (n=20, 9.1%).

For the whole cohort (2012-2023), newborn examinations were performed in 98.8% of cases. During this period, GPs were the most common examiners (54.8%), followed by hospital paediatricians (41%). This suggests a shift with hospital paediatricians becoming the primary examiners in recent years and the emerging availability of midwife examiners.

In 2023, the National Newborn Bloodspot Screening (NNBS) programme was completed for 96.4% of infants born at home (n=214 of 222; unknown for 1 infant), with eight women declining the screening. Across the 2012–2023 cohort, the NNBS programme was completed for 97.8% of infants.

Vitamin K administration

In 2023, 83.4% of infants born at home (n=186 of 223) received vitamin K. Among them 72.6% (n=135) received it by intramuscular (IM) injection and 27.4% (n=51) received it orally.

Across the full cohort from 2012 to 2023, vitamin K was offered to all newborns as recommended by the HSE to reduce the risk of bleeding disorders. (14) It was declined by 19.9% of parents.

Infant feeding

In 2023, 93.7% of women who gave birth at home exclusively breastfeed their infants at discharge. Partial breastfeeding and artificial feeding remained low overall.

From 2012 to 2023, exclusive breastfeeding has consistently been the predominant feeding method among babies born at home, reported in over 93% of cases on day one after the birth and at discharge from the home birth service throughout the reporting years. Although there's been a slight decline since 2014, rates have remained consistently high.

Figure 23: Method of feeding at day 1 and at discharge for babies born at home, 2012-2023                 

Infant transfers following home birth

In 2023, 8.1% (n=18 of 223) of infants were transferred to hospital after the home birth. Of these transfers, twelve infants were transported by ambulance, five by private car, and the mode of transport was unknown for one case.

Across the full cohort from 2012 to 2023, it was reported that 4.5% of infants were transferred to hospital. The proportion of infant transfers varied over the years (from 2.3% to 8.1%), reaching its highest level in 2023.

Figure 24: Trend in infants transfers for babies born at home, 2012-2023

In 2023, the most common reason for infant transfer was to accompany the mother to the maternity unit (n=11 of 18; 61.1%), followed by respiratory symptoms (n=3; 16.7%). All 18 infants were reported to be well at discharge.

From 2012 to 2023, the leading causes for infant transfer were: respiratory symptoms (33.3%), accompanying the mother who required a transfer (29%), suspected fetal anomaly (8.6%) and low Apgar scores (7.5%).

Infants requiring additional care

In 2023, three infants born at home required a higher level of care, i.e. in the special care baby unit (SCBU) or neonatal intensive care unit (NICU). The length of stay ranged from two to 14 days, and it was reported that all infants were later discharged well. Reasons for admission included jaundice, thermoregulation concerns and IV antibiotic requirements.

Across the full cohort from 2012 to 2023, 62 infants required additional care in SCBU or NICU. All of which were reported to be well at discharge.

2.5 Perinatal mortality

A total of 10 perinatal deaths were submitted to the audit for the years 2012-2023 inclusive of all women who registered with the service (Table 4). This comprised of five stillbirths, four early neonatal deaths and one late neonatal death.

All but one baby was born in the hospital setting (90%). Antepartum transfers were required in 6 cases (60%), with indications including reduced fetal movements, bleeding, abruption, and the identification of a uterine fibroid.

Intrapartum transfers accounted for the remaining 4 cases (40%); two in the first stage of labour, one in the second stage, and one in the third stage. The duration of intrapartum transfer, where data was available, ranged from 15 to 45 minutes. Indications for intrapartum transfer included delays in labour (with associated findings such as cervical swelling, difficulty determining fetal position, and requests for pain relief), bleeding, and neonatal resuscitation at birth.

All cases were also submitted to the NPEC Perinatal Mortality National Clinical Audit (PMNCA). The causes of death were categorised as follows: among the stillbirth cases (n=5), two were due to placental abruption, one due to a placental condition, one was a shoulder dystocia with ascending infection and one further stillbirth was unexplained. The neonatal death cases (n=4 early and n=1 late neonatal death) were linked to hypoxic ischaemic encephalopathy (n=2), infection (n=1), and a respiratory condition (n=1), with one case awaiting Coroner report.

To provide additional context, perinatal mortality rates were also calculated for two subgroups within the registered home birth cohort. Between 2012 and 2023, there were four perinatal deaths among 2,541 women who started labour at home, giving a rate of 1.57 per 1,000. Among women who gave birth at home, there was one perinatal death among 2,075 births, giving a rate of 0.48 per 1,000. These subgroup rates should be interpreted with caution, as they refer to increasingly restrictive, lower-risk groups within the registered home birth cohort, making direct comparison with adjusted national perinatal mortality rates less appropriate.

Table 4: Perinatal mortality cases of all women registered for a home birth, 2012-2023

Table 5 provides data on perinatal deaths among all women registered with the Home Birth Service from 2012 to 2023 and perinatal deaths from all births in Ireland in 2023, excluding cases due to termination of pregnancy or due to major congenital anomalies. The perinatal mortality rate for all women who registered for a home birth from 2012 to 2023 was 2.91 perinatal deaths per 1,000 registrations, equivalent to one perinatal death for every 340 registered home births. No perinatal deaths in the registered home birth cohort were associated with major congenital anomalies.

The relatively small number of deaths among registered home births limits the scope for making meaningful comparisons. However, as no perinatal deaths in the registered home birth cohort were associated with major congenital anomalies, the home birth figures are most appropriately compared with the adjusted national perinatal mortality rates. It can be seen that the rate of stillbirth, early neonatal death and perinatal death among registered home births was broadly similar to the equivalent adjusted rates among all births in 2023.

Table 5: Perinatal mortality rates among all women registered for a home birth, 2012–2023, and adjusted national perinatal mortality rates, 2023

Note: Rates are presented per 1,000. For registered home births, rates are calculated using the number of women registered with the HSE Home Birth Service from 2012 to 2023 as the denominator. For all births, rates are based on adjusted national perinatal mortality rates for 2023, excluding deaths due to termination of pregnancy and major congenital anomalies. No perinatal deaths in the registered home birth cohort were associated with major congenital anomalies. 95% CI = 95% Poisson confidence interval.

Adverse incidents

This section presents data from 2021 to 2023, during which more detailed information on adverse incidents was available among women who gave birth at home. During this period, 126 adverse incidents were identified. A HSE National Incident Report Form (NIRF) was completed in all but one case.

Most incidents (88.7%) were classified as Category 3, the lowest severity level. A smaller proportion were Category 2 (9.7%), and just 0.8% were classified as Category 1. Two incidents had missing data on the category of the incident.

The most common incidents were waterbirths (46%), Born Before Arrival (BBA) of the midwife (23.8%), and postpartum haemorrhage (7.1%).

Waterbirths were reported due to the HSE’s temporary pause on waterbirth in the home setting (in effect from November 2020 to December 2023), which required a NIRF submission for any such case.

Severe complications were rare. However, one maternal death occurred in 2022 following a planned home birth. A formal review of this case is currently underway, with a report expected from the HSE.

Overall, the majority of reported incidents were either policy-triggered (e.g. waterbirths during the HSE pause) or related to manageable clinical situations, with very few high-severity events reported.

References

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Citation for this report

Citation for this report: San Lázaro Campillo I & Keane J, Corcoran P, Escanuela Sanchez T, McKernan J and Greene RA on behalf of the Registered Home Births National Clinical Audit Governance Group. Registered Home Births National Clinical Audit Report 2023; HSE National Home Birth Service. Cork: Health Service Executive, 2025.

Funded by the Irish Health Service Executive