Understanding the pros and cons of homebirth

For women who have healthy, low-risk pregnancies homebirth is a safe option, provided your location is in close proximity to a hospital. If risks or complications arise throughout the pregnancy or during the birth, and it is no longer deemed safe to deliver at home a hospital birth will be required.

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Homebirth is usually overseen by a private midwife who must be registered with the Midwifery Board of Australia to practice and be insured.

Midwives who care for women at home are specially trained and come equipped with everything they need to monitor you and your baby and treatment. If complications arise during the birth, the midwife will have a plan in place and arrange for a transfer to the nearest hospital where she will hopefully have visiting rights and can remain your primary caregiver.

It has been demonstrated in numerous studies around the world that midwifery-led continuity of care throughout pregnancy and labour not only reduces c-section rates but also increases maternal satisfaction rates. The largest meta-analysis (by Reitsma et al. 2020) of 16 studies and 500,000 planned homebirths also showed that there was no difference in mortality rates when compared to hospital births.

Some possible benefits of homebirth:

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• Higher chance of a natural birth
• Less chance of medical intervention (eg. inductions), allowing for natural start and progression
• Lower chance of cesarean section
• Comfort and security of being in own home
• Family and siblings can be present
• Not having to leave kids to go to the hospital
• No need to travel during labour
• High chance of a positive birthing experience
• Familiar surroundings
• Less anxiety around the hospital and medical intervention

It is important you talk with your caregiver about the risks involved with a homebirth and what the plan involves if complications do arise and how you will be admitted to the hospital. Often the midwife will remain your primary caregiver even if a transfer for an epidural or c-section occurs and an obstetrician in the public hospital then works with your midwife.

There are a lot of myths and misconceptions about birth, and especially homebirth so it is good to have open conversations, ask questions and do your own research.

One of the most important things to consider before choosing a private midwife is how long the journey would be from your home to the hospital, in the case of a transfer. A 15-20 min car ride is often considered a safe duration.

Within that time the hospital is notified and for example, the operating theatre would be prepared while mum is in transit so that emergencies are dealt with immediately upon arrival. When a midwife is sitting with her one labouring mum at home (rather than perhaps at a desk and dropping into numerous birth suites over a shift) her continuity means that she can be incredibly aware of any anomalies early on.

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There are some disadvantages you should also consider:

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• In the event of complications, you will need to be transferred to hospital
• Possible delays in getting to the hospital
• Restricted access to care and medication if required
• Epidurals are not available at home

Women with high-risk pregnancies, multiples (eg. twins), if the baby is breech or if you have previously had a cesarean are all factors that mean your caregiver may not recommend a homebirth.

When you are weighing up your options, some helpful questions to ask your care provider would include:

• Where is the nearest hospital in case of an emergency?
  
• Ambulance cover – will the cost of transport be covered or will you have to pay for it?
  
• What is the cost? On average you can expect to spend between $3000-$6500 on a homebirth.
  
• What costs are covered by Medicare/private health insurance, if any?
  
• Who will be providing my care? Will it be the same midwife throughout the pregnancy and birth?
  
• How will we manage pain relief during labour, are there any options available?
  
• Your midwife’s attitude to family/siblings etc being present.
  
• What continuity of care will you receive after the baby is born (eg. breastfeeding support, treatment etc)? 

Deciding to have a homebirth is a decision that will be weighed up with both personal preference but also health and risk factors. Ultimately, even if you have your heart set on a homebirth it might not always be the safest option for you and your baby and you should always remain open to this.

Find a registered care team you trust to help you make the best possible decision. Read the latest research and watch some of the interesting films made about numerous different types of birthing environments in films like Orgasmic Birth.

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