Homebirth In Australia
After the exciting – or surprising – news of your pregnancy settles in, one of the first things you do is choose a maternity care provider.
Part of that decision involves choosing where you would like to give birth.
For some first time parents (and even experienced parents), there might be an assumption that the hospital is the ‘only' or ‘right' option for a birth location.
However, having a homebirth is a perfectly safe option for low-risk women.
The Australia’s Mothers and Babies report shows that homebirth in this country is on the rise. In 2009, there were 863 babies born at home. This increased to 1345 in 2010, and in 2012 there were 1177 home births.
Around 75% of women who had a homebirth in Australia were having their second or subsequent baby, but homebirth is also an option for first time mothers.
Why Do Women Want To Birth At Home?
Women who choose to birth at home have varied reasons for wanting to do so. For the most part, it's driven from the desire to keep their birth as normal and complication-free as possible.
Leah Hardiman, president of Maternity Choices Australia, says, “Homebirth is a wonderful choice for many women. Women often report back that they felt respected, and their overall experience was positive.”
Other reasons women are choosing to birth at home are:
- Continuity of care from one or two known midwives (during a hospital birth, usually unknown midwives intermittently care for the labouring woman, until it's time to push, when the obstetrician is called to catch the baby)
- Reducing the risk of interventions and further complications
- Labouring and birthing in the comfort and privacy of home
- Less risk of infection.
Is Homebirth Safe?
One of the biggest myths perpetuated is that birthing at home is an unsafe practice.
Research has shown again and again that planned homebirth is safe for low risk women. The Birthplace Study and this study from the Netherlands demonstrate that a homebirth does not increase the risks of injury or death among low-risk women.
Recently, the UK’s National Institute for Health and Care Excellence (NICE) updated their guidelines with regards to maternity care. The guidelines recommend that low risk women should be provided with information regarding an increased chance of interventions with obstetric care.
NICE also put a particular emphasis on recommending that low risk women were made aware of the option and safety of a planned homebirth.
Is Homebirth Legal?
Women have the fundamental right to choose where and with whom they give birth. Homebirth in Australia is not illegal.
Midwives do need to meet certain requirements for registration with Nursing and Midwifery Board of Australia. One of these requirements is to have professional indemnity insurance (PII) that covers all of their practice.
Midwives working through public hospitals are covered by their employers’ insurance. Privately practicing midwives must have insurance for antenatal and postnatal care, but are exempt from requiring insurance for labour and birth care.
As of April 2015, privately practicing midwives who are not Medicare eligible are no longer able to renew their insurance for antenatal and postnatal care when it runs out. A Medicare eligible midwife is one who has met the requirements of the Eligible midwives’ registration standard and has a Medicare Provider Number.
How To Have A Homebirth
There are two main ways you can have a homebirth in Australia, either through a program linked to a public hospital or by employing a private midwife.
Midwives who care for women at home during pregnancy and labour are highly skilled and trained. They have special equipment which they bring to your home when you are in labour. It's used for monitoring you and your baby, and for treatment (in the unlikely chance of complications arising).
Private Practice Midwives (PPMs) are self employed and often work in a group practice with others. Women who develop complications during pregnancy are referred to an obstetrician within a hospital for specialist care. If complications occur during labour, the PPM will arrange transfer to the nearest hospital. Currently PPMs do not have access to hospital rights, except for eight hospitals in Queensland, one in South Australia, and one in Western Australia.
What Are The Costs of Having A Homebirth?
If a PPM is Medicare eligible, this enables their clients to claim Medicare rebates on antenatal and postnatal care. The average cost of employing a PPM is between $3500-$5500. Some private health insurers provide rebates for private antenatal and postnatal care.
There are around 12 publicly funded homebirth programs in all states, except for Queensland, the Australian Capital Territory and Tasmania. The programs are run through the public hospital system, and women may need to live within a certain distance of the hospital to access the program.
There is specific criteria for eligibility that varies depending on the state. The main criteria is that women are having a low risk, healthy pregnancy.
Midwives provide what is known as caseload care, involving continuity of care with an allocated secondary or back up midwife. If a woman develops complications during her pregnancy or labour, the primary midwife collaborates with other medical staff and the woman is no longer able to birth at home.
Access to public funded homebirth programs is free.
What Are The Benefits of Homebirth?
Midwives are trained professionals who focus on birth as a natural and normal process (but will refer clients to specialist care when things are no longer low risk). They work with women to form a relationship that provides women and their families with specialist one to one care.
There are many benefits of homebirth:
- More likely to have a natural birth
- Allows for the natural start and progression of labour (fewer inductions and related complications)
- Continuous support and care during labour
- Women can have their other children/relatives present
- Avoidance of unnecessary procedures such as routine monitoring
- Lower risk of c-section
- Supported and gentle beginning into parenthood
- No need to travel during labour
- More positive birth experience
- More successful ongoing breastfeeding relationship
- Increased chance of going into labour spontaneously
- Lower risk of complications for baby, as the result of interventions
Is Homebirth For Me?
Most women want to have a natural, vaginal birth, with no complications that endanger her baby or herself. Yet, they might dismiss homebirth as the most likely way to achieve this.
Choosing where to give birth has a far greater impact on birth outcome than many people realise. Obstetric care is linked with a higher risk of interventions during labour, including induction of labour (which means a labour becomes high risk, and is more likely to result in c-section), episiotomy, epidural and c-section.
Perhaps you want pregnancy and birth care at the centre of your care provider’s focus. You might feel strongly that your role as the key decision maker will not be as respected in a hospital environment. This is especially true for women who have previously experienced birth in hospitals and felt their care was not woman-centred or respectful. You may want to choose each member of your birth team and get to know them before you go into labour.
Whatever your reason for being interested in homebirth, it's worth exploring your options and talking to others that have chosen a midwifery led model of care.
While some women who have medical conditions or a baby who will require specialist medical care, women experiencing a low risk, healthy pregnancy can consider homebirth as a safe option.
What If Something Goes Wrong?
The main concern for any woman giving birth is something may happen to endanger the life of her baby or herself. There is an expectation that medical assistance needs to be immediately on hand to avoid complications. While there is no guarantee nothing will go wrong during labour in any situation or birth place, complications when birthing at home are very rare. This is likely due to the lack on interventions in the first place.
Midwives see their clients regularly during pregnancy, often in the client's own home. The midwives invest time getting to know their clients, building a relationship with them. The appointments are usually much longer than the 5-10 minutes women normally see a doctor for.
The trust and knowledge gained during this time is obvious during labour and birth. Midwives can observe their clients on a continuous basis, unlike in hospitals where they may be looking after more than one labouring woman at a time. Therefore they can better understand how a woman's labour is progressing and what she may need.
At home, there is no reliance on machines – instead, a focus on the woman's physical labour, as well as close contact and support. This allows midwives to spot if a complication is on the horizon and act early to alleviate or to make a plan to transfer to hospital.
Midwifery is a ‘hands on’ approach to birth care. Many labours are slow or stalled because of baby’s positioning. Midwives are experienced and knowledgeable in the art of helping a woman labour as their baby descends and moves into an optimal position for birth.
In some situations, labour can stall if a woman is experiencing unresolved fear or trauma. The relationship which has been established enables the midwife to address these issues during labour. This can help the birthing woman move past these issues to successfully birth her baby. In a hospital, a stalled or slow labour is usually seen as a failure to progress and is deemed to be managed — often by inducing artificial contractions (similarly to being induced) or even a c-section.
Midwives bring a kit, including resuscitation equipment, instruments for suturing, catheterisation packs, medications for bleeding, and IV equipment. These tools and their training provide security if an unexpected complication arises.
Tips and More Information
Deciding to have a homebirth is a very personal one. Not many people are aware of the facts or understand the safety of birthing at home. Doctors, family and friends can be very unsupportive and try to dissuade you from choosing to homebirth. They may not be up to date on the current evidence and information about the safety of birthing at home.
Talking to others who have experienced birth at home is a good place to start. There are homebirth groups on Facebook where you can read stories of other women’s experiences. Most states have homebirth groups that meet monthly and it can be a good way to meet others and share information about local midwives. Meeting with midwives will also help you to find the right one for you and your personal situation.
You can read more about myths surrounding homebirth here.
There are a number of advocacy groups that you may wish to contact for further information about the current situation for homebirth.