About homebirth

Homebirth is a safe option for women who:

• are healthy
• have a low-risk pregnancy
• can transfer to a hospital if they need to.

In homebirth, you often have more say over decisions about yourself and your body, care and birth environment. Women who choose homebirth often want very little medical intervention and medical pain relief. Homebirth also offers higher breastfeeding success.

If you’re having a homebirth, a midwife will care for you during pregnancy. This gives you the chance to have a positive, ongoing, one-to-one relationship with a health professional throughout your pregnancy.

Pregnancy care for homebirth is usually with private midwives. All private midwives must be registered with the Nursing and Midwifery Board of Australia to practise and be insured. Insurance covers pregnancy and postnatal care but not birth. In some states, you might be able to see a midwife as part of a publicly funded homebirth program.

Booking a homebirth

If you want to have a homebirth with a private midwife, you might not need a GP referral. It depends on whether your midwife has a collaborative arrangement with a hospital or obstetrician.

If you want to have your pregnancy care through a public homebirth program, you’ll need a GP referral.

If you think you might be pregnant, see your GP or contact a private midwife as soon as possible to start your pregnancy care. The GP, private midwife or hospital midwife will let you know whether a homebirth would be advisable for you.

To find a private midwife, you can use:

• the Homebirth Australia website or call (02) 6545 3612
• the Midwives Australia website
• the Australian College of Midwives website or call 1300 360 480 (local call cost).

Pregnancy care for a homebirth

If you’ve been accepted into homebirth by a private midwife or a public homebirth program, you usually see one midwife throughout your pregnancy. Your pregnancy appointments are likely to be with the midwife in your home, at a hospital or in the community.

Your midwife will talk with you in detail about pregnancy, birth and parenting, and options for birth and breastfeeding classes if you want to do them. As part of your homebirth plan, your midwife will discuss booking you into a back-up hospital.

If any pregnancy health problems come up, your homebirth midwife or GP might refer you to a hospital obstetrician for a consultation. If there are concerns about your health or your baby’s health, an obstetrician might recommend that you don’t go ahead with a homebirth.

Around the day of the birth

If you reach 37 weeks of pregnancy and your pregnancy is still low risk, you can usually go ahead with your homebirth plans.

Once labour is progressing, your midwife and a second midwife will come to your home and care for you during labour and birth.

After the birth, the two midwives will check that you and your baby are both well and might stay with you for around 3-4 hours. They will check on you and your baby every day for a few days, depending on how you and your baby are going. Some midwives are available for phone advice (or a visit) up until your six-week check.

If the midwives have concerns about your health or your baby’s health at any stage during pregnancy, labour, birth or after birth, they might recommend that you transfer to a hospital. They might call an ambulance to take you to the hospital.

The homebirth environment

Many women who homebirth enjoy being in their own home – a familiar place with familiar people.

At home, you might move furniture around or put cushions and blankets where you think you’ll need them. For example, you might want to lean over a couch during contractions. You can use candles, dimmer switches, lights and lamps to create soft lighting. You can control the temperature to make sure that you stay warm and comfortable.

You can choose how many support people you’d like with you during labour and birth.

Your midwife will bring:

• a small oxygen tank
• essential birth equipment
• some medical supplies.

If you’re interested in a water birth, your midwife might have a birth pool you can hire or let you know where you can hire one.

Birth complications: how they’re handled at a homebirth

Midwives are educated and trained to deal with most problems in low-risk pregnancies during a homebirth.

But if you or your baby need extra medical care or there’s a problem during labour, the two midwives attending your homebirth will talk with you about transferring to a hospital and the safest way to get you there.

Once you get there, an obstetrician will manage any problems and do any procedures you need. Unless your homebirth midwife has a special agreement with the hospital, she won’t be able to keep caring for you in the hospital but will stay on to support you. The hospital midwives will provide the clinical care for you instead.

If you go into labour before 37 weeks or your baby needs high-level medical care, you’ll go to a hospital with a neonatal intensive care unit (NICU) or special care nursery (SCN).

Sometimes you’ll be well enough to go home, but your baby will need to stay in hospital.

Costs of homebirth

If you have private health insurance, the cost of a homebirth with a private midwife might be partly covered. You can also claim the cost and possibly get a medical expense rebate as part of your tax assessment.

Before you employ a midwife, ask her exactly what her fee includes and what Medicare or private health fund rebates you can get. You can get rebates for pregnancy and postnatal care but not care during birth.

A few hospitals and birth centres now offer Medicare-funded homebirths as an option for some women. In this case, here are some of the costs you can expect:

• Medicare covers (or partly covers) the cost of your care.
• There might be costs for tests and ultrasound scans. You can often get some money back from Medicare.
• There might be a cost for birth classes, if you want to do them.
• If you hire a doula, there’ll be a cost, which depends on the doula’s experience, level of care and involvement in your pregnancy.
• Check with your midwife about any other costs.

Homebirth: other things to think about

If you’re interested in a homebirth, it’s a good idea to think about:

• where you live – you need to have a clear plan for transferring to a hospital in case of an emergency
• ambulance cover – you need to have it or be prepared to pay the cost of ambulance transport to hospital if needed
• emergency care – talk with your midwife about what will happen if you need to go to hospital
• your views about pain relief in labour
• your midwife’s approach to care and family members
• equipment and services for birth and your ongoing care
• your home environment and the support you’ll need from family and friends.

Knowing your options and talking about them with your midwife or doctor can help you feel more prepared and happier about your pregnancy and birth experience in the long run.