Homebirth is being able to birth in comfortable
and familiar surroundings
Women choose homebirth for many reasons including:
- personalised care from a qualified midwife throughout her pregnancy, birth and post-natal period, in the comfort of her own home
- being able to birth in comfortable and familiar surroundings
- decreased need for interventions and drugs during labour
- women can choose who is present at their birth
- no separation from their baby
- no separation from their partner and/or other children
- less risk of infection during a homebirth, as homes generally don’t harbour dangerous bacteria, unlike hospitals
- the freedom to do what she wants during labour – dance, sing, scream, walk around the backyard or submerge in a pool or bath
- babies frequently have fewer problems after birth
- increased success rates with breastfeeding
- trusting, one-on-one relationships with independent midwife or carer can be particularly important for women with special needs due to trauma following earlier hospital experiences or who have experienced sexual assault
- birth rituals can be planned according to spiritual and cultural beliefs
- much higher success rates for VBACs (vaginal birth after caesarean)
Expanding midwife-led models of care and publicly funded homebirth services will take women and their babies out of Australian hospitals, free up beds for our ageing population, provide a cost saving to government and deliver better health outcomes and greater satisfaction to birthing mothers in this country.
HOW DO I HAVE A HOMEBIRTH?
Many people are surprised to know that they can have a baby at home. According to the latest ‘Mothers and Babies Report 2012‘, there were 1,177 babies who were born at home in Australia in 2012, however it is likely that this number is higher due to not being reported to the perinatal data collections.
Most women who have homebirths engage the services of an independent midwife. These midwives provide all your prenatal, labour, birth and postnatal care. Other women choose to have homebirths through a publicly funded program provided by a public hospital.
CAN ANYONE HAVE A HOMEBIRTH?
Most healthy women with normal pregnancies are suitable candidates for a homebirth. However you may be surprised to learn that women safely give birth to first babies, twins, babies in a breech position, after 40 weeks of pregnancy, after caesareans and when they are in their 40s – all at home.
Talk to Independent Midwives about your particular situation and whether they feel experienced enough to provide the services you require. The more health information you can give your midwife, the better her advice to you.
If you are having a homebirth via a publically-funded program, there are some restrictions about which women and pregnancies are accepted for a homebirth. These restrictions usually include, pre 37 weeks and post 42 weeks gestation, previous caesareans, breech presentation, twins, group B strep, insulin dependent gestational diabetes, high BMI, and other health complications. In these situations, talking to an independent midwife to see if she will still support you is advisable.
IS MY HOME SUITABLE FOR A HOMEBIRTH?
Any home is a suitable place to give birth as long as you feel comfortable and safe there. Babies are born in top-floor flats, homes with stairs and homes with children and pets present.
Many women use water for pain relief during labour and many also choose to use a birth pool, which can be hired or purchased, or may come from your midwife as part of her fees. If you want to do this, it’s a good idea to consider the ease of access to hot running water.
You may also want to consider the distance between your home and the nearest hospital in case you need to transfer to hospital during labour. You can ask your midwife about what arrangements she would make should you need to transfer. The most common reason for transfer to hospital is due to long labour and exhaustion, or obstructed labour.
The latest Australian figures show that over 1100
women have a homebirth each year
There is a wealth of evidence to support the safety of planned, assisted homebirth
In a recent, large scale study of 5000 women planning a homebirth in the US and Canada, researchers found that outcomes for mothers and babies were the same as for low-risk mothers giving birth in hospitals, but with a fraction of the interventions. 
Planned home birth for low risk women using certified professional midwives is associated with lower rates of medical intervention, but with similar rates of mortality for newborn babies and mothers during birth to that of low risk hospital births.
The Cochrane Collaboration, the largest and most reputable collection of evidence-based medicine reviews in the world, also recently published ground breaking evidence comparing midwifery-led care compared to other models of care (obstetric, general practitioner and shared care). See: Midwife-led versus other models of care for childbearing women[1,2], 8 Oct 2008
The review of midwife-led care covered midwives providing care antenatally, during labour and postnatally. This was compared with models of medical-led care and shared care, and identified 11 trials involving a total of 12,276 women.
Midwife-led care was associated with several benefits for mothers and babies, and had no identified adverse effects.
Benefits for women in the midwife-led care include:
- fewer hospital admissions,
- fewer epidurals or any need for pain relief,
- fewer surgical cuts to the perineum,
- fewer forceps and vacuum birth.
There were also:
- increases in normal vaginal births,
- greater feelings of control during labour and birth,
- higher breastfeeding rates and
- shorter hospital stays for babies.
Overall there was no difference in the numbers of babies dying – though fewer appeared to die before 24 weeks under midwife care. None of the other major complications of pregnancy and birth were any different.
The recommendation of the reviewers was unequivocal: All women should be offered midwife-led models of care and women should be encouraged to ask for this option.
Some people worry about what would happen should the mother or baby suddenly require medical assistance. Although there can be no guaranteed outcomes in any birth, the protective features of homebirth are linked to non-interference with the woman’s natural birthing processes. Midwives who facilitate homebirth are educated and experienced in assessing the wellness of mother and baby throughout the episode of care.
Midwives 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, other health professionals or facilities such as obstetricians and hospitals.
The Cochrane review concluded that it was not just women with uncomplicated pregnancies that benefited from midwifery care. The key is continuity of care, recognition of complications and good collaboration with doctors if and when complications eventuate.
The latest Australian figures show that just over 1100 women plan a homebirth each year.
While many women give 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 through Community Midwifery Programs. In NSW, publicly funded homebirth services have been established since 2005 at St George in Kogarah, since 2007 at Belmont and since mid 2008 at Wollongong Hospitals. From 2006, publicly funded services have also operated in Alice Springs and Darwin.
The NSW Framework for Maternity Services (2000) is policy currently forming the platform for maternity services across NSW. It promotes continuity of care and the provision of publicly funded homebirth. NSW Health also introduced a Homebirth Policy Directive in mid 2005 that supports and encourages the setting up of home birth services through the State’s Area Health Services.
 Ackermann-Leibrich et al (1996); Bastian, Keirse, & Lancaster (1998); Campbell R, Macfarlane A (1994) Chamberlain, Wraight, & Crowley (1997); Crotty, Ramsay, Smart, & Chan (1990); Gulbransen, Hilton, & McKay (1997); Johnson & Daviss (2005); Macfarlane A, McCandlish R, Campbell R. (2000); Murphy & Fullerton (1998), Olsen O. (1997); Wiegers, Keirse, & van der Zee (1996); Woodcock, Read, Moore, Springer NP, Van Weel C (1996); Stanley, & Bower (1990)  Johnson KC and Daviss B, Outcomes of planned home births with certified professional midwives: large prospective study in North America. BMJ 2005;330:1416 (18 June)
Jill Cohen, Associate Editor, Midwifery Today
The Myth of A Safer Hospital Birth for Low Risk Pregnancies
Judy Cohain, CNM
Home Birth Isn’t Just For Hippies; It’s For Moms Who Want The Safest Delivery Possible
Elizabeth Nolan Brown
Natural Childbirth: Is homebirth more dangerous than hospital birth?
Chris Kessler, L.Ac
FOR SPOUSES AND FAMILIES
Husbands and Home Birth: A Call for Women to Educate Men
All That Matters is a Healthy Husband (or: why giving birth matters)
Molly Remer, MSW, ICCE
The 7 Secrets Of Being A Homebirth Dad
A Dad’s Journey into Homebirth
Siblings and the homebirth setting
Yvonne Lapp Cryns
Homebirth: Do I Need a Doula?
If I’m hiring a midwife, why do I need a doula?
Why women shouldn’t fear home birth
Nation-wide study in the Netherlands found that planning a home birth does not increase the risks of perinatal mortality and severe perinatal morbidity among low-risk women, provided the maternity care system facilitates this choice through the availability of well-trained midwives and through a good transportation and referral system
Canadian study (ontario) finds that All measures of serious maternal morbidity were lower in the planned home birth group as were rates for all interventions including cesarean section for low risk women
Women planning birth in a midwifery unit and multiparous women planning birth at home experience fewer interventions than those planning birth in an obstetric unit with no impact on perinatal outcomes.
Study of over 140,000 women in Netherlands found that Homebirth was actually safer than hospital birth for low risk women – if care is led by a midwife and good hospital transport is available for emergencies
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