I think govt HB programs have their place. I think they are great for introducing homebirth as an option for women who may never have considered homebirth. I don't believe they are any safer than homebirth with an independent midwife, and sometimes this is how they are presented.
Really interesting to read this discussion. I'm living in the Netherlands at the moment and here homebirth is the norm. In fact, unless there is a serious medical reason directly relevant to the birth requiring a hospital delivery health insurance companies will cover all costs for a midwife assisted homebirth but none of the costs of a hospital birth. Of course the situation is different for many many reasons.
What I find really interesting is that given how my last birth went I'm too high-risk for a midwife assisted homebirth here in the Netherlands and I'll have to have a midwife assisted birth at a hospital next time.
Now I think if I was still in Oz I could probably find an independent midwife willing to give homebirth another try with me. However, the system here is fully regulated so that there are just normal registered midwives who work in the normal system, there are no independent midwives that I could go to to try to get around this.
Personally, I'm not too concerned about it. As long as I can take my own midwife with me into the hospital I'm happy. And I do know how close me and my son came to dying during his birth and can definitely understand their reasons.
I just find it interesting that here where homebirth is such a norm, it's in some ways more restricted.
thanks for your post nyigi. that is one of the potential problems that I see with govt regulated homebirth programs.
I don't think homebirth will ever become the 'norm' here, and the regulations that have been introduced have already had a significant effect on the number of midwives working independently. if the situation doesn't change track soon, we will have a similar outcome of few independent midwives, but without the culture or practise of widespread govt supported homebirth.
I don't post often but saw the discussion on hospital homebirth programs and thought I'd add my 2c.
I birthed at home through the Sunshine Hospital homebirth program in Melbourne. I think hospital homebirth programs get a bad rap because there are some misconceptions about them.
Yes, there are restrictions on who can get into the program, and they appear to have more restrictions on when they ask a woman to transfer to hospital. My experience with Sunshine was that I had the same midwife throughout my pregnancy, and, presumably just like most IMs, an alternate midwife who attended when my midwife was unavailable. They worked in a caseload team and we were able to meet the rest of the team during the pregnancy.
Most of my early appointments were at an out patients Clinic, until later in the pregnancy when they were at my home. I was provided with a birth pool, oxygen tanks and synto (the latter two were never used).
What I think is misunderstood about these programs is the notion that they are restrictive because "the hospital says so," like it's just some crappy policy made up by Obs. The real reason though, is that the people running the programs want it to succeed. The Sunshine program, for example, was originally a pilot funded by the government. The midwives in the program are as passionate about homebirth as anyone else, and they wanted it to be rolled out further and funded on an ongoing basis. In order for that to happen, they needed to protect the program from poor outcomes. The less "risky" a pregnancy, the more successful it will be as a homebirth. The less transfers, the better for the overall statistics. And the more positive outcomes (including from those that transferred), the better for the program. By keeping it to very low-risk pregnancies, the program is protected for other women to utilise it. It's a bit of a socialist approach to homebirth, I guess - if there is a poor outcome during one of the homebirths, then there is more likely to be negative attention from the media, more scrutiny, and less chance that other women could access the program in the future. In a way, by joining the program and accepting the policies and conditions, each woman is taking one for the team.
I fully respect why many women will say they prefer an IM, that they dislike the restrictions on the hospital-run programs. That is their prerogative. And yes, some IMs will manage a homebirth differently to how an hospital program would manage it. But the hospitals have different mandates and when the tax-payer is paying the bills, they have to protect themselves.
FWIW, the restrictions were also negotiable in my experience. I hit 42 weeks and whilst the "policy" was to go to hospital after that, my midwife negotiated for me to stay home until 42+2 (I birthed at 42w, so it was not needed in the end). I was also given full respect and autonomy over everything that happened. There was no pushing for inductions, or interventions, or tests. During my labour, no one touched me, except occasionally to check baby's heart rate. No one touched me or baby during delivery or afterwards. My birth was perfect and I would recommend a hospital program to anyone who thought it was a good fit for them.
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