Hi Samantha,
You are absolutely right, it is the woman's choice to give birth wherever he or she chooses. However, in terms of retaining an independently practicing midwife, a reliable midwife will adhere to admission criteria such as those laid out above, as there is research which indicates that certain types of pregnancy carry an increased risk of complications. Twin or multiple pregnancies, for example, are a statistical rarity and certainly not a "normal" pregnancy, in that "normal" human physiology only produces one egg in order that there be only one pregnancy. So therefore, pregnancies such as these carry a greater risk of complications. My personal belief, as a nurse and as a father of two girls born at home (not as a midwife, although as part of our business I am quite familiar with the research surrounding birth at home) is that homebirth is a safer option than hospital birth for women with a normal pregnancy, "normal" being defined according to the kind of criteria I mentioned above, as long as they are supported by an appropriately trained and experienced individual. I also believe that, for women who are isolated from medical care, it is sensible to take measures to ensure that medical care is available; whether that means relocating closer to medical care, or alternatively, choosing to birth in hospital but educating yourself and bringing with you a vocal advocate to be your voice during labour and ensure your well-research wishes and desires are accepted, even if they happen to go against hospital policies, policies which often exist for the convenience of staff, not women.
My wife often poses that exact situation to me as a moral dilemma - knowing the risks inherent in medicalisation of a hospital birth, would I support her to birth twins at home? My answer is that no, I would not; but that I would pay for the services of an IPM to accompany us to the hospital as an advocate; that I would light candles in the birthing suite, burn oils, play music, and dim the lights; bring our doona from home and put it over the bed, close the cupboards and the windows; blow up our own birthing pool; bring sandwiches and food and drink; and then I would politely give the midwives and any obstetric registrar present a packet of Tim Tams and let them know that, if we needed them, we would let them know, and that until that point, the only people who we would permit into the room were one hospital midwife and our own support people, and that we were willing to sign any waiver or document that they desired us to sign to facilitate this birth experience in the safest and most natural possible way, and that we had personally chosen and employed an experienced midwife as a support person whose judgement we trusted and that if they honestly felt that complications were arising that required intervention, we would obviously accept such intervention.
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