Our resident midwife discusses the available research on home births. Home birth has always been a contentious issue in Australia, largely fuelled by the media and the medical profession. Your personal feelings about home birth may also be affected by previous birth experiences, the feelings of your friends and family and whether you think the journey is as important as the outcome or that a healthy baby is the aim, regardless of how it gets here. The biggest fears surrounding home birth usually boil down to one question, is it safe?
There are many studies into the safety of home birth but not many good quality ones. Unfortunately it is the poor quality studies that the media usually report on. Flawed studies have included women who had initially planned a home birth but then transferred to hospital care during pregnancy due to a complication arising. These women may have birthed in hospital but are included in the home birth statistics because of their initial intention to home birth. They have also included women who have birthed at home with known risk factors or without a midwife or medical practitioner present. If you are looking for information on home birth you need to dig deep!
It is a common misconception that women who choose to home birth are taking a risk or are ill informed. In fact the opposite is true. The person who has the baby’s best interests at heart is nearly always the mother. A recent review (published Feb 2012) of planned home births in Western Australia found that women who choose to home birth are in fact very well informed and have a higher level of education than women who choose a hospital birth. Also, for women who are at low risk of developing complications, home birth attended by a midwife is well proven internationally to be at least as safe as hospital birth, but it has the added advantage of resulting in less interventions, a lower rate of caesarean section and assisted deliveries and higher rates of maternal satisfaction. There is no difference in outcomes for the baby.
In some states such as WA home birth is provided as a publicly funded scheme which has a very strict admission criteria excluding any women with risk factors. All of the Midwives are competent and equipped to deal with maternal and neonatal resuscitation, obstetric emergencies and perineal suturing but the vast majority of women birthing at home will not need any of these skills. In all states there is also the option of employing a Midwife in private practice. You will have to pay for the services of a Midwife in Private Practice as they are not usually covered by private health funds or medicare.
Low risk women are allowed to choose an elective caesarean, which has a much higher rate of complications than a home birth both for mother and baby, but for some reason they are not seen to be taking a risk, where as home birthing women are. My advice if you are considering a home birth is to be flexible, realistic and don’t listen to the ill informed people who insist on scare mongering with stories of their sister’s friend’s cousin twice removed who would have died if she wasn’t in hospital. Even if you are not considering a home birth I would highly recommend watching The business of being born and The face of birth. Familiarise yourself with some well researched studies and support groups such as home birth australia and regardless of what you choose, make a well informed decision based on what you feel is best for you and your baby.
Caroline May qualified as a Midwife in 1999 and has worked in both community and hospital settings around Australia and in the UK. Currently residing in Perth with her partner and two young children, Caroline is particularly interested in home and waterbirth and is passionate about enabling women to make an informed decision and play an active role in their care. You can find all her articles here.