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Home Birth – choosing a natural and gentle birth
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Home Birth – choosing a natural and gentle birth

by Rebekka Atz

Giving birth is one of the most amazing, exhilarating and delightful events a family can experience. It is a journey that should be cherished, celebrated and honored. Many women who choose the option to give birth at home share this belief. They understand that a home birth can be exhausting, uncomfortable and messy. However, these women have trust in the natural powers of birth. Home birth mothers believe that the familiar environment provides the best conditions for an undisturbed and satisfying birthing process.

Who are these women choosing a home birth in Australia? 

Let’s have a look at the facts about home births in Australia. Of the 312.153 babies born in 2012, only about 0.4% (1.177) were born at home1.  Nearly all (99.5%) of these babies were born by non-instrumental vaginal birth.

An average home birth mother is about 1.5 years older than the average non-home birthing mother (31.7 years compared to 30.1 years in 2012 1, 2) . Most of these mothers live in major cities (74.7%), very few (about 8.4%) reside in outer regional and remote areas1.

There are hardly any home birthing mothers in Australia younger than 20 years old (0.8%), but nearly a third of them is over the age of 35 1. Mothers of Aboriginal or Torres State Islander origin only account for 1.2% of the overall number of home born babies1.

Most home birth mothers are multiparous (had more than one birth). Only one in six home birth mothers gave birth the her first baby this way1.

Statistically speaking, women who partake in at-home births are more educated and of higher occupational levels than the Australian average 3.

The reason why a fetal death during a home birth is more likely to be “covered” by the mainstream media is probably because it hardly ever happens. The fetal death rate for home births in Australia was 0.5% in 2012, compared to a total average of 7.4% of all births in the same year 1. But interpretation of these figures can be difficult, as these are only statistic rates. You have to consider that most women choosing a home birth are “low- risk” and transfers to the hospital due to complications during the pregnancy are not considered.

But interpretation of these figures can be difficult, as these are only statistical rates. You have to consider that most women choosing home births are “low risk.” Hospital transfers due to complications during the pregnancy are not considered.

All stats aside, home birthers are a lot of fun to hang out with!

What are the reasons for families to choose a home birth?

First of all, it seems that home birthing families have a reasonable awareness and judgement of risks. They generally acknowledge that there is always that element of risk when giving birth. Home birthing mothers know that neither their babies, nor themselves are invincible. They are neither careless, nor irresponsible.

Usually, a home birth is a well-informed choice of confident mothers (and fathers) who “have done their research.” They assess the risks and come to the conclusion that for them, “the hospital is not the safest place to have a baby.” Instead, they associate risk with giving birth in hospitals, where interventions and interruptions during labour are more likely to occur. By choosing an at-home birth, they have made a choice that protects them (and their babies) from these risks 3,5.

In studies women stated the following reasons for choosing a home birth 4,5:

  • avoiding unnecessary interventions
  • feeling independent with the freedom to make their own choices
  • feeling strong, confident, comfortable and familiar at home
  • had the opportunity to do it their way
  • staying home protected them from hospital related activities
  • had faith in normal birth
  • perceived birth as a basic social process

Women who had previously chosen home births reported a higher level of satisfaction from the birthing experience itself compared to women who had hospital births5.

06082012083410_b by Jason Lander, on Flickr
Creative Commons Creative Commons Attribution 2.0 Generic License   by  Jason Lander 

 

Home birth in other 1st world countries

So, where does Australia stand in comparison to other countries and home birth rates?
Our neighbour New Zealand has a much higher home birth rate than Australia (between 3.0%-5.0%). In some areas, where excellent local support from home birth associations and midwives is available, the rate is as high as 12.5% (reported in the West Coast of the South Island in 2011)7.

The home birth rate in the UK varies. It is just over 2.0% on average, with home birth rates higher in Wales (3.4%) and England (2.5%), and significantly lower in Scotland (0.6%) and Northern Ireland (0.38%) 10,11.

The US has a home birth rate of about 1.0%. Similar to Australia, the majority of the mothers who choose to give birth at home in the US has a college education. They state that they consider home births as a safe option with less risk of unnecessary medical interventions. Many women choose a home birth after a negative hospital experience in the past6.

1.5% of all babies in Germany are born at home. The legal framework for midwives to attend home births is currently changing, and the future of home births is uncertain.
The home birth rate is by far the highest in the Netherlands. One in every five babies is born at home! However, the home birth rate is declining. Between 1994 and 2010, the percentage of home births fell steadily from 34.1% to 23.4% 8.

How Can You Have a Home Birth in Australia?

Choosing a home birth involves making a carefully thought-out decision. If you go with the mainstream flow and seek prenatal care from your GP or Obstetrician, he will usually book you in to the local hospital, where they will then tell you what to do next. However, if you choose or consider a home birth, I assume naturally that you want to play a more active role in your prenatal care, birth, and all decision-making surrounding it. And you will have to take action to make it happen.

Basically, you have three options:

Engange with a publicly funded home birth program

Publicly funded home birth programs are the result of consumer demand12. There are currently 12 publicly funded home birth programs available in Australia*:

Northern Territory:

  • Darwin Home Birth Service
  • Alice Springs Hospital

New South Wales:

  • St George Hospital
  • Wollongong Hospital
  • Tamworth Hospital
  • Belmont/ John Hunter Hospital
  • Orange Aboriginal Medical Centre

South Australia:

  • Women’s and Children’s Hospital
  • Lyell McEwin Hospital

Victoria:

  • Sunshine Hospital
  • Casey Hospital

Western Australia:

  • Community Midwifery Program, Perth

*(Publicly funded home birth programs are not available in QLD, ACT and Tasmania)

This option of care is usually available to “low risk” women only. The programs are based within the public hospital system. The midwives are covered by professional indemnity insurance (PII) provided by the hospital itself as part of their employment. These programs are often linked with existing birth centres or midwifery group practices12.

Public home birth services usually follow preexisting policies and guidelines: the Australian College of Midwives Consultation and Referral Guidelines or South Australian Government Policy for Planned Birth at Home, or other local state / territory health services guidelines 12. In addition to that, some programs develop their own hospital-generated guidelines.

The policies and guidelines include the criteria used to determine if a women is eligible for a home birth and for transfer to hospital. I urge you to ask about these policies when you engage with the service so that you fully understand the framework your service is working under.
Entry criteria varies across the services. Exclusion criteria can include preterm labour (before 37 weeks) or “overdue” babies (42, sometimes even 40, weeks), women with a previous caesarean section (VBAC), multiple pregnancies, prior complicated obstetric (diabetes, hypertension, hemorrhage) or neonatal history. Some services have restrictions for age (under 18), body mass index (BMI over 40) or distance (e.g. less than 30-minute drive, or “within geographical boundaries”) 12.

The criteria used for transferring women from home to hospital care also varies considerably across programs. They include, but are not limited to, “unsuitable home conditions,” labour dystocia, ante-/postpartum hemorrhage, fetal distress, maternal fever and third degree tear12.

There is not much data available to determine the overall “rejection” rate for such inquiries. In one study12, the Community Midwifery Program in Perth stated that they rejected about 30% of inquiries for medical, geographical and workforce factors.

Home birth with a privately practicing midwife (PPM)

A privately practicing midwife (PPM) is a registered, trained midwife who is self-employed. Sometimes several private midwives work together out of a group practice. PPMs are also referred to as “independent midwives.”

If you choose to engage a PPM, you and your midwife can discuss the options and details of the care provided. Many women appreciate this flexibility and prefer not to be bound to a hospital framework (as is often the case for publicly funded programs).
Some women with previous caesarean sections or other medical implications engage a PPM because they are not considered “low risk,” and therefore not accepted into a publicly funded program. Other women simply have certain expectations for their care that cannot be met by PPMs, i.e. they may want to avoid certain screenings and tests that are compulsory in a hospital based home birth program. Be aware that some PPMs may not feel comfortable with the idea of caring for high risk women.
A PPM has to be paid “out of pocket”. Costs will vary. You will have to pay about $2,000 for the actual birth, and between $1,000 and $3,000 for the ante- and postnatal visits.
PPMs can choose to apply for Medicare eligibility. If a PPM becomes an “eligible midwife,” Medicare rebates are available for her clients. Whether a PPM is “eligible” or not does not reflect the quality of her practice. Some highly-experienced midwives choose not to become eligible for various reasons 13.

Medicare rebates are not available for the actual home birth; they can only be claimed for midwifery care planning visits, antenatal and postnatal care (both short and long consultations) and birth care at a hospital. For the Medicare rebate, a medical practitioner usually needs to be consulted for a “collaborative agreement” (signing off on the homebirth) 12. In order to avoid booking-in for an appointment at a hospital (and potential further unwanted demanded tests and screenings), some women specifically seek a non-eligible midwife.

Due to the current lack of insurance options, the future of home births with PPMs in Australia is uncertain.  An exemption for professional indemnity insurance (PII) is currently in place, “legalising” home births for PPMs. This exemption expires in December 2015. So far, there is no official statement from the authorities responsible (Australian College of Midwives and Nursing and Midwifery Board Australia) to attempt a solution for this problem.

Freebirth/ Unassisted Birth

There are no official freebirth statistics available, but it would be safe to say that very few babies in Australia are “free born” – that is, without the involvement of a medical practitioner or registered midwife.
Some women involuntarily freebirth because they do not make it to the hospital, or the midwife for the planned home birth couldn’t be there in time. Others see a freebirth as a valid birthing option and deliberately choose to birth without assistance. A freebirth might also be the second best choice for women who are unable to engage a PPM for their planned home birth.
Some free birthers prefer to birth their babies alone. Others choose to have their partners or older siblings present. Women may also receive support for the labour and birth by a family member, a friend or doula.

Shared Care 

Any of these options can be combined with additional care from your GP, Obstetrician or private Obstetrician. But be aware that most women report to receive limited support for their home birth choice from their medical practitioner 5. In order to avoid “shopping around” and unpleasant appointments that may create doubt and anxiety, it is best to seek recommendations for supportive practitioners from other home birth women.

Get involved!

Luckily, we live in the age of the Internet and social media. Technology allows us to access information that can help us to make informed decisions. There are many facts and figures about birthing options available, for both natural and home births.
Personally, I find the exchange with like-minded women very valuable. There are many forums and Facebook groups out there. You can connect with other home birthers, share your experiences and learn from theirs.
Enjoy and embrace the process; it is all part of it. And don’t forget – birth matters!

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