Having a baby at home can be an option for pregnant women who are healthy, have a low-risk pregnancy and live close to a hospital in case the birth does not go to plan.
If you give birth at home, you should be supported by a registered midwife, GP obstetrician or obstetrician who will be with you while you are in labour. Most pregnant women who have a homebirth employ only a private midwife. This midwife will provide all your pregnancy care, attend the birth of your baby and provide follow-up care.
Women who choose homebirth often do so because they want to give birth in a comfortable, familiar environment without too much medical intervention or pain relief. If you elect to have a homebirth and complications occur during the pregnancy or birth, you might need to have your baby in a hospital.
How homebirth works
Homebirth is usually with a private
midwife; however, some public hospitals in Victoria offer publicly funded homebirth programs.
Pregnancy care
If you are planning a homebirth, your pregnancy appointments are likely to be with a midwife in your home, at a hospital or at a local clinic.
During these appointments your midwife will talk with you about pregnancy, labour and birth and develop a birth plan based on your preferences. Part of this plan might be to book you into a local maternity service or birthing unit in case there are deviations from normal progress or abnormalities develop.
You will discuss pain relief, such as the TENS (transcutaneous electrical nerve stimulation) machine, and items you might want to prepare such as a heat pack or a Swiss ball. You might want to use a birth pool, which the midwife can help you organise.
The midwife will monitor your health, give advice and answer any questions you might have.
At the birth
When you are in the early stages of labour, you will contact your midwife to discuss how the labour is progressing. Your midwife will come to your home and stay until the birth. Depending on how she works, the midwife may call a colleague to assist during the birth itself. If she regularly works with others, you might have met her colleagues during your pregnancy.
The midwife will bring most of the necessary equipment to assist with the birth but may ask you to provide old sheets, towels and blankets, for example.
You can decide who else you would like at the birth. You might want your partner, your children or other family members such as your mother or sister.
Transfer to hospital
Your midwife might recommend you transfer to a hospital if things do not go to plan or simply because your labour has slowed down. Depending on the circumstances, the midwife might call for an ambulance or you could travel to hospital in a car.
At hospital, your midwife will stay with you as much as possible, although the hospital midwives and doctors will probably take over your care. Some private midwives have existing arrangements with hospitals that will allow them to continue to be closely involved in your care.
After the birth
Once your baby is born and the midwife is satisfied that you are both well, she might give you and your partner or support person some private time while she cleans up and completes paperwork. She will weigh and check the baby over and guide you through your first breastfeed.
Your midwife should stay at least two hours after the birth and give you some clear information about how to care for your newborn and what to do if you have any concerns. A private midwife will then visit regularly until you gain confidence.
It is a good idea to make an appointment to see your GP for a full check when the baby is about a week old. Your midwife should also contact your local maternal and child health nurse to arrange a home visit, but if not, you can organise it yourself by calling your local council.
Who is suitable for a homebirth
Homebirth is suitable for healthy women with a low-risk pregnancy. Pregnant women in a higher risk category are not usually suitable for safety reasons.
Pregnant women who might not be able to have a homebirth include those who:
- are older and having their first baby
- have had previous complications in pregnancy or birth
- are expecting twins
- live a long way from a hospital
- have a breech baby
- have had a previous caesarean
- develop complications during pregnancy such as pre-eclampsia.
Factors to consider when planning a homebirth
Choosing to give birth at home is a personal choice that women make for a number of reasons, including:
- You can give birth in familiar surroundings where you may feel more relaxed.
- You will not have to arrange care for your other children, if you have any.
- You are more likely to be cared for by a midwife you have become familiar with over the course of your pregnancy.
- You can have as many people as you like present for the birth.
Some of the things women should consider when deciding on whether to have a homebirth include:
- You may need to be transferred to a hospital if things go wrong during the labour or birth, or if your labour does not progress.
- You will not have access to an epidural at home.
Homebirth safety issues
If you give birth at home, you should be supported by a registered midwife, GP obstetrician or obstetrician who will be with you while you are in labour.
Homebirth is not as integrated into Australia’s health system as it is in some overseas countries such as the United Kingdom, New Zealand and The Netherlands. In those countries, homebirth is a common birth choice for many pregnant women.
In Australia, authorities disagree about the safety of homebirths. The Australian College of Midwives, for example, supports homebirth as an option in low-risk pregnancies for women who are cared for by an experienced midwife. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists does not support the practice of planned homebirth.
The Department of Health & Human Services provides guidance to public health services on what they need to do to establish a safe, high-quality and sustainable homebirth program.
Organising a homebirth
Once your GP has confirmed your pregnancy and that homebirth is a viable option for you, you can organise a homebirth through your local hospital (if available) or by employing a private midwife.
Some public hospitals, such as Casey Hospital (Berwick) and Sunshine Hospital (St Albans) in Victoria offer publicly funded homebirth programs, but many do not.
You do not need a referral to contact a private midwife; however, some private midwives who can offer Medicare rebates might ask for one from a GP. You will need a referral if you choose to use a public homebirth program.
To find a private midwife, you can:
Homebirth costs
A few public hospitals in Victoria now offer homebirths as an option for women with low-risk pregnancies. If you choose this option, the birth will be covered by Medicare. Other costs might include:
- tests and ultrasound scans (you can usually get some money back through Medicare)
- birthing classes, if you choose to do them.
Private midwives work for themselves so there is a cost associated with their services.
Private midwives work for themselves so there is a cost associated for their services. If the midwife is an ‘eligible midwife’, Medicare provides rebates for some of these services. Some private health funds also provide rebates.
A homebirth with a private midwife can cost between $3,500 and $6,000. This fee will cover your pregnancy care, the labour and birth, and home visits for two to six weeks after the birth. Before you employ a midwife, it is a good idea to ask exactly what their fee includes and about any possible Medicare or private health fund rebates. If you employ an ‘eligible midwife’, you can claim Medicare rebates, for care given during pregnancy and after the birth, of about $1,000–$1,800.
There are no Medicare rebates for a homebirth with a private midwife, even if the midwife is an eligible midwife. If you have to go to hospital, there may be a rebate for some of the fee.
Insurance and homebirth
If you use a hospital or birth centre program that offers homebirths, the birth will be covered by the hospital or birth centre’s insurance.
Private midwives do not have professional indemnity insurance to cover the birth itself (even if they are an eligible midwife). The professional indemnity insurance of a midwife will only cover your pregnancy and follow-up care. Your midwife will ask you to sign a document that shows you understand she is not insured for the birth.
If something goes wrong during the birth and you want to sue the midwife for negligence, you would be suing them personally. If you were successful, your midwife may not have the funds to pay you the damages you may be awarded by a court.
Changing your mind about homebirth
It is unlikely that you will be able to choose a homebirth very late in your pregnancy because private midwives get booked up. If you have already organised a private midwife for a homebirth but then decide you want to give birth in a hospital, you can do this right up until the birth itself.
Other things to think about
If you are interested in a homebirth, it is a good idea to think about:
- where you live – it is best to be close to a hospital in case of an emergency
- ambulance cover – if you need emergency transport to hospital you will have to pay for the full cost of the ambulance if you do not have cover
- how you would like to manage your pain during labour – the options are more limited outside of hospital
- finding the right midwife to suit your needs and who supports your birthing choices
- who you would want present at the birth, and if the midwife is okay with this
- where in the house you would like to give birth.
Important things to remember
If you are considering a homebirth, it is important to:
- have a registered midwife, GP obstetrician or obstetrician to care for you during labour and birth
- understand that you might need to be transferred to hospital if medically necessary
- book into your local hospital in case you have complications leading up to or during labour
- have regular monitoring from a midwife or doctor during your pregnancy
- continue to receive care from a midwife or doctor after the birth
- have your newborn baby checked by a doctor in the first week after birth
- make sure your midwife or doctor checks the baby properly after the birth or refers you to a service that can
- be sure your baby is offered treatments such as a vitamin K injection.
Where to get help