So you're having a baby. Or you're wanting to conceive. And you want to have the care of a midwife for your pregnancy and then birth at home, on nature's timeline.
The increasing amount of medical research showing that homebirth is as safe as hospital birth for a woman at low risk of complications, who lives within reasonable distance of a back-up hospital, and who is attended by an experienced professional midwife. A range of research now shows that the risk of mother or baby being injured or dying at a homebirth under these criteria is the same as (if not lower than) if they were in hospital.
Women from all walks of life are having their baby in the familiar environment of their own home. While many birth with independent (or private) midwives, publicly-funded homebirth has been available for a small number of women through some public hospitals in South Australia.
What if something goes wrong at home?
Homebirth is often perceived as entailing more risk than hospital birth because people worry about what would happen should the mother or baby suddenly require medical assistance. There are several ways in which such problems are avoided. Firstly, midwives who facilitate homebirth are educated and experienced to assess whether your home and the medical wellness of you and your baby are suitable for homebirth. Only women who are deemed by an experienced homebirth midwife to be at low risk of complications or medical conditions are advised to consider homebirth. Secondly, if a complication develops during labour or birth at home then the midwives can phone ahead for your back-up hospital to start preparing for when you arrive.
How do you start planning a homebirth?
Read books.
Talk to those that have done it already.
Talk to birth professionals to see which one you click with! This will also help you meet local midwives and help you think about which midwife might suit your preferences. You might start by phoning some midwives to chat more about homebirth and whether or not it would suit you. Remember that you are employing a care provider, and have the right to ask lots of questions about how any birth attendant (be they midwife, GP or obstetrician) cares for women in pregnancy, birth and post natally. Ask for their statistics on interventions, hospital transfers and caesarean rates.
Join a forum.
Once you have found a midwife that you feel comfortable with, who has vacancies and is available around your due date, she will arrange your first antenatal visit, usually at home. Many women find consultation hours more flexible than those provided by hospitals. This can make it easier for their husband/partner to meet the midwife too, and it is more convenient when there are other children because they can play until the midwife arrives and then be involved in the antenatal check. Some women do not decide on homebirth until quite a way through their pregnancy, but it may still be possible to arrange – phone a midwife for advice. Be aware that some GPs do not recommend homebirth because they are not aware of the up-to-date research, or that public hospitals are increasingly offering it as an option.
What about paying for a homebirth? Can I use my Private Health Insurance?
Homebirth is free if you see a midwife from a Community Midwifery Program or a hospital-based homebirth service. Women who contract an independent or private midwife pay the fees themselves and feel that it is well worth the personal and continuous attention that they get throughout their whole pregnancy, labour, birth and postnatal period. Anecdotally, these fees are often similar to the out-of-pocket expenses that you would pay for a private obstetrician - between $2000 and $4000. However, fees vary widely depending on which area of Australia you live in, so it is best to contact individual midwives to ask them. Women are advised to check their individual situations with the individual insurer and what level of cover they require for which services, and to also check what smaller amounts they may be eligible for rebate on (eg prenatal education/care and postnatal care).
What about antenatal tests, scans and check-ups?
Choosing to birth at home does not prevent you from accessing the full range of antenatal testing and scans. Your midwife is well qualified to give you information about what testing may be appropriate to consider, and how to best go about accessing these services. Usually, unless you are having a homebirth via a community midwifery program or a midwifery group practice, then if you want medical testing you will need to see a GP or attend an antenatal clinic at a hospital to get the forms for these tests. However, the results are usually sent to both yourself and your midwife for your records. For well women, with normal healthy pregnancies, your midwife will provide comprehensive advice on nutrition, health maintenance, and the usual regular antenatal checks (maternal blood pressure, growth and heart rate, position of the baby, and general wellness checks), all in your home, at a time convenient to both of you. Anything out of the realms of ‘normal’ is referred to an appropriate medical practitioner, and care continues either in tandem, or back with your midwife alone, depending on the issue. Your midwife or birth professional will have the time to discuss the pros and cons of undertaking these tests and what they mean in the context of your birth plans.
What happens when you go into labour?
Many women have signs or feelings that their body is getting ready for labour well before it actually starts, such as increasing tightening of the abdomen. Others have no sign until they get full-on contractions. Whatever you feel, you will be able to talk to your midwife by phone and she will be able to reassure you by phone, or to visit your home to assess your condition. Most women keep in touch these ways until the midwife and woman decide that labour is progressing well and it is best for the midwife to be at the home. Usually the woman chooses a particular area for the birth, even if she labours throughout the whole house or garden. The woman and her family will usually also have prepared the area in advance, perhaps also setting up a birth pool and beginning to fill it once labour is established. Women often put down plastic sheeting and old towels on the floor in case they want to birth “on land”. The midwife will advise in advance of any other preparation required. Children can be present or not, according to what the woman and family feel is best – you could discuss this with other families who have already birthed at home. However, note that if children are prepared for a little noise and blood they are generally a lot less concerned about birth than adults!
What happens after the birth?
After the birth, your midwife will make sure that towels and other linen used for the labour and birth are put in the washing machine, that you and your partner/family have been fed and watered, and that you are comfortable for her to leave. However, she/they will usually stay at least a couple of hours after the birth, and often for around four hours to take medical observations. You can have champagne and snacks on the bed, couch, or wherever you are! Your midwife will also help with the first few breastfeeds if you require help, and will be available by phone until she visits again, usually within 12 to 24 hours of the birth. Most midwives visit daily after the birth until the woman is happy for the visits to become more spaced apart. Postnatal visiting (including weighing the baby, well-baby and well-mother checks) usually last officially for 6 weeks, but the bond between a family and their midwife usually lasts a lifetime.
Where can you get more information?
Deciding to have a homebirth in Australia can be more difficult than other birth decisions because fewer people are familiar with it. Talking to women and midwives experienced with homebirth will help you to gather more information and know what questions you have to answer!
Sample birth plan to come!
