About homebirth

Homebirth is a safe option if you:

• are healthy
• have an uncomplicated pregnancy
• can transfer to a hospital if you need to.

In homebirth, you often have more say in decisions about yourself and your body, care and birth environment. Women who choose homebirth often want very little medical intervention and medical pain relief.

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. This ongoing relationship can reduce your chances of needing medical intervention during birth and increase your chances of breastfeeding.

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

If you want to have your pregnancy care through a publicly funded homebirth program, you need a GP referral.

If you want to have a homebirth with a private midwife, you don’t need a GP referral. But some eligible private midwives can offer Medicare rebates, and you need a GP referral to get these rebates.

Here’s how to find a private midwife:

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

If you need help to organise your pregnancy care or to speak with health professionals, you could ask a family member, friend, multicultural health worker, case manager or Aboriginal Health Worker.

Pregnancy care for a homebirth

If you’ve been accepted into homebirth by a private midwife or a publicly funded 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
• antenatal classes
• breastfeeding classes.

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 uncomplicated, 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 midwives will check that you and your baby are both well. They might stay with you for about 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 6-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

Your home is a familiar place to give birth.

At home, you can 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 want with you during labour and birth.

Your midwife will bring:

• a small oxygen tank
• essential birth equipment
• 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 uncomplicated pregnancies during a homebirth.

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

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, they won’t be able to keep caring for you in the hospital but will stay on to support you. The hospital midwives will provide 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. Sometimes you’ll be well enough to go home after birth, but your baby will need to stay in hospital.

Costs of homebirth

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

A few public hospitals and birth centres now offer Medicare-funded homebirths as an option if you’re eligible. 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 antenatal 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.

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.

Homebirth: other things to think about

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

• where you live and how you’ll get to a hospital in case of an emergency
• how you’ll pay for ambulance transport to a hospital if you need it
• what will happen and how you’ll feel if you need to go to a hospital
• what your preferences are for pain relief in labour
• how you want your midwife to approach your care and include family members in your care
• what equipment and services you need for birth and your ongoing care
• how you’ll set up your home environment for homebirth
• whether you have the support you need from family and friends.

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