Q&A with Community Midwife Aine Hennessy

Have you been considering a home birth? Do you know about the the Community Midwives Association (CMA). They are a group of self-employed midwives who offer the HSE Home Birth Service. And I personally think they are Ireland's best kept secret!

Aine has kindly answered some commonly asked questions on this fantastic service!

Q. Imagine someone has never heard of community midwives, can you explain the service and how women/couples can contact you?

A. The Community Midwives Association (CMA) are a group of self-employed midwives who offer the HSE Home Birth Service to women and families who chose to birth at home. They offer continuity of care during pregnancy, birth and the postnatal period. They sign a contract with the HSE which outlines the service they provide, eligibility criteria, ongoing assessment and payment schedule. All the midwives do annual training and education to keep skills up to date. You can find details of all the midwives on our website communitymidwives.ie along with their location and contact details. You can call or email the midwife closest to you for further information on home birth and signing up to the service.

Q. What training do community midwives take?

A. All the midwives in the CMA are registered midwives and have done the same training as every other midwife. They are required to have training in a hospital setting before working in the home birth service. Each year, our midwives attend study days and further education to ensure they keep on top of their skills as a midwife, as well as staying up to date with most recent evidence. These study days include obstetric emergencies, neonatal resuscitation, manual handling, basic life support, water birth and many more.

Q. Have community midwives previously worked in maternity hospital setting or always home births?

A. All our midwives have experience working in a hospital setting prior to joining the CMA and working in home environments.

Q. Do you have the same midwife through all of your visits?

A. Yes – continuity of care is key and knowing your midwife to build a relationship of trust. You will have the same midwife throughout your antenatal care, she will attend your home birth and continue care postnatally.

Q. What do all 11 visits include?

A. You are entitled to 11 visits in total under the HSE Home Birth Service – 5 antenatal visits, your home birth and 5 visits postnatally, usually spread over a 2 week period. Antenatal visits are exactly the same as the hospital ones – check the woman’s blood pressure, urine sample, palpate the abdomen and listen to baby’s heartbeat. However, most antenatal appointments with your midwife is spent building that relationship, gaining trust in each other, as well as preparing for birth from a physical and emotional perspective. The postnatal visits include a physical assessment of both mother and baby, monitoring emotional wellbeing, how the mother and family are transitioning with a new baby, demonstrating practical skills such as nappy changes, feeding, bathing baby, etc. The midwife will help with feeding. She will monitor baby’s weight and also complete any additional tests such as the Newborn Bloodspot Screening test (usually done around day 5 after birth).

Q. Is it just as safe to have a home birth?

A. Home birth is a safe option for low-risk women. The Birth Place Study done in the UK is a great resource when it comes to comparing outcomes between women who birth in hospital, a birthing centre and at home. We have low rates of caesarean, epidural, instrumental birth within our home birth service, as well as fantastic satisfaction rates from the women and their families regarding the care they receive from their midwife. You can find our annual statistics on the Community Midwives Association Facebook and twitter pages.

Q. What equipment do midwives take to home births?

A. We have A LOT of equipment! Each woman receives a birth pack with all the basic equipment we need for every home birth – cord clamps, cord scissors, gloves, needles, and syringes, etc. Each midwife carries oxygen and Entonox, emergency medications in case of any concerns for bleeding after birth, fluids, cannulas, needles, catheter equipment, oxygen masks for mother and baby. We set up a little resuscitation area for baby at every birth in case baby needs help breathing at the birth. On top of that, we carry equipment we use more frequently such as blood pressure monitor, dopplers to listen to baby’s heartbeat, weighing scales and measuring tape, thermometer…. I could be here all night!

Q. How you would you personally describe the difference in setting between a home and hospital birth?

A. It’s like day and night. You create an environment in your home where you feel safe – lighting, candles, music, birth pool/bath, cushions, blankets, your own bed! Home is where you feel most safe so the natural hormones which we need for birth can work as they need to, undisturbed. The woman has freedom to move around and go where her instinct tells her and the midwife will follow. The midwife is there to support and facilitate. At the end of the day, the woman births her baby. The midwife should be watchful, listening for changes in the woman. The continuity of care you receive through home birth means your midwife knows what you want, she knows if things begin to go awry and acts accordingly because she knows your normal parameters. She knows your baby’s heartbeat to a T. There is nothing like the bond you build with your midwife and the midwife with you. Hospitals are known to be clinical, clean, brightly lit, noisy, people shuffling around. This is not to say hospital births are bad or negative in any sense of the word. Many women have empowering and positive hospital births. It is how you manage it from a psychological side of things in my opinion. Physically, you can move around, sit on a birthing ball, use the shower, or birth pool if available, dim the lights, close the labour room door. But by creating a bubble around you to protect your natural hormones and allow them to produce and flow as needed can be more difficult in a hospital setting. Having a supportive team around you is vitally important and sharing your birth preferences with them, particularly if there is a shift change and a new midwife enters the room. You try and build up a new relationship with a new midwife and that can be tricky. Doable, but tricky!

Q. Is there an ambulance on call, should be one required?

A. Yes, we always call the national ambulance service when the woman is in labour. We send in a form during the pregnancy with the woman’s details, so when the midwife calls them, they can pull up the woman’s file and have the location flagged in case we do need to transfer.

Q. Finally, do you have any advice for any women who are considering a home birth?

A. Do your research. Understand what home birth is and what it entails. While it can sound lovely at the time, you need to make sure you are doing it for the right reasons. We have had many women call our midwives looking for a home birth during the Covid-19 pandemic and lockdowns over the past 18 months, but not necessarily doing it for the right reason, mostly fear. Also, keep in mind that opting for a home birth does not always mean you will birth at home. There are many reasons we need to transfer into hospital for either the safety of the mother or the baby or both. I always encourage women opting for home birth to also have hospital birth preferences written out in case of transfer. Create a space in your home where you feel safe and comfortable and excited to birth. Focus on positive birth stories. Complete an antenatal course such as hypnobirthing to help stay calm, relaxed and focused at home. And enjoy the whole experience!

I hope you enjoyed this read as much as I did!

Ailish 🌻