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.
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 through some public hospitals in South Australia.
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.
What about paying for a homebirth? Can I use my Private Health Insurance?
Homebirth can be 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 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 - between $2000 and $4000,. however it varies between providers so it is best to contact individual midwives to ask them.
As for private health cover, 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).
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. Your midwife or birth professional will have the time to discuss the pros and cons of undertaking these tests and what they mean in the context of your birth plans.
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 in a conversation or will 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.
What about older siblings at the birth?
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 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 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.