Recommendations progressed from previous reports

NPEC collaboration with the DMOs to further develop the home birth audit form.

Several measures have been put in place to develop and improve the data collection form for the home birth clinical audit, including building and managing the new form on a secure online platform.

Owner: NPEC/ Home Birth services

Newborn Infant Physical Examination (NIPE) availability in the community setting.

In 2023, the number of midwives who performed the NIPE on infants born at home continues to increase (21%) compared to the previous years 2022 and 2021 (15% and 2% respectively).

Owner: NWIHP/Home Birth services

Maternity units identifying a liaison obstetrician or a specific home birth clinic.

A specific liaison obstetrician or clinic was available for 56% of women who registered for a home birth in 2023, an increase from last year (48%).

Owner: NWIHP

Identification of a communication pathway to capture data points when a woman’s care is transferred to the maternity unit.

In 2023, the community midwives had full access to 67.5% of the clinical maternity records following antepartum transfer, compared to 36.8% in 2022 and just 20.9% in 2021. Following an intrapartum transfer, 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.

Owner: NWIHP/Home Birth services

Recommendations from the 2023 report

Continue to encourage presence of a second midwife at the home birth.

In 2023, there continues to be a slight increase in the attendance of a second midwife at the home birth, from 76% in 2022 to 78.5% in 2023. A further 14% arrived very shortly after the birth and were present for the delivery of placenta. The presence of two midwives at the home birth has been a mandatory part of the service since 2014. This should continue to be encouraged as an important safety measure when providing community care.

Owner: NWIHP/Home Birth services

Promote uptake of Vitamin K administration for infants born at home.

In 2023, 83.4% of infants born at home received Vitamin K. Across the full 2012–2023 cohort, Vitamin K was offered to all newborns, as recommended by HSE policy, but was declined by 19.9% of parents. Continued efforts are required to support informed decision-making and improve uptake of Vitamin K administration, in line with HSE guidance, to reduce the risk of vitamin K deficiency bleeding. Uptake should continue to be monitored through the national home birth audit.

Owner: NWIHP/Home Birth services

Waterbirth guideline adherence.

Water births are available again in the community following a temporary pause, which was lifted in December 2023. Since the service resumed, all midwives involved have been undergoing specific training, in line with the HSE Guideline on the Management of Water Birth for the home birth services (2). It is recommended that the water temperature is monitored at least hourly, which was noted in 85% of women who used water during their labour in this 2023 cohort. Ongoing education and training on supporting women using water immersion for labour and birth remains a key safety measure.

Owner: NWIHP/Home Birth services