Homebirth

What is homebirth?#

Homebirth means you plan to give birth at home under the care of a registered midwife, with as little intervention as possible. It can be an option if you are healthy, have a low-risk pregnancy and are able to reach a maternity hospital quickly and easily.

Some reasons people consider a homebirth include:

• You want to be cared for by a midwife of your choice.
• You can give birth in familiar surroundings where you may feel more relaxed.
• You want greater control over your birth experience in your own home.
• You do not want to leave your other children.

You can change your mind about giving birth at home at any time and decide to have your baby in a hospital instead. During your pregnancy, your midwife may also advise that a homebirth is no longer the safest option for you or your baby, and that your care and birth should be managed in a hospital.

Questions to think about#

If you are considering a homebirth, it can help to think through questions such as:

• Will I feel safe at home?
• Who will look after my other children if I need to travel to hospital?
• How would I get to hospital if I needed to, and could an ambulance reach my home easily?
• Is my midwife close by and easy to contact, and is she part of a team?
• What are the costs of a homebirth?
• Am I healthy, and is my pregnancy low-risk?
• Am I happy to give birth without access to an epidural?
• Were my previous births uncomplicated, or did a previous baby need unexpected extra care at or after birth?
• How can I check that my midwife practices safely and has the right skills?
• Can my midwife continue to care for me if I need to go to hospital, and what can I do if I feel worried about my care?

Is homebirth an option for me?#

Every pregnancy and birth is different, so you need advice from your doctor or midwife about whether homebirth is right for you. It is generally considered for people who can reach a maternity hospital easily if needed; many homebirth programs require that you live within a short drive of the hospital.

Low-risk pregnancies are usually those where you:

• are healthy and do not have significant medical conditions, such as pre-existing diabetes, obesity or cardiovascular disease
• are expecting one baby
• have had a previous baby without major complications, and no previous baby who needed unexpected extra care at or after birth
• have not had previous uterine surgery, including a caesarean section
• have a safe and suitable home environment

As a pregnancy progresses, your situation can change in ways that affect your decision. For example, a homebirth may no longer be suitable if it is suspected or known that your baby will need additional care at birth, or if complications develop such as pre-eclampsia, gestational diabetes or placenta praevia. Other factors that may affect suitability include a pregnancy supported by assisted reproductive technology such as in vitro fertilisation (IVF), being at the extremes of childbearing age, being unable to attend antenatal appointments, or not having had recommended pregnancy screening tests.

This information is provided as an example only and is not a comprehensive guide to whether a homebirth is suitable. It is essential that your doctor, specialist or midwife assesses your suitability and any risk factors to determine whether homebirth is an option for you.

Making an informed decision#

It is important that you have all the information you need to make an informed decision. Ask your healthcare providers about the care they offer and their skills and experience. Taking a friend or family member to appointments can help you make sure you have heard and understood the information and advice.

Ask your midwife how they put professional safety and quality guidelines into practice. Be sure to discuss insurance, as professional indemnity insurance for privately practising midwives often does not cover labour and birth. It also helps to understand requirements such as:

• two skilled, registered health professionals being present at the birth
• your midwife being competent in basic adult life support and newborn resuscitation
• your midwife seeking your written, informed consent

Is homebirth safe?#

High-quality evidence on homebirth is limited, and much of our understanding comes from research conducted in other countries. In healthy women with low-risk pregnancies, this research has found that:

• for women having their first baby, a planned homebirth increased the risk of serious problems for the baby from about 5 in 1,000 for a hospital birth to about 9 in 1,000 for a homebirth
• for women having their second or subsequent baby, a planned homebirth appeared as safe as a hospital birth

Professional bodies generally support homebirth as an option for women with a low-risk pregnancy who are cared for by a midwife or team of midwives, and recognise that every woman has the right to choose the place of birth. Whatever you intend, it is important that you and your family are well informed and understand the potential benefits and harms for both mother and baby. This is best achieved through open conversations between you and the registered health professionals caring for you, who may include obstetricians, primary care doctors and midwives.

Other pregnancy and birth care options#

Before choosing a homebirth, speak with your doctor or midwife about the full range of care options, sometimes called “models of care.”

Many public hospitals offer models where you are cared for by a small, multidisciplinary team of clinicians, usually led by midwives. Collaborative models, in which a privately practising midwife cares for you within a hospital, are another option. These models can:

• help you weigh the suitability of different maternity care options
• allow you to receive ongoing care from a midwife or team of midwives
• support your choice to have a birth with as little intervention as possible
• provide access to medical backup if it is needed

Public homebirth programs are usually provided by midwives employed by a hospital, supported by clinical services, supervision and review. Each program has its own criteria for who can take part, reflecting what is safest for the local community and the staff involved.

Choosing a private midwife#

Homebirth services are also offered by privately practising midwives. If you go this route:

• Check that the midwife is appropriately registered and meets the required registration standards, and whether there are any conditions on their practice.
• Make sure you clearly understand their fees, what those fees cover, and whether you may be eligible for any rebate.
• Remember that private midwives’ professional indemnity insurance often does not cover labour and birth at home.
• Check that you understand all associated costs, including ambulance transport if you need it.
• Ask how the midwife uses professional safety, quality and referral guidelines to provide care.
• Get a second opinion if you are unsure about the care that will be provided.

Where to get help#