Safety concerns raised over home birth services at Cork hospital

Concerns around patient safety were noted in a HSE audit of home birth (HB) services, including at Cork University Maternity Hospital (CUMH).

The audit reports, seen by The Echo, showed issues around record keeping and communication between self employed midwives and hospitals, as well as safety concerns related to the ability to get to hospital in sufficient time in case of an emergency.

The level of assurance of the adequacy and effectiveness of the governance, risk management, and internal control system at CUMH was rated “limited” assurance, the same rating as the other two sites audited, Rotunda and Coombe in Dublin. 

Site visits

Site visits were conducted at the CUMH HB service on April 11, 2024, with auditors reviewing 30 randomly selected domiciliary midwifery motes, including 10 in Cork, of home births from the total of 218 for the period March, 1, 2023, to February 29, 2024.

It was advised at interview in both Rotunda and the Coombe that the distance to the hospital was “rarely an issue” due to the proximity of women using the service, and the urban location.

However, as CUMH covers a wider and often rural area, it was advised that in applications where distance was considered excessive, other options such as advising the woman to move closer to a maternity unit post 36 weeks gestation were discussed. Nationally there was no agreed standard maximum safe travel time or distance from the woman’s residence to the nearest maternity hospital.

No discharge summaries

Two of the 10 Cork midwifery motes involved a hospital transfer. Handover to hospital staff was recorded, but not in the required format. Additionally, no discharge summaries from maternity units were found in the motes.

At CUMH, three of the four self employed community midwives had outstanding training requirements, and an out-of-date training record template was still in use.

Of 10 motes reviewed at the Cork hospital, three lacked evidence that the receiving hospital and ambulance service had been notified of the planned home birth, and the hospital was issued a recommendation to fix this.