Home birth

What are my options for where I have my baby?

When you find out you're pregnant, you will need to choose where to give birth. Think about:

• if you would like to have your baby in a hospital, at a birthing centre or at home
• if you would like a doctor, an obstetrician or a midwife to care for you
• what you want the birth to be like

Ask your doctor or midwife about the choices available where you live. Discuss the options with your partner if you have one and talk to your friends and other mothers in your area.

Most births in Australia happen in a hospital. You might prefer to give birth at home if you can.

Some public hospitals and private midwives provide homebirth services. You can ask your midwife or doctor if this option is available to you. It will depend on:

• whether you have a higher chance of pregnancy complications
• where you live
• if you will have support at home after you give birth

If you are at risk of significant complications, a hospital birth may be a better option.

Woman-centred care

Australia is a safe place to have a baby. Maternity service providers follow a woman-centred care model. You can make shared decisions about your care and stay in control of your choices.

You have the right to respectful maternity care that is culturally safe and enables informed choices. Take the time to find a care provider that you trust and feel comfortable with.

If you'd like to give birth at home, it's important to talk to your midwife or doctor about the reasons for your decision. Make sure you find out what homebirth involves. You should understand both the benefits and the possible , and the problems that can arise for you or your baby.

Homebirth is not the same as freebirth. Freebirth is where you choose to give birth at home, without care from a qualified midwife.

Why might I prefer to have a homebirth?

You might like to give birth at home because birth is a natural process and being in hospital makes it feel more medical.

You might choose homebirth because you hope to have more control over the birth process at home than you would in hospital. Perhaps you have had a difficult experience with a previous birth in hospital.

Wherever you give birth, you should be able to decide what happens to you.

What are the benefits of a homebirth?

If you give birth at home, you will be in familiar surroundings. This can help you feel more relaxed and better able to cope. You might also:

• have more privacy than in hospital
• have your friends and family with you
• have as many support people as you choose
• be looked after by a midwife or doctor you know well
• have a better chance of success with early breastfeeding
• avoid unnecessary medical interventions

You might hear that there is less chance of your baby needing to go into special care or being resuscitated at birth during homebirth. But remember, only low risk labour usually takes place at home. Evidence shows little or no difference in safe outcomes for babies born in planned home birth compared to planned hospital birth.

Some of the benefits of planned home birth over planned hospital birth for low-risk women are:

• higher chance of unassisted vaginal birth
• lower chance of serious damage to your perineum
• lower chance of caesarean birth
• lower chance of use of instruments to assist with the birth

Continuity of care

Continuity of care is where the same midwife or team of midwives care for you during your pregnancy and birth.

This model of care can help you have a healthy pregnancy and birth. The same midwife can also help as you start parenting your new baby.

Many hospitals and birth centres offer midwifery continuity of care, also known as caseload or midwife group practice.

You can also get the benefits of continuity of care for your homebirth by employing a private midwife.

What are the limitations of a homebirth

There are some disadvantages you should think about if you're considering a home birth. You should consider that:

• you may need to be transferred to a hospital if there are complications during the labour, birth or afterward.
• some pain relief options such as nitrous oxide gas and epidurals are not available at home.
• homebirth with a private midwife is expensive, as the birth is not covered by Medicare.
• there are not many public hospitals that have a homebirth program.

Is homebirth safe for me?

A planned homebirth is not considered safe for all births.

It may be safe for you if you meet all the following criteria:

• Your pregnancy is low risk.
• Your pregnancy continues to be low risk through to 36 weeks or more.
• You're cared for by a registered midwife who is appropriately trained.
• There is a smooth plan in place to transfer you to hospital safely and quickly if problems arise.

If there are risks or complications during your pregnancy, homebirth will not be able to provide all the support you might need to keep you and your baby healthy.

Some examples of when your doctor or midwife will recommend you give birth in hospital are if you:

• are expecting twins or more
• baby is breech
• have had a previous caesarean
• are aged over 40 years
• have certain medical conditions

Who will provide care for me if I have a homebirth?

If you plan to give birth at home, you should be supported by a registered midwife with homebirth credentials, a specialist obstetrician or GP obstetrician. Obstetricians do not attend the birth but are involved in planning with the midwife.

A few hospitals have a public home birth option attached to their midwife group practice. If you can book into a service like this, you will go to the hospital for antenatal appointments. Another option is antenatal care from your local doctor.

Two health professionals who are registered with the Australian Health Practitioner Regulation Agency (AHPRA) and have appropriate skills and training must be present to care for you during labour and birth. In Australia this generally means two midwives are there on the day. Alternatively, you could have a midwife and a doctor caring for you.

Midwives caring for a homebirth must follow all the guidelines of the Australian College of Midwives and the Nursing and Midwifery Board of Australia. Doctors must have registration and insurance to provide homebirth care.

What happens during a homebirth?

When you think your labour has started, call your midwife. They will decide when to come to your home.

If you are planning a waterbirth, talk to your midwife about what you need to do.

As the time to give birth gets closer, a second midwife will usually arrive. They'll share updates on your progress with the hospital as needed.

Your midwife can support you with managing pain.

If you need any help or your labour is not progressing as well as it should, your midwife will arrange for you to be transferred to hospital. You must be prepared to go to hospital if your midwife considers it necessary.

What happens after a homebirth

A midwife will stay with you for about 4-6 hours after your baby is born. They will visit you the next day to check on you and your baby.

Let your midwife know if you'd like to keep the placenta.

Find out when and where to go for the routine newborn health tests.

What problems could arise if I have a home birth?

Every birth involves some degree of risk.

If you experience a serious complication during labour, you will need to be urgently transferred to hospital. This can be harder for you or your baby than if you were already in hospital. If you're at home, your access to specialist care may be delayed. Talk to your doctor and midwife about the risks of homebirth.

The most common emergency situations are if you lose too much blood or if your baby doesn't breathe when they're born.

If this is your first baby, you're more likely to need transfer to hospital than if you've given birth before.

What do I need to do if I am planning a homebirth?

If you would like to have a homebirth, you first need to check with your local hospital or private midwifery practice to see if they provide homebirth.

It's important to:

• book into your local hospital as a backup option, in case your birth does not go to plan
• make sure your midwife has a plan to get you to hospital as quickly and safely as possible if anything goes wrong
• have regular antenatal care by a midwife or doctor during your pregnancy
• have postnatal care by your midwife
• be sure your baby is offered vitamin K and hepatitis B vaccination and other treatments required after birth

You should also ensure that your midwife or doctor performs tests for your baby after the birth. These tests include the heel prick test and a hearing screen. If they do not perform these tests, they should refer you to a service that does them.

Your midwife will check your baby when they're born and in the first days afterwards. If you'd like your baby to be checked by a doctor, you can take them to your own usual doctor.

What questions should I ask?

You can ask your midwife anything you are unsure about. Here are some questions you might want to ask:

• How long would it take if I need to be transferred to hospital?
• Which hospital would I be transferred to and how would I get there?
• Would a midwife be with me all the time?
• Who can I contact when I go into labour?
• How do I prepare my home for the birth?
• How can I get a birthing pool?

Resources and support

To find out more about home birth, visit these organisations:

• Homebirth Australia for a directory of homebirth providers and information about giving birth at home.
• Midwives Australia for information on maternity services in Australia.
• Australian College of Midwives to learn more about the roles of a midwife.