Whom this affects: AIMS Ireland have been contacted by Lecturers in the School of Nursing and Midwifery at Trinity College Dublin, by practicing midwives, by homebirth midwives, by pregnant women, birthing people and their families to highlight their lack of choice for a safe birthing option at home.

The issue: The HSE currently has a ban on women birthing in water in community settings.

Labouring in water is enabled with birthing pools and hydrotherapy. However, women are encouraged to exit the pool for the birth. This is not something many women would want to do, or are able to do sometimes minutes before birth is imminent. Mostly women want to focus on their breathing and composing themselves for the birth of their baby rather than execute the difficult physical manoeuvre of getting out of a pool.

The Ban: The suspension of waterbirth as part of the HSE's National Home Birth Service occurred in November 2020, following two adverse incidences in domiciliary settings. Unlike any other maternity incident we are aware of, the suspension of waterbirths occurred before a formal investigation was conducted.

Suspension of a HSE service without due diligence does not happen, to the best of our knowledge, in any other area of maternity care. The idea that you would suspend caesarean section, for example, following an adverse incident and before a thorough investigation was undertaken is unthinkable.

In this case the suspension came first and the investigation second. We have now been informed that the investigation found no link whatsoever with the adverse incidences and giving birthing in water.

As yet, none of these reports have been made publicly available and the ban persists, resulting in women and their families still being denied the safe choice of water birth at home in Ireland.

Safety record: The biggest study into the safety of water births was conducted in the US in 2021 and compared 17,530 water births and 17,530 non-water births in a healthy, low-risk pregnancies population (Bovbjerg et al., 2021). The report found that there was a lower risk of several maternal and neonatal outcomes, including postpartum haemorrhage, fewer perineal lacerations and hospitalization soon after delivery, and no increase in neonatal death in women who birthed in water. Importantly, there was no difference in the number of neonatal deaths between babies born underwater and those born on land. Neonatal hospital admissions are also reduced in those babies who were birthed in water.

An inquiry carried out by the National Perinatal Epidemiology Centre (NPEC) on the foot of this HSE investigation found that there were no adverse clinical outcomes associated with water birth in the community setting in the previous 12 years, since the HSE's National Homebirth Service with the Self-Employed Community Midwives was first established in 2008.

The use of a birthing pool is now considered a safe alternative to medicalized birth, for women who have a low-risk pregnancy (Barry et al 2020, Bovbjerg et al 2021).

Yet despite all of the above, 18 months on, this non-evidenced based, unequitable ban on water birth by the HSE in home birth settings is still in place.

We ask the Minister of Health: Given the evidence of the safety of water birth Internationally, and the lack of any evidence showing the risk of waterbirth in Ireland we ask the Minister for Health, Stephen Donnelly to, instruct the HSE to lift this ban on water birth as part of the National Home Birth Service with immediate effect and to enable women and birthing people in Ireland to have the safe choices in labour and birth that is consistent with a 21st century maternity service.

For more information contact Dr. Margaret Dunlea, School of Nursing and Midwifery, Trinity College Dublin or AIMS Ireland.

Photograph by kind permission of Nicole Hamic (Copyrighted)