The development of a suite of audit tools for the HSE National Home Birth Service

Research indicates that place of birth is a factor in both maternal and infant outcomes and that, for both multiparous and nulliparous women, a planned home birth leads to fewer interventions than for those birthing in an obstetric hospital. Home birth is also acknowledged as a safe option for both low risk multiparous and nulliparous healthy women. The evidence also indicates that there is no increased risk relating to perinatal outcomes for multigravida women birthing at home; however the evidence indicates that infants of nulliparous women have a slightly increased risk of a poorer perinatal outcome and thereby transfer of care may be required. Accordingly, healthy women with straightforward pregnancies should have access to and information about all birth settings including: birth centres, including alongside and freestanding midwife-led birthing centres; home birth and obstetric-led units; along with the related maternity care outcomes for the settings. Likewise, midwives providing home birth services should be supported in their practice through a seamless maternity service linking community and hospital settings (Midwifery 2020, 2010) and a comprehensive clinical governance arrangement, including an audit mechanism that promotes best practice.

The HSE Home Birth Service in Ireland currently offers a home birth service to low risk women with a straightforward pregnancy who choose to plan to have a home birth. In 2013, the HSE established a Clinical Governance Group (CGG) to develop a system for clinical governance for the national homebirth service provided by Self Employed Community Midwives (SECM). As part of the process of developing a governance infrastructure for the service, the HSE commissioned a research team at the UCD School of Nursing, Midwifery and Health Systems to develop an audit tool as part of this infrastructure. The project to develop the audit tool was conducted over a six-month period in late 2015 and early 2016. Using a process of stakeholder engagement, including users of the home birth service and representatives of women’s advocacy groups, the team developed a suite of four bespoke audit tools with the assistance of an expert panel. The tools are designed as self-completion tools for use by homebirth service users, midwives, the HSE, and a third party. Key principles informed the content of the tools, including: recognising and enabling choice and shared decision making; supporting women in their choice of place of birth; recognising birth as a normal physiological process; promoting quality and safety of midwifery practice; and effective and transparent governance of the home birth service.