What is Home Birth
A home birth often conjures up fear in the minds of many women who tend to associate it with being “unsafe” and with not being able to have pain relief.
However, increasing numbers of women are choosing home birth when they find out how much more in control women feel when they birth at home, or when they discover the increasing amount of medical research which shows that homebirth is as safe as hospital birth for a woman at low risk of complications who is attended by an experienced professional midwife, and who lives within reasonable distance of a back-up hospital.
In more recent times research has started to show that the risk of the mother or baby being injured or dying at a homebirth under these criteria are usually the same as (if not lower than) if they were in hospital.
So, who is having a home birth?
In 2003 figures show that just over 700 women planned a homebirth in Australia that year. In 2009, there were 29,650 home births in the United States (representing 0.72% of births), the highest level since data on this item began to be collected in 1989.
Previously, the percentage of home births had declined slowly from 0.67% of all U.S. births in 1990 to 0. 56% in 2004.
These women come from all walks of life, but the one thing they have in common is wanting to have their baby in the familiar environment of their own home.
While many birth with independent (or private) midwives, publicly-funded homebirth has been available for a small number of women for many years in some Australian states such as Western Australia, South Australia and New South Wales through Midwifery Programs.
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 unnecessary episiotomy
- even if hospital transfer is needed, the risk of caesarean is low
- antenatal and postnatal visits at home, in the community, 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 such as 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, resuscitation equipment, and drugs to stem bleeding after the birth. Even if you choose homebirth but are unsure about managing without medical pain relief, or if it becomes necessary during labour, you can still transfer from home to hospital care in pregnancy or in labour. Note that 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?
Some people worry about what would happen should the mother or baby suddenly require medical assistance at a home birth. Although there can be no guaranteed outcomes in any birth, the protective features in a home birth are linked to not interfering with the woman’s natural processes. Many people particularly worry about what would happen should a caesarean become necessary. However, research shows that less than half of all caesareans occur within thirty minutes of the decision, so even if you were already having your baby in hospital a caesarean could take much longer to start than you think. If a complication develops at a homebirth the midwives phone ahead for the hospital to start preparing for when the mother arrives. Midwives in Australia use the Referral Guidelines of the Australian College of Midwives to support informed decision making by their clients when it may be necessary for the woman or baby to be seen by, or transferred to the care of additional health professionals or facilities, such as obstetricians and hospitals.
Start planning a homebirth?
- Speak to a midwife or midwifery/homebirth program manager who provides homebirth care in your area
- Find yourself a birth information group where you can listen to women’s and men’s stories of homebirth. This will also help you find homebirth books and videos, and find names of local midwives to help you think which midwife might suit your preferences
- Be aware that some GPs and obstetricians do not recommend homebirth, and may actively discourage it, because they are not aware of the up-to-date research or aware that public hospitals are increasingly offering it as an option
Once you have found a midwife who is available around your due date she will arrange your first antenatal visit, possibly at home or a community health centre. Many women find consultation hours are more flexible than in hospitals and that home visits are more convenient if other children are present as they can play at home until the midwife arrives and then be involved in the antenatal check. Some women do not decide they want a homebirth until well into their pregnancy, but it may still be possible – phone a midwife for advice. Many women planning homebirth also book with a back-up hospital – your midwife can help with this.
How much is a homebirth and is this covered by Private Health Insurance?
Homebirth is free if you are accepted into an Australian publicly-funded Community Midwifery Program or a hospital-based homebirth service. Women who contract an independent or private midwife usually pay the fees themselves and feel that it is worth the personal and continuous attention received throughout their whole pregnancy, labour, birth and postnatal period. Anecdotally, these fees are often similar to the out-of-pocket expenses that are paid for a private obstetrician. However, fees vary widely depending on which area of you live, 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 ask what level of cover they require for which services, and to also check what smaller amounts they may be eligible for rebate on (ie prenatal education/care and postnatal care). If you require further information on this, contact the Maternity Coalition.
What about antenatal tests, scans and check-ups?
Choosing to birth at home does not preclude you from accessing the full range of antenatal testing that is available. Your midwife is well qualified to give you information about what testing may be appropriate for you to consider, and how to best go about accessing these services. Usually, unless you are having a homebirth via a community midwifery program or a midwifery group practice, then if you want medical testing you will need to see a GP or attend an antenatal clinic at a hospital to procure the necessary forms. The results are usually sent to both yourself and your midwife for your records. For well women with normal healthy pregnancies the midwife will provide comprehensive advice on nutrition, health maintenance, and the usual regular antenatal checks (maternal blood pressure, growth and heart rate, position of the baby, and general wellness checks). Anything out of the realms of ‘normal’ is referred to an appropriate medical practitioner, and care may continue either in collaboration, or back with your midwife alone, depending on the issue.
When you go into labour?
Many women will 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. Whatever you are feeling, you will be able to talk to your homebirth midwife by phone to keep her informed of what is happening, and she will be able to reassure you by phone, or visit your home to assess your condition. Most women keep in touch like this until the midwife and woman decide that labour is progressing well and it is best for the midwife to be at the home.
Often mothers prepare a ‘nest’ where they plan to give birth, even though they move throughout the whole house or garden during labour. If your labour becomes very intense you may need somewhere with complete quietness so that you are not distracted. You and your family can prepare the area in advance, perhaps also setting up a birth pool and beginning to fill it once labour begins. It is 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. Remember that birth is not completed until the placenta (‘afterbirth’) has come out. Your midwife will advise you on how she manages this important stage of birth.
Children can be present or not during the labour and/or birth, according to what the woman and her family feel is best – you could discuss this with other families who have already birthed at home. However, if children are prepared for a little noise and blood, for example with homebirth books or homebirth videos, they are generally less concerned about birth than adults.
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, for example with breastfeeding. She will not leave you until she is confident that you and your baby are well. She will be available by phone until she visits again, usually within 12 to 24 hours of the birth. Most midwives visit daily thereafter until you are happy for the visits to become more spaced apart or to cease. Postnatal visiting (including weighing the baby, well baby and well mother checks) 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.