Homebirth is increasingly being spoken about as an alternative to hospital birth. Some hospitals are now offering a homebirth program, and of course homebirth is available through independent midwives. Homebirth remains a less common choice for birth, with the majority of Australian women birthing in hospital. So why are some women deciding to birth at home?
For many, the belief in the safety of homebirth is an important factor. Women who choose homebirth do a lot of research into their decision. Isis, an Essential Baby member, states, "I began my parenting journey as a trusting, somewhat ignorant and yet positive 24-year-old. My resulting [birth in hospital] and recovery from it taught me a lot about myself and my birthing body. I learnt a lot about our maternity system, about research and evidence based practice. Interactions with hospital staff during that pregnancy and after my son's birth angered me, witnessing the postnatal treatment/distress of a [new mother] only cemented the knowledge that I didn't need, or want to be in the system, unless absolutely necessary for any subsequent children. So my third baby was a planned home birth even before conception."
For some women, the decision to homebirth is made because of distance from the hospital and/or a history of fast labour, making homebirth a safer option: these women face the very real risk of birthing on the side of the road or in the car, unattended by a midwife. Heidi, an Essential Baby member recalls that in her first birth, she did not realise she was in active labour. The birth centre staff encouraged her to stay home. Eventually her "waters broke and I had an overwhelming urge to push. We drove in school hour traffic to the hospital and it was terrifying. I was so scared that I was going to give birth in traffic. The pain during contractions while going round corners or over speed humps was unbearable." When she got to the birth centre, she was full dilated.
Cesca planned a birth centre birth with her first baby, but realised that in an emergency it would be a 15 min ambulance trip to hospital, whereas it was a 5 min trip to hospital from her home.
For other women, the decision to have a homebirth is informed by the fact the fewer interventions are used at home, and therefore women having homebirths can avoid complications that often result from intervention that is commonly used in hospital - things like induction, epidural, breaking the waters and episiotomy. Suzy (an Essential Baby member) wanted to avoid having "midwives doing extensive internal exams causing extreme pain completely unnecessarily." KM saw The Business of Being Born, a documentary on home birth and maternity care in the U.S. "After seeing this, I knew that home birth was the best option for me due to it being safe and having less chance of interventions for birth (I had interventions for my first two births - induction and drugs through labour that I had more knowledge of the impacts of now 9 years after my last child)."
Essential Baby member and new Mum Reenie says, "The more I learned about intervention, the more concerned with hospital births I became as this state has an incredibly high rate of Caesarean section. I found it bizarre that you weren't allowed anything stronger than a Panadol while pregnant, but they wanted to put all sorts of drugs into you while in labour!"
For other women, the decision to involve children in the birth is important. Waterbirth is a common method used in homebirth, and this is not permitted in some public and private hospitals. This was a motivating factor for Suzy and KM.
What sort of care and services are available from homebirth midwives?
Isis states, "The care provided by my midwife was second to none. Having 1-2 hour appointments in my own home were such a treasure, compared to the rushed 5-10 minute face-to-faces that the hospital offered (and that doesn't include the 20-80 minute wait times!). The relationship we built over the pregnancy was one that ensured total reciprocal trust and respect between us. The parameters set upon the birth were personalised to our requirements, not a faceless hospital policy. Labouring in my house meant no restrictions. After the birth - having my own lounge to sit on, privacy, security. My shower, my family, my home."
New Mum Reenie states, "My midwives were completely focused on me. No running off down a corridor to some other woman."
Typically, homebirth midwives book no more than four women each month. This allows the midwife time to get to know each woman during pregnancy - to find out what is important to her, her wishes for her pregnancy, labour, birth and postnatal period, and to build a firm relationship. Generally, each visit includes a physical check of the woman, antenatal education, health promotion, a discussion of what to expect in coming weeks and birth preparation. Midwives attend you at home when you are in labour, and then provide home visits (often daily) after your baby is born.
Heidi states, "Having a homebirth was the best decision I've ever made. It was the most wonderful experience of my life. To experience birth like that - painless, blissful, profoundly beautiful."
So then, what are the disadvantages?
For some women, the cost of homebirth with a private midwife is prohibitive. In Australia, homebirth costs anywhere between $2,500 and $5,000. Despite the cost, Heidi sees the benefit, "I wouldn't have paid for a private midwife because they are very expensive where I live ($4k). I would now though, because I know how much better homebirth is."
New Mum Reenie mentions, "I had to educate my fiance so that he was comfortable with the idea. Like most, he viewed birth as potential disaster, rather than a normal process. He was reluctant at first, but after attending a 'choices in childbirth' talk and hearing all the facts, (as well as some hospital horror stories from people attending) he was all for it!"
Can I have a home birth?
Safety is an important factor. While homebirth is an excellent choice for some families, others may choose a birth centre or hospital birth. Women who choose a hospital birth may:
- have a pre-existing medical condition
- prefer the option of epidural pain relief
- feel safer in hospital/birth centre
- have a condition called placenta praevia, where the placenta covers the cervix.
Heidi points out that "there is the assumption in our society that (homebirth) is generally unsafe", and therefore some professionals will encourage all women to birth in hospital, regardless of whether they are high or low risk. Gail (username Midwitch) was "told I couldn't birth vaginally. When I did with no problems, I was told the next one would be too dangerous to birth vaginally. By my fourth homebirth I was also having very large, very late (14 days) babies, all increasing my risk. Luckily my midwife never doubted me or feared I couldn't do it - I've now had seven babies, five at home. No complications, no problems."
There are some complications and pre-existing medical conditions for which a hospital birth would be a safer option. For further information about your individual situation, please speak with your midwife or doctor.
What happens if something goes wrong during my homebirth?
This question is commonly asked when the topic of homebirth comes up. Put simply, if something goes wrong, you transfer to hospital. There is a strong reliance on the midwife's skills at ensuring that you are low risk at the start of your pregnancy, and that you remain low risk throughout your pregnancy, labour and birth. At any time the midwife has concerns, she will discuss them with you and will work together with you to devise a plan of action. This might involve getting a second opinion from another midwife, getting a consultation with an obstetrician or complementary therapist, or referring you to hospital.
KM had a post-partum haemorrhage which was managed by her midwives.
"Unfortunately my pulse and BP would not stablise afterwards and my midwife could not get a line in." KM transferred to hospital and her midwife went with her, advocating for her at the hospital. Cesca also has a post-partum haemorrhage but "it was mild and the midwife could control it with drugs at home."
Gail transferred in labour: "My third baby (second homebirth), I transferred in for foetal distress. He had the cord around his neck and two true knots in it. He birthed quickly in good condition so we went home two hours later."
The other common reasons a women may transfer in labour are for a labour that is not progressing, or the woman's decision to have an epidural.
What does the research say?
A Canadian study involving 5,418 women who had planned a midwife-attended homebirth found that 12.1% of those booked for homebirth transferred to hospital. 4.7% women had an epidural, 2.1% had an episiotomy, 1% had a forceps delivery, 0.6% had a vacuum extraction, and 3.7% had a caesarean section. In other words, 94.7% women had a normal vaginal birth! The study found that these rates were substantially lower compared with low risk US women having hospital births. The neonatal mortality rate was 1.7 deaths per 1000 planned home births, similar to risks in other studies of low risk home and hospital births in North America. No mothers died. The authors concluded that planned, midwife-attended home birth for low risk women in North America was associated with lower rates of medical intervention and similar intrapartum and neonatal mortality to that of low risk hospital births in the United States. (BMJ 2005;330:1416)
Author Melissa is an Essential Baby member and an independent midwife.
Discuss homebirthing with Essential Baby members in the homebirthing forum.