Homebirth

Can anyone have a homebirth?

About 1,000 women each year in Australia choose to give birth at home (Hilder et al 2014). Private midwives care for the majority of these women.

Private midwives work for themselves rather than a hospital. This means a cost is associated with their service. If the midwife is an Endorsed Midwife, Medicare provides rebates for some of these services, and some private health funds also provide rebates. A few hospitals and birth centres in Australia are now offering Medicare-funded homebirths as an option for women who are considered low-risk.

Regardless of the model you choose, the same midwife or small group of midwives provides pregnancy, birth and postnatal care.

If you choose to give birth at home and complications occur during the pregnancy or birth it may mean you will need to have your baby in hospital.

Most midwives will accompany and support you when this occurs and continue to care for you along with the hospital doctors and midwives. Your private midwife is allowed to accompany you as a birth support person, but they’re usually not able to continue to be your midwife. If they have visiting rights to the hospital, though, they can continue to be your midwife, and this is becoming more and more common.

Intervention rates in birth are low and women's satisfaction with care is extremely high when cared for by known midwives (Sandall et al 2013).

How do I organise a homebirth?

Ask your GP when you confirm your pregnancy or, if your family doctor isn't supportive of the idea, contact an organisation representing independent homebirth midwives, such as the Australian College of MidwivesOpens a new window, Midwives AustraliaOpens a new window, Homebirth AustraliaOpens a new window or your statewide organisation, for advice.

A private midwife can carry out your antenatal care, attend the birth of your baby at home if all goes to plan, and provide postnatal care too. A homebirth with a private midwife will cost about $3,500 to $5,500.

Private midwives can now be notated as Endorsed Midwives. This means:

• they meet particular professional standards
• they have a collaborative arrangement with an appropriate doctor, hospital or similar health service, to enable seamless consultation, referral or transfer if you need it
• they can attend women in birth centres and hospitals, as well as at home
• you can claim Medicare rebates for some of their services

Is homebirth covered by Medicare?

If you’re part of a hospital or birth centre program that offers homebirths, the birth will be covered by Medicare.

If you’ve engaged a private midwife who is an Endorsed Midwife, you can claim Medicare rebates for:

• all prenatal and postnatal care
• care provided during labour and the birth itself only if the birth occurs in a hospital or birth centre

So any midwife can provide homebirth services, but there are no Medicare rebates for birth at home with a private midwife, even if the midwife is an Endorsed Midwife. Some private health insurers will provide a partial rebate.

If your midwife isn’t an Endorsed Midwife, her prenatal, labour and birth, and postnatal services aren’t covered by Medicare, and you will have to pay her fees. Again, some private health insurers will provide a partial rebate, and you can claim the midwifery fees as rebate in net medical expense in your tax return.

Will my midwife be insured for my homebirth?

If you’re part of a hospital or birth centre program that offers homebirths, the birth will be covered by the hospital or birth centre’s insurance.

If you’ve engaged a private midwife, she won’t have professional indemnity insurance that covers the birth itself (even if she’s an Endorsed Midwife). Her insurance will only cover antenatal and postnatal care. Your midwife will ask you to sign a declaration that you understand there’s no insurance cover for the birth.

This means if you wanted to claim damages for negligent care during the birth itself and you were successful in your case, your midwife would be liable to pay the damages herself, which may limit the amount of damages you would receive.

Is it safe?

The safety of planned, assisted homebirth for low-risk women is supported by international research. A study of more than half a million women in The Netherlands found no difference in death or serious illness (de Jonge et al, 2009), whether they birthed at home or in hospital. Homebirth is well integrated into the health system in The Netherlands, where the homebirth rate is 25 per cent.

In the UK, New Zealand and The Netherlands, homebirth is a mainstream birth choice for many women and is supported by government.

Homebirth isn’t fully integrated into Australia’s health system and authorities here are still divided on the issue. The Australian College of Midwives, for example, supports homebirth as an option for low-risk women in the care of an experienced midwife (ACM 2011). The Royal Australian and New Zealand College of Obstetricians and Gynaecologists, however, doesn’t support it (RANZCOG 2014).

In some states of Australia, homebirths are supported by the state public health system, so Medicare-funded homebirths are now an option for low-risk women through a few hospitals and birth centres.

Can I change my mind?

Yes – at any time. In practice, opting early on for a homebirth allows you the greatest possible flexibility, as private midwives tend to book out quickly. Then you can decide to transfer to hospital right up to the birth itself. Waiting until later may limit your possibilities because of the difficulty in finding a midwife at short notice – but it isn’t impossible!

What happens if I need to go to hospital in labour?

Your midwife will talk to you and your birth companion about why she believes a transfer to hospital would be a good idea. Then, depending on the reasons for transfer, she will make arrangements with the hospital you will be moving to and either call an ambulance or, more likely, get your car ready to transport you.

This sounds very dramatic, but in fact you're far more likely to need to transfer to hospital because your labour has slowed down than because there's a real emergency.

At the hospital, the midwife who has been at your home will stay with you as a support person. The hospital midwives and doctor will usually take over the management of your care, unless your midwife has visiting rights at the hospital. This is becoming more common.

Who will be present at the homebirth?

Your private midwife will stay with you once your labour is underway or when it’s imminent. She may call a colleague to assist during the birth itself, in which case you should have had the opportunity to meet this person during your pregnancy.

Who else is there is up to you – it's your home, after all – your partner, other children, your mother, a doula or support person are all possibilities.

What equipment do I need?

Very little. A few weeks before your due date, your midwife will bring round a "birth pack" containing all the bits and pieces she needs. You may be asked to provide a portable heater, drop sheets, old towels, blankets or buckets, for example.

Discuss with your midwife what you would like to have available, such as heat packs, a Swiss ball or even a birth pool, and she will tell you how to organise it if you don't already know.

What happens after the birth?

Once your baby and the placenta are born and the midwife is content that you're well, she may leave you and your partner alone with the baby, while she cleans up and updates your notes. She'll then help you with breastfeeding, check you and your baby over (weights and measures can be done now) and see you into bed.

A midwife should always stay at least two hours after the placenta has been born, and before she leaves give you clear instructions on what to expect in regards to blood loss and your baby's early behaviour. You should feel able to call her again if you are at all concerned.

Your midwife will then visit you daily for a few days and then less frequently as you gain confidence.

Some midwives advise that you see you family GP when the baby is about a week old for a full check, including heart and hips if they’re not skilled in this area of practice. You should also be offered the choice of joining community mothers groups and to have your baby's hearing screened at either the local hospital or community health centre.

Your midwife may also contact your local child health nurse and make an appointment for you. But if she doesn’t, you can book one yourself through your local council. Or, if there are none in your area, book in to see your GP.

Read more about whether homebirths are safe.