Homebirth – Having A Homebirth In Australia
So, who is ‘doing it'?
The latest national figures show that just over 700 women planned a homebirth in Australia in 2003. While many women give birth with independent (or private) midwives, publicly-funded homebirth has been available for a small number of women for many years in Western Australia and South Australia through Community Midwifery Programs, since 2005 in NSW at St George public hospital in Kogarah, and from 2006 in Alice Springs and Darwin. The South Australian Department of Health is currently finalising a policy on ‘Planned Birth At Home' to enable midwives from public hospitals in SA to provide homebirth.
Why Do Women Choose Homebirth?
Two of the main reasons women choose homebirth are to avoid what they have previously experienced, or anticipate might happen, with hospital birth, and/or to have their baby with care from just one or two midwives who they can
come to know and trust. Some other reasons are that:
- In the familiar environment of their home they often feel more in control of their labour and birth, and can have whoever they want (or don't want!) present
- There is less risk of infection for both mother and baby
- There is less risk of an unnecessary episiotomy
- Even if hospital transfer is needed, the risk of caesarean is very low
- Antenatal and postnatal visits at home or in the midwife's home feel much more personal than visiting an antenatal clinic with many other women.
Common interventions available in hospital, such as induction and epidural, are unavailable at home, but this is exactly why many women choose homebirth. Women cope with the work and pain of labour using various methods including immersion in water, shower, massage, aromatherapy and walking. Homebirth midwives do not usually carry pethidine or gas, but do carry safety equipment like oxygen, suction, and drugs to stem bleeding after the birth. One of the main factors which seems to make homebirth successful is the woman and her care provider(s) having confidence in her body's natural ability to give birth.
What If Something Goes Wrong At Home?
Some people worry about what would happen should the mother or baby suddenly require medical assistance. Although there can be no guaranteed outcomes in any birthing process, the protective features in homebirth are linked to non interference with the woman's natural processes. Midwives who facilitate homebirth are educated and experienced to assess the wellness of mother and baby throughout the episode of care. Midwives use the Referral Guidelines of the Australian College of Midwives, to support informed decision making by their clients when may be necessary for the woman or baby to be seen by, or transferred to the care of, other health professionals or facilities such as obstetricians and hospitals. (http://www.acmi.org.au/text/corporate_documents/ref_guidelines.htm).
How Do You Start Planning A Homebirth?
- Speak to a program manager or midwife who provides homebirth care in your area
- Find yourself a birth information group where you can listen to women's stories
- Be aware that some GPs and obstetricians do not
recommend, or will actively discourage, homebirth
- Your midwife will advise you on how to make a back up booking at a suitable hospital.
What About Paying For A Homebirth? Can I Use My Private Health Insurance?
Homebirth is free if you are accepted into a publicly funded Community Midwifery Program or a hospital-based homebirth service. Fees vary widely depending on which area of Australia you live in, so it is best to contact individual midwives to ask them. There are about nine private insurers in Australia who reimburse for homebirth or private midwifery. Women are advised to check with the individual insurer and what level of cover they require for which services. If you require further information on this, contact the Maternity Coalition – Australia's national maternity consumer advocacy organisation.
What About Pre-Natal Tests, Scans And Check-Ups?
Usually blood tests and scans are arranged by a GP or hospital antenatal clinic. The results can be sent to both yourself and your midwife on your request. The midwife provides regular antenatal checks (maternal blood pressure, growth and heart rate, position of the baby, and general wellness checks), at a time convenient to both of you. Anything out of the realms of ‘normal' is referred to an appropriate medical service, and care may continue either in collaboration, or back with your midwife alone, depending on the issue.
What Happens When You Go Into Labour?
Many women have signs or feelings that their body is getting ready for labour well before it actually starts, such as increasing tightening of the abdomen. Others have no sign until they get full-on contractions. Most women keep in touch until the midwife and woman decide that labour is progressing well and it is best for the midwife to be at the home.
Usually mothers prepare a ‘nest' where they plan to give birth, even though they move throughout the whole house or garden in labour. You and your family can prepared the area in advance, perhaps also setting up a birth pool and beginning to fill it once labour begins. It's wise to put down plastic sheeting and old towels on the floor and protect a comfortable chair. Your midwife will advise you in advance of any other preparation required. When your labour is very intense you may need complete quietness so that you are not distracted. Remember that birth is not completed until the placenta (or ‘afterbirth') has come out. Your midwife will advise you on how she manages this important aspect of birth.
Children can be present or not, according to what you feel is best – you could discuss this with other families who have already birthed at home.
What Happens After The Birth?
Your midwife will usually stay for about four hours after the birth, observing you and your baby, and assisting as needed. She will not leave you until she is confident that you and your baby are well. Your midwife will be available by phone until she visits again, usually within 12 to 24 hours of the birth. Most midwives visit daily after the birth until you are happy for the visits to become more spaced apart or cease.
Postnatal visiting usually finishes at 6 weeks, but the bond between a family and their midwife usually lasts a lifetime. Where maternal and child health services are provided locally the midwife arranges that referral.
Your helpers can make sure that towels and other linen used for the labour and birth are put in the washing machine, that you and your partner/family have been fed and watered, and that you are resting.
Where Can I Get More Information?
Deciding on a homebirth in Australia can be more difficult than other birth decisions because less people are familiar with it. Talking to women and midwives experienced with homebirth will help. To find out more read Sheila Kitzinger's excellent book ‘Birth Your Way: Choosing Birth at Home or in a Birth Centre'. The new Australian book ‘Better Birth:
The Definitive Guide To Childbirth' (Newman & Hancock 2006) has women in four of its twelve stories comparing their homebirths with their other births in a hospital or birth centre.
For children the book ‘Hello Baby' (by ABC Books) is very good, written from a child's perspective, but also a good insight for adults. And try to watch as many homebirth videos as you can.