'Choice and intimacy'. These are the reasons Melbourne mum, Simone Bates-Smith, chose a home birth for the arrival of her daughter Eve, in 2017. Simone is among a tiny percentage of women opting to give birth at home in Australia, where fear surrounding home birth is still prevalent despite being commonplace in many other countries.
According to a 2015 study published in the International Journal of Women's Health, Australia has the third lowest rate of planned home births among a group of developed nations at 0.4 per cent. Our neighbour, New Zealand, ranks much higher at 3.3 per cent, but both pale in comparison to The Netherlands at 20 per cent of all births.
Parts of the UK are even piloting an initiative to increase home birth rates to 50 per cent after the British Royal College of Obstetricians issued a statement recommending home births for low-risk women.
So what do these countries know that Australia doesn't?
For those women seeking an intervention-free birth who have progressed through pregnancy without complication, home birth seems like an obvious choice. Australia has staggeringly high rates of birth intervention, with a third of women giving birth by caesarean, and a further 45 per cent receiving some form of induction or augmentation during labour.
While some interventions may be lifesaving in emergency situations, a number of studies published in the British Medical Journal have shown medical intervention can be particularly harmful if administered during low-risk births, and may prolong recovery and separation between mother and baby during the crucial bonding period.
Unnecessary interventions can also increase rates of birth trauma, jaundice, breathing problems and feeding difficulties after birth.
It's these findings Simone stumbled upon when researching the kind of birth she wanted for her first pregnancy. 'Going into hospital is the first intervention' she explains, 'and the more I researched the more I knew that's not what I wanted. I was determined to have a natural birth, and I knew I was far more likely to have that at home,' she says.
Dr Michael Gannon, Obstetrician and President of the Australian Medical Association (AMA) says the AMA fully supports a woman's choice for a home birth, but questions their safety. He confirms that 'for women in the lowest quartile of obstetric risk there is not an appreciable increase in mortality' for a home birth, but reiterates that hospital is the safest place for any birth, despite the high intervention rate. 'Procedures can be undertaken very quickly in hospital, and I reflect weekly on how close a baby came to being in trouble, or not surviving labour,' he explains.
The safety of home births has been questioned by a number of studies that show a higher neonatal death rate, but the data reveals a significant confounding factor. Namely, that unplanned, emergency home births (that often result in poorer outcomes for mother and baby) are included in addition to planned home births where the mother and birthing team is adequately prepared.
When this is accounted for, the research is undoubtedly in favour of planned home births for low-risk pregnancies, which indicates no increase in neonatal morbidity or mortality rates. Additionally, home birth mums often have better health outcomes and report higher satisfaction levels with their overall experience.
Despite the weight of this evidence, home births have been tarnished by a number of high profile cases gone wrong, such as the tragic deaths of home birth advocate Caroline Lovell and baby Joseph Thurgood-Gates, both deemed avoidable deaths by coroners and found later to be due to medical negligence.
Martina Gorner, a home birth midwife and founder of Ten Moons Personal Midwifery, explains that when performed according to strict safety guidelines, the home birth experience is second to none.
Ten Moons is the first and only private midwifery practice in Australia to have a certified quality management system in place, and excellent safety standards have been maintained since opening in 2014. Martina's aim is to offer 'woman-centered, personalised and holistic midwifery services that respect the rights and choices of pregnant and birthing women.'
Private midwives, like Martina, are often the only option for women seeking the home birth route. Currently, only a handful of publicly funded home birth programs exist nationwide, and Queensland does not offer a public home birth option at all. This lack of access is likely a huge factor in Australia's low home birth rate, with research showing that more women would consider a home birth if it was more readily available.
Despite limited access to a public option, pregnant women face losing the home birth altogether unless the government finds a solution for the looming 2019 expiration of the insurance exemption, which currently allows private midwives to attend home births. The number of private home birth midwives continues to dwindle due to pressure from regulatory bodies and the publicly scrutinised home birth deaths in recent years.
In the end, Simone's birth was more than she could have ever hoped for, and wishes more women had access to this option. 'I'd do it again, no question,' she says. 'I loved the intimacy between my partner and I during birth, and the transition straight into family bonding time. It was such a lovely, empowering start to motherhood.'