Homebirth FAQs!!

The idea of homebirth can conjure up fear in the minds of women in Australia if they associate it with being “risky” and believe they will be without any pain relief. However, increasing numbers of women are choosing homebirth when they find out the benefits, or discover the increasing amount of medical research showing that homebirth is as safe as hospital birth for a woman at low risk of complications, who lives within reasonable distance of a back-up hospital, and who is attended by an experienced professional midwife. A range of research now shows that the risk of mother or baby being injured or dying at a homebirth under these criteria is the same as (if not lower than) if they were in hospital.

So, how many women are “doing it”?

The latest figures show that just over 730 women planned a homebirth in Australia (Australia’s Mothers & Babies 2004, Australian Institute of Health & Welfare 2006). While many assume that homebirth is for “hippies”, in fact women from all walks of life are having 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 Western Australia and South Australia on Community Midwifery Programs (eg the Northern Women’s Community Midwifery Program in the Playford area of SA), since 2005 in NSW at the St George public hospital in Kogarah, and from 2006 in Alice Springs and Darwin. In early 2007 the South Australian Department of Health was finalising its first policy on “Planned Birth At Home” to enable midwives from SA public hospitals to support 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:

• antenatal and postnatal visits at home feel much more personal than visiting an antenatal clinic with many other women;
• 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 or caesarean.

The main interventions available in hospital are unavailable at home, but this is exactly why many women choose homebirth. Furthermore, feeling more confident, comfortable, and relaxed during labour often means that less pain relief is needed than if you were in hospital, and labour and birth progress more smoothly so that less medical intervention is needed. Women cope with contractions 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, and drugs to stem bleeding. 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 in pregnancy or in labour. Remember, choosing homebirth does not mean that you can no longer access medical or hospital care. However, 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?

Homebirth is often perceived as entailing more risk than hospital birth because people worry about what would happen should the mother or baby suddenly require medical assistance. There are several ways in which such problems are avoided. Firstly, midwives who facilitate homebirth are educated and experienced to assess whether your home and the medical wellness of you and your baby are suitable for homebirth. Only women who are deemed by an experienced homebirth midwife to be at low risk of complications or medical conditions are advised to consider homebirth. Secondly, if a complication develops during labour or birth at home then the midwives can phone ahead for your back-up hospital to start preparing for when you arrive. Midwives in Australia have a set of recommended practice guidelines devised by the Australian College of Midwives. These provide a framework around which women and their midwives can make appropriate and safe decisions that are right for the individual woman’s circumstances.

How do you start planning a homebirth?

You are in the right place!! This website is a great place to start gathering information about birth and homebirth in particular (check out our pages of 'recommended reading' and 'internet resources'). The next thing to do is to find yourself a birth information group where you can listen to women’s stories (such as the Homebirth Network coffee mornings). This will also help you meet local midwives and help you think about which midwife might suit your preferences. You might start by phoning some midwives to chat more about homebirth and whether or not it would suit you. Remember that you are employing a care provider, and have the right to ask lots of questions about how any birth attendant (be they midwife, GP or obstetrician) cares for women in pregnancy, birth and post natally. Ask for their statistics on interventions, hospital transfers and caesarean rates.

Once you have found a midwife that you feel comfortable with, who has vacancies and is available around your due date, she will arrange your first antenatal visit, usually at home. Many women find consultation hours more flexible than those provided by hospitals. This can make it easier for their husband/partner to meet the midwife too, and it is more convenient when there are other children because they can play until the midwife arrives and then be involved in the antenatal check. Some women do not decide on homebirth until quite a way through their pregnancy, but it may still be possible to arrange – phone a midwife for advice. Many women planning homebirth also book with a back-up hospital - your midwife can help you with this. Be aware that some GPs do not recommend homebirth because they are not aware of the up-to-date research, or that public hospitals are increasingly offering it as an option.

What about paying for a homebirth? Can I use my Private Health Insurance?

Homebirth is free if you see a midwife from a 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 well worth the personal and continuous attention that they get throughout their whole pregnancy, labour, birth and postnatal period. Anecdotally, these fees are often similar to the out-of-pocket expenses that you would pay for a private obstetrician. However, fees vary widely depending on which area of Australia you live in, so it is best to contact individual midwives to ask them. Otherwise, there are about nine private insurers in Australia who reimburse for homebirth or private midwifery. Women are advised to check their individual situations with the individual insurer and what level of cover they require for which services, and to also check what smaller amounts they may be eligible for rebate on (eg prenatal education/care and postnatal care). If you require further information on this, contact the Maternity Coalition’s South Australian Branch at maternitycoalitionsa@yahoo.com.au

What about antenatal tests, scans and check-ups?

Choosing to birth at home does not prevent you from accessing the full range of antenatal testing and scans. Your midwife is well qualified to give you information about what testing may be appropriate 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 get the forms for these tests. However, the results are usually sent to both yourself and your midwife for your records. For well women, with normal healthy pregnancies, your 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), all in your home, at a time convenient to both of you. Anything out of the realms of ‘normal’ is referred to an appropriate medical practitioner, and care continues either in tandem, 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. Whatever you feel, you will be able to talk to your midwife by phone and she will be able to reassure you by phone, or to visit your home to assess your condition. Most women keep in touch these ways until the midwife and woman decide that labour is progressing well and it is best for the midwife to be at the home. Usually the woman chooses a particular area for the birth, even if she labours throughout the whole house or garden. The woman and her family will usually also have prepared the area in advance, perhaps also setting up a birth pool and beginning to fill it once labour is established. Women often put down plastic sheeting and old towels on the floor in case they want to birth “on land”. The midwife will advise in advance of any other preparation required. Children can be present or not, according to what the woman and family feel is best – you could discuss this with other families who have already birthed at home. However, note that if children are prepared for a little noise and blood they are generally a lot less concerned about birth than adults!

What happens after the birth?

After the birth, your midwife(s) will 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 comfortable for her to leave. However, she/they will usually stay at least a couple of hours after the birth, and often for around four hours to take medical observations. You can have champagne and snacks on the bed, couch, or wherever you are! Your midwife will also help with the first few breastfeeds if you require help, and 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 the woman is happy for the visits to become more spaced apart. Postnatal visiting (including weighing the baby, well-baby and well-mother checks) usually last officially for 6 weeks, but the bond between a family and their midwife usually lasts a lifetime.

Where can you get more information?

Deciding to have 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 also for adults. Take the opportunity to watch as many homebirth videos as you can (look in the Homebirth Network SA library or ask others who have birthed at home).

To find out more about homebirth please thoroughly explore the Homebirth Network SA website, come along to our coffee mornings,. and feel free to contact us, a midwife or a doula with your questions or concerns.

"Having a Homebirth in Australia"

by Lareen Newman PhD and Tania Smallwood BMid RM (both of Maternity Coalition), and Justine Caines (Secretary of Homebirth Australia).

Adapted by L Newman for the Homebirth Network South Australia, February 2007.

For literature references used for this article, please contact matcoalitionsa@yahoo.com.au

Disclaimer: The authors intend this article as a general guide only. You are advised to see a midwife experienced with homebirth to discuss your own personal situation and condition.