Home

Planned Home Birth is a choice made by a small but growing number of Australian women, who are cared for by 1 or 2 known midwives throughout their pregnancy, birth and postnatal period. This option is provided both by independent midwives and by a small number of public hospitals with Caseload Midwifery Programs or Midwifery Group Practices. In 2011, 99% of Australian women who planned to give birth at home with midwifery care, had a natural vaginal birth.

There is no strong evidence from high quality research to favour either planned hospital birth or planned home birth for low-risk pregnant women. Increasingly better observational studies suggest that planned hospital birth is not any safer than planned home birth when it is assisted by an experienced midwife with collaborative medical back up. What these studies do show however, is that hospital birth may lead to more interventions and more complications than planned home birth (Olsen et al.2012).

Women who plan to give birth at home are generally cared for by a primary midwife who leads their care, and one or two backup midwives. Midwives working with women planning to give birth at home, work collaboratively with a medical back-up team so that should a specialist referral or a transfer to hospital during labour become necessary, this can occur smoothly.

During your pregnancy you will see your midwife regularly to check on your progress. These appointments may take place in your home or at a community clinic. All decisions are made in partnership with your midwife. Your midwife may provide you with a referral for additional tests and advice if you choose to do so.

When you go into labour, if things are progressing normally you stay at home and are attended by your midwife. During early labour you can be in touch with your midwife by phone, as you feel the need. Midwives are on-call and available 24 hours a day by mobile or pager. Once active labour is established, you will be cared for by your primary midwife or the backup midwife if she is unavailable. Your second or backup midwife is then called when labour is advanced, to be present for the birth.

The midwives will bring with them all the equipment needed for a safe birth. They observe the woman's progress during labour and regularly check the baby’s heart rate. If they have any concerns about the woman's or baby's health, they will discus it with her and may recommend that a transfer to hospital is required.

Olsen, O. and Clausen, J.A. (2012). Planned hospital birth versus planned home birth. Editorial Group: Cochrane Pregnancy and Childbirth Group. Published online at http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000352.pub2/abstract.

Public Health System

The option for home birth in the public health system is generally an extension to the existing Midwifery Group Practice provided by specific public hospitals. Midwifery Group Practices provide caseload midwifery programs, which offer you the opportunity to be cared for by a known midwife throughout your pregnancy, labour and the early weeks of parenting.

These programs cater to women who are at low obstetric and medical risk and are available to women who can meet the following criteria:

• You have a Medicare card (or if not you can arrange with the hospital to pay privately for your care);

• A single uncomplicated pregnancy with a head down presentation (individual programs may have further restrictions);

• A term pregnancy, between 37 – 42 weeks gestation;

• The woman resides in the catchment area or within a 30 minute radius of the hospital;

• The home environment is assessed as being safe for the mother, baby and midwives; 

• The woman has current Ambulance membership;

• There is an available booking on the service.

Professional indemnity insurance for the midwives is provided by the hospital employer, and the programs operate within the public hospital system. Should women develop risk factors during pregnancy or labour, the primary midwife continues care in collaboration with medical staff, and the woman’s birth place changes to the birth centre or labour ward.

Advantages of publicly funded planned home birth programs:

• There is a greater chance of having a normal vaginal birth with less intervention, with no increased risk to the baby;

• The costs are covered by Medicare;

• You will know and the midwife who will be caring for you, and she will know your birth preferences in detail;

• You will have more control over the environment in which you labour including privacy, darkness, noise, warmth and access to warm water;

• Partners tend to be more involved as they know the environment well;

• Women tend to feel more relaxed and able to respond spontaneously to their labour;

• You can stay in the bath or pool to give birth if you wish;

• After the birth you can relax at home with your new family;

• Your baby is born into the microbiome of your home rather than being exposed to 'foreign' bacteria in the hospital environment;

• Transfer to hospital may be more smooth than in the care of a privately practising midwife;

• Your midwife visits you at home for up to 4 weeks after your baby’s birth.

Disadvantages of publicly funded planned home birth programs:

• You may not meet your midwife until very late in your pregnancy;

• You will be allocated a primary midwife rather than make an active choice;

• Your primary midwife may not be able to attend your birth;

• This is a low risk model of care and may not available for women who have had a caesarean, or those with a breech presentation or twins for example;

• There may be other limitations to you being able to access this option e.g. where you live, health concerns etc.;

• Publicly funded home birth programs are not currently available in Queensland, the Australian Capital Territory or Tasmania;

• Publicly funded home birth programs are often oversubscribed;

• Staffing issues in publicly funded home birth programs may result in the hospital being unable to accommodate home birth and you will be requested to come to the Birth Centre or Labour Ward to birth;

• To access drugs for pain relief you need to transfer to hospital;

• You might have to transfer from home to hospital if a complication arises. Transfer rates vary according to whether or not you are having your first baby and the program you are accessing;

• If something does go unexpectedly and seriously wrong during labour at home, the outcome for you and the baby could be worse than if you were in a hospital labour ward with access to specialised care;

• You will need to be clear with friends and family about visiting hours, so you can get good rest after your baby is born;

• You will need to make arrangements for help with household tasks, so that you can get good rest after your baby is born.

Publicly Funded Homebirth Programs in Australia

NORTHERN TERRITORY

Darwin and Alice Springs

Community Midwifery Practice & Homebirth Service in Darwin & Alice Springs – established 2008
Darwin: Phone: (mobile) 0417 810 5350417 810 535
Alice Springs: Phone: (08) 8951 7067(08) 8951 7067; (mobile) 0401 114 1880401 114 188
This is a Northern Territory government supported home birth service within the Community Health Branch of the Department of Health & Community Services (DHCS). The service is located in Alice Springs and Darwin and is provided to enable Home Birth Midwives, in collaboration with the multidisciplinary health team, to provide effective and professional primary midwifery care across pregnancy through to the postpartum period. The midwives support eligible women electing to labour and birth at home if they live within the specified boundaries.

Website: health.nt.gov.au/Womens_Health/Maternal_and_Infant_Health/Home_Birthing/index.aspx

NEW SOUTH WALES

Sydney

St George Hospital – established 2005
The Midwifery Outreach program operates out of the existing birth centre:
St. George Hospital,
Grey Street
Kogarah NSW 2217
Phone: (02) 9113 3103(02) 9113 3103
Midwifery Coordinator: Shea Caplice

Royal Hospital for Women in Randwick, Sydney.
Midwifery Group Practice provides continuity of midwifery care by several groups of midwives who are on call throughout the pregnancy, birth and early postnatal period at home. Places are limited for this option and are generally not available if you live outside of the RHW area.
Royal Hospital for Women
Barker Street,
Randwick, NSW 2031
Phone: 9382 6111

Wollongong Hospital Homebirth Service – established 2009
Midwifery Group Practice provides the home birth option.
Wollongong Hospital
Crown Street,
Wollongong NSW 2500
Phone: (02) 4222 5000(02) 4222 5000

Tamworth

Tamworth Hospital – established 2005
Dean Street,
Tamworth NSW 2340
Contact: Robin Skewes Clinical Midwifery Consultant.
Phone: (02) 6767 7318(02) 6767 7318

Mullumbimby

Mullumbimby Homebirth Program
Azalea Street
Mullumbimby NSW 2482
Phone: (02) 6639 8226(02) 6639 8226
Web site: nnswlhd.health.nsw.gov.au/about/hospitals/mullumbimby-district-war-memorial-hospital/mullumbimby-birth-centre/the-home-birth-program/

Illawarra Shoalhaven

SESIAHS - AMICHS Illawarra Shoalhaven - established 2009
Shellharbour Square, Shellharbour NSW 2529
Phone: (02) 4295 2418(02) 4295 2418(02) 4295 2418

Newcastle

Belmont / John Hunter Hospital – established 2007
Freestanding birth centre within Belmont Hospital, also offering a homebirth service.
Belmont Hospital,
Croudace Bay Road,
Belmont NSW 2280
Phone: (02) 4923 2291(02) 4923 2291
Midwifery Coordinator: Carolyn Hastie, 0428112786

Orange Aboriginal Medical Service – established 2010

SOUTH AUSTRALIA

Adelaide

Women's and Children's Hospital – established 2009
Midwifery Group Practice
Women's and Children's Hospital
72 King William Rd,
North Adelaide, SA 5066
Website: www.wch.sa.gov.au/services/az/divisions/wab/mid_gp/index.html
All bookings for public antenatal access can be made by phoning the SA Pregnancy Information Number 1300 368 8201300 368 820 

Northern Area Midwifery Group Practice
Lyell McEwin Hospital
Haydown Road, Elizabeth Vale SA 5112
Phone: (08) 8182 9000(08) 8182 9000 (paging service to leave message)

VICTORIA

Melbourne

Sunshine Hospital - established 2010
176 Furlong Road,Royal Hospital for Women
St Albans VIC 3021
Phone (03) 8345 1333(03) 8345 1333
Website: http://www.westernhealth.org.au/Services/Womens_and_Children/MaternitySe...

Casey Hospital – established 2010
Home birth Unit
62 Kangan Drive, Berwick VIC 3806
Phone (03) 8768 1200(03) 8768 1200
http://www.monashhealth.org/icms_docs/13525_Home_birth_information.pdf
Midwifery Unit Manager Ph: 8768 1755

WESTERN AUSTRALIA

Perth

Community Midwifery Western Australia– established 1996
Unit 1/ 40 Pearse Street, Fremantle WA 6959
Phone: (08) 9430 6882(08) 9430 6882
Website: www.cmwa.net.au

ACT

No publicly funded homebirth programs.

QUEENSLAND

No publicly funded homebirth programs.

TASMANIA

No publicly funded homebirth programs.

Private Health System

The private health option for care at home is to hire privately practising midwives. In areas of Australia where there are no Publicly Funded Homebirth programs, this is the only model of care available to women who plan to give birth at home.

Independent or privately practicing midwives are registered with the Nursing and Midwifery Board of Australia. Some private midwives ('eligible' midwives) now have Medicare provider numbers in the same way that doctors do. This means that you can access rebates from Medicare for the antenatal care, services provided in a hospital/birth centre where the Eligible Midwife has visiting rights and postnatal care they provide. However, there may be a 'gap' which you have to pay, as with private obstetricians.

It is best practice to hire one midwife as your primary caregiver and a second midwife who will be called for the birth, but whom might share the provision of your care during pregnancy so that you can get to know her. Your midwife will work collaboratively with a medical back-up team and may make a back up booking for you at a local hospital. This means that should a specialist referral or a transfer to hospital during labour become necessary, this can occur as smoothly as possible.

During your pregnancy you will see your midwife regularly to check on your progress. These appointments may take place in your home or at your midwife's home. All decisions are made in partnership with your midwife. Your midwife may provide you with a referral for additional tests and advice if you choose to do so.

When you go into labour, if things are progressing normally you stay at home and are attended by your midwife. During early labour you can be in touch with your midwife by phone, as you feel the need. Your midwife will be on-call and available 24 hours a day by mobile or pager. Once active labour is established, your primary midwife will come to your home and stay with you until you have your baby. Your second or backup midwife is then called when labour is advanced, to be there for the birth.

The midwives will bring with them all the equipment needed for a safe birth. They observe the woman's progress during labour and regularly check the baby’s heart rate. If they have any concerns about the woman's or baby's health, they will discus it with her and may recommend that a transfer to hospital is required.

Most independent midwives will have a list of inclusion criteria, inside of which they are comfortable to provide care for women planning to give birth at home. These criteria will vary from midwife to midwife, but might exclude women who are:

• planning to birth a breech baby or multiple babies;
• labouring before 37 completed weeks gestation.

Advantages of planned birth at home with an independent midwife:

• You choose your midwife based on how good a 'fit' her values and attitudes are with your own. Your level of trust in your midwife is relatively high because of this,, and she will know your birth preferences in detail;
• There is a greater chance of having a normal vaginal birth with less intervention;
• Planning to birth at home means that you are able to choose who you want to be at your birth as well as having control over the environment in which you labour including privacy, darkness, noise, warmth and access to warm water;
• Partners tend to be more involved as they know the environment well;
• Women tend to feel more relaxed and able to respond spontaneously to their labour;
• You can stay in the bath or pool to give birth if you wish;
• Your baby is born into the microbiome of your home rather than being exposed to 'foreign' bacteria in the hospital environment;
• After the birth you can relax at home with your new family.
• Your midwife visits you at home to provide postnatal care for as long as you want her to (fee for service).

Disadvantages of planned birth at home with an independent midwife:

• On the whole this is a low risk model of care and may not available for women who have a breech baby or twins for example.
• Privately practising midwives may be limited in number in particular postcodes and may be booked up.
• You might have to transfer from home to hospital if a complication arises. Transfer rates vary according to the midwife you are working with.
• If something does go unexpectedly and seriously wrong during labour at home, the outcome for you and the baby could be worse than if you were in a hospital labour ward with access to specialised care.
• Independent midwives are currently unable to access professional indemnity insurance.
• Independent midwifery care costs approximately AU$5,000.
• To access drugs for pain relief you need to transfer to hospital.
• You will need to be clear with friends and family about visiting hours, so you can get good rest after your baby is born.
• You will need to make arrangements for help with household tasks, so that you can get good rest after your baby is born.

 The list of Australian Independent Midwives can be found at this link http://www.midwivesaustralia.com.au/?page_id=68.