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We don’t have to look very far into the past to see that everyone was born at home. It was just the way it worked. Women did their thing, surrounded by other women and doulas, amid a wealth of love and experience. Nobody questioned it. Sometimes the outcomes weren’t as planned, and that was part of it, too. But nobody was to blame.
Modern Day Birthing Options
These days we have ‘options’. Modern medicine has improved beyond recognition. We have achieved great things, things that would once have been labelled miracles. And many lives have been saved and extended. And for that we should be thankful.
But somewhere along the way, we have been duped into believing that pregnancy and childbirth are conditions that require treatment, rather than natural processes that need only management. So it’s not hard to understand why those from whom we usually seek ‘expert’ guidance try to steer us to give birth in a place where they feel safe and are protected. In our society, the doctor still knows best in the minds of most people.
“Home birth is important as it is the only place I have seen women truly birth in their own power. Unhindered, undisturbed.” (Mae’t Pearson)
Practising midwife, Mae’t Pearson, believes that the home birth option is not openly discussed with expectant mothers. Some professionals who do not support home birth effectively act as ‘gatekeepers’ by blocking access to relevant information. There is also a general fear of the unknown, especially for a first time mum. So having a home birth is not a common choice in Australia. In 2013, the vast majority of babies were born in hospital – 97% – while only 0.3% were born at home. The main reason for this low number is most likely a lack of support.
A former midwife with experience in both home and hospital births in NSW, Rosie Bookallil, believes that age may also be a factor in the view that home birth is not a safe option. The average age of first time mums in Australia was 28.6 years in 2013, while the proportion of mothers aged 35 and over has increased from 19% in 2003 to 22% in 20131.
Ms. Bookallil also acknowledges that education and the availability of support, whether that be from their partner or the community, are key factors in the choices that women make regarding their place of birth. It is a woman’s responsibility to inform themselves of the options they have surrounding the place of birth. Given the negative attitudes and lack of support surrounding home birth, women have to educate themselves about their options and make the appropriate preparations, even for unexpected outcomes, such as a last-minute transfer to hospital.
Homebirth is legal in Australia
Some women still believe, wrongly, that home birth is illegal in Australia, or have a warped view of the potential outcomes portrayed in the media. We rarely hear of maternal deaths that occur during childbirth in hospitals, but if it happens during a home birth, it makes front page headlines. Just a few years ago, Channel 9, following up on a story about a deregistered midwife, was sued for breach of privacy when they filmed through the kitchen window of an Adelaide woman giving birth at home2.
Another reason for the high percentage of hospital and birthing centre choices is the availability of funding. Private health insurance covers some of the expenses incurred in hospital deliveries, but none of the fees charged by home birth midwives. Public funding for home births is limited, but you can find a sizeable list of available services on the Pregnancy, Birth and Beyond website. These programs are free for those entitled to Medicare benefits, however there are stringent guidelines regarding who is eligible for these services. Factors affecting eligibility include determination of the risk involved to both mother and baby, as well as geographical location i.e. distance from the nearest health care centre or hospital.
While the number of publicly funded programs for home birth in Australia is growing, we are still way behind countries like The Netherlands, where low-risk women are actively encouraged to give birth at home and 30% of women do so. New Zealand (11%) and the United Kingdom (2.9%) are also leading the charge on this issue3.
Finding a Home Birth Midwife
Finding a midwife to attend a home birth is not as hard as you may think. Jane Palmer’s excellent website, Pregnancy, Birth and Beyond, provides a link where you can search for a midwife in your local area by simply inputting your postcode. Registered midwives are available in many areas of Australia, and midwives are eligible for registration, and by extension, Medicare provider status, as long as they meet the requirements regarding qualifications as outlined in Sections 52 and 53 of the Health Practitioner Regulation National Law (NSW). However, there are still issues with insurance that you need to be aware of.
In the past, midwives have found it impossible to gain professional indemnity to cover their attendance at a home birth. Insurance is readily available for antenatal and postnatal care, but not intranatal i.e. for the actual birth. While this situation is still under review, in April 2016 the NSW Minister for Health approved the extension of an insurance exemption for privately practising midwives (PPMs) attending home births to provide labour and intrapartum care4 There are regulations surrounding the granting of this extension, one of which is the ‘informed consent of the woman, identifying that she understands the midwife does not hold insurance for intrapartum midwifery care at home.’
One of the best arguments for home birth comes from Mae’t Pearson, who believes that ‘home birth is important as it is the only place I have seen women truly birth in their own power. Unhindered, undisturbed. Hormonally, emotionally, it is the place closest to her innate birthing ability. Homebirth is the place where midwife and family are truly in partnership. I love seeing the woman’s face when she did it! And those precious hours afterwards where they just breathe their baby in, tucked up in bed, whilst their place is cleaned like nothing ever happened. Just the sweet memories.’
Whatever you decide on, the place where you will give birth has to be right for you AND your baby. The most important thing is that it happens in a place where you feel safe. That might be a hospital; it might be a birth centre; or it might be at home.
But know one thing – it is your choice, and it is your right to be provided with evidence-based, unbiased information, including the potential advantages and disadvantages5, you need to make an informed decision for you and your family.