Yes. All of the research for the last twenty years confirms that for women who have had a normal pregnancy, having a baby at home as part of a planned home birth is as safe as a hospital birth.1-4 All of these studies also indicate that, in many ways, having a baby at home is safer than having a baby in hospital. Home births carry with them a significantly lower risk of unnecessary medical interventions. Home births progress more quickly and have a much lower incidence of obstructed labour than hospital births. Babies born at home are less likely to be sedated, and are less likely to need resuscitation. There is a much lower risk of complications leading to assisted birthing, such as forceps and vacuum extraction, for babies born at home. And in addition to all of this, research consistently shows that women who have their babies at home as part of a planned home birth rate their satisfaction with the experience higher than women who have their babies in hospital.1
Do I need to have a doctor’s permission to have my baby at home?
No, you do not. There is no law against giving birth outside of hospital, and there is no law against having an independent midwife.5,6 You have a right to have your baby wherever you are comfortable. Regardless of where you choose to have your baby, you should ensure you have a health professional or team of health professionals that you trust on hand to assist you.
But one of my friends had a baby, and their baby would have died if they weren’t at hospital. What if that happens to my baby?
Research from the last twenty years has consistently shown that many of the complications that occur during a hospital birth simply do not occur at a home birth.1-4 Labour at home progresses faster, women are better able to cope in their own environment, and as a result, babies do not become distressed and tend to cope well with the birth experience. In contrast to this, labour in hospital often progresses more slowly, and as a result, the baby becomes tired and distressed before they are born. There are many possible reasons for this difference between home and hospital births. Hospital is a foreign environment. Many women spend much of their labour at home, and then choose to present to the hospital to give birth. This change in surroundings often causes labour to slow down. Your mind subconsciously body knows it is leaving a familiar place and as a result, it causes the labour to slow down to avoid the baby being born en route to the hospital.2-4 Once in hospital, common methods of monitoring your progress, such as cardiotocography (CTG) limit your movement, which further impedes your labour.7 Some hospitals place restrictions on position and posture in labour - they may prefer you to labour in a bed, on your back or your side, and these positions make it very difficult for the baby to move down the birth canal.8 Instead of respecting and encouraging your own innate ability to manage the pain associated with child birth, many hospitals encourage pharmacological pain relief for women who might otherwise manage well without it. Unfortunately, epidural and narcotic pain relief both obstruct labour, with narcotic pain relief also sedating the unborn child.9,10 And finally, research shows that women who have a midwife or health professional that they have formed a trusted relationship with, over the course of their antenatal care, give birth more quickly, and with a lower likelihood of complications.1-5
Humans are naturally very good at giving birth. The philosophy of home birth is to assist this natural procedure and to intervene on the rare occasions that complications occur. Rarely, complications do arise at a home birth, but your midwife is trained to deal with these, and the initial management of such complications is exactly the same at home, as it is in the hospital.6,11 See also: What if I need to go to hospital? And What if I need a caesarean?
How often do I see you during my pregnancy?
A homebirth midwife will see you more frequently, and for longer, than you would be seen in either the public hospital system or private obstetric care. Initially you will see me once a month, then every two weeks, and as we draw close to the birth, every week. Our visits last between one and two hours, and include clinical assessment and education. If you have a specific issue that requires me to see you more frequently than this, I am able to attend you for extra visits, for an additional fee.
Are you on call 24 hours a day?
For routine matters, your midwife will prefer to be contacted during business hours. If you have any kind of emergency, your midwife is on call for you 24 hours a day. Extra visits during the antenatal and postnatal periods will often attract an additional fee. Your midwife will be on call for you 24 hours a day, seven days a week for the birth. If, for some reason, your midwife may not be available when you go into labour, then you will be informed well in advance, and alternate arrangements made for your care in the event that they cannot be present.
Do you perform the Glucose Tolerance Test (GTT)?
No, we do not perform the Glucose Tolerance Test. We also do not routinely refer you to have a GTT performed. Most hospitals in Australia have ceased routinely referring their clients for the GTT as well.5
Do you perform an ultrasound?
No, we do not perform an ultrasound. That needs to be performed by a qualified technician. We do recommend that you have an ultrasound, though, and during your pregnancy we will write to your GP, obstetrician, or hospital clinic to recommend that they refer you for one.5
Do I need anything special to give birth at home?
Your midwife can talk to you further about specific things you need at home for a home birth, but as a general rule, it is a good idea to have a supply of clean towels and linen that you don’t mind getting dirty. Your midwife will assist in arranging for oxygen to be delivered to your home before the birth. Otherwise, you can expect your midwife to bring any necessary equipment or supplies.
Can I have my children present?
When children are adequately prepared for the birth experience, it can be a wondrous event that brings your family together in an entirely new way.12,13 Even young children can be prepared for the birth experience, and there is no evidence at all that being present at the birth of a baby is harmful to children of any age. We recommend that when children are present during the birth, you enlist the assistance of another adult who the children are comfortable with to act as their carer during this time. Otherwise, we discuss specific methods of preparing children for the birth during our antenatal care.
How will my baby be monitored during labour?
During labour, your midwife will regularly listen to your baby using a fetal Doppler, a special type of portable ultrasound that will detect the baby’s heartbeat. Research indicates that this kind of monitoring, known as intermittent Doppler monitoring, is as effective as more invasive forms of monitoring that are used in hospital, such as cardiotoucography, or CTG.7,14 Doppler monitoring also allows you freedom of movement and the flexibility to labour in water, if you so desire.
What if I need to go to hospital?
During a normal pregnancy and labour, it is unusual for complications to arise that would require you to go to a hospital for medical care.1-4 Should this occur, your midwife will arrange for immediate transfer to your booking hospital by ambulance. Your midwife will accompany you to the hospital. Unfortunately, once in hospital, the public health systems in most Australian states do not recognise your midwife as an independent practitioner, and so your midwife will no longer be able to provide midwifery services; however, they will remain with you as a trusted advocate and support person.
What pain relief options are open to me at home?
The use of inhaled nitrous oxide, narcotic, or epidural pain relief all require the assistance of a medical officer. As a result, my practice does not offer these pain relief options at home. I do not recommend the use of pharmacological pain relief during birth. Narcotic pain relief affects the baby’s ability to breathe when it is born.15 Epidural pain relief limits mobility and increases the likelihood of medical intervention being necessary during birth.9 The use of artificial pain relief may also reduces the body’s ability to deal with pain naturally.10
There are a number of non-pharmacological pain relief options open to women during a home birth. Transcutaneous Electric Nerve Stimulation (TENS), Homeopathic pain relief remedies, as well as the use of heat packs, breathing techniques, and labour in water, are all effective in reducing the pain associated with labour.16-18 We are also supportive of guided birthing techniques such as Hypnobirthing or CalmbirthTM.
What if my baby needs assistance being born - for example, forceps?
During a normal pregnancy and labour, it is very unusual for your baby to have difficulty being born.1-4 Independent midwives encourage you to move around and assume birthing positions which assist the descent of the baby through the birth canal.8 Giving birth in a familiar environment also removes subconscious fears or concerns which might impede the progress of your labour. Additionally, some research has shown that up to 60% of hospital births that require forceps are associated with the use of epidural anaesthesia.19 As a result, the need for forceps or other birth assistance, such as vacuum extraction or episiotomy, is much less common at home than in the hospital.1-4 If, however, your labour did become obstructed, and the baby was having trouble being born, there are recognizable signs that your midwife will be assessing, and you would be transferred to hospital as soon as it became necessary.
What if my baby needs rescuscitation?
The initial procedures for resuscitating a newborn are identical for both home and hospital births.20 The infant is stimulated to encourage breathing, and if necessary, suction is used to clear the airways of any fluid. If the baby is still slow to breathe, “bag and mask” resuscitation can be used to breath for the baby until it breathes on it’s own or, if necessary, is transferred to hospital. Cardiac massage can also be used if the baby’s heart is not beating. All of the equipment required for these procedures is carried by your independent midwife, who is also trained and accredited yearly in neonatal resuscitation.
What if I need a caesarean?
During a normal pregnancy and labour at home, it is unusual for complications to arise that would require your baby to be born via caesarean.1-4 However, research indicates that once the need for a caesarean is identified, to avoid further complications, the caesarean should take place within 75 minutes.11 In the event of a caesarean being required, your midwife will arrange for your immediate transfer to hospital care and urgent admission for a caesarean, within this 75 minute time frame. See also: What if I need to go to hospital?
Do I have to go to the hospital after the baby is born?
If you have had a normal pregnancy and birth and you and your baby are healthy, you do not have to go to hospital after your baby is born. Your midwife can provide all of your postnatal care.6 If you wish to have your new baby examined by a medical officer, you may either present to your booked hospital after the birth, or your can take your baby to see your General Practitioner. You may also choose to present to your local maternity ward or hospital clinic for the State-wide Infant Screening for Hearing test. This is a non-invasive procedure that will test whether the baby has any hearing problems.
Who cleans up the mess?
After your baby is born and examined, and you have been examined, your midwife will assist you to have a shower and ensure you are resting comfortably. Afterwards, your midwife will assist your partner or support person in clearing up, although a home birth is invariably less messy than most people think.
How often do you see me after the baby is born?
After the baby is born, your midwife will see you every day for the first four days. During this time, your midwife will assess you to ensure that you are breastfeeding successfully, that your baby has no health problems after the birth, and that your body is beginning to return to normal after the birth. The Newborn Screening Test, a test that is performed on all Australian babies to check for a number of very rare genetic disorders, is offered during this time.
After this, you will have another visit at one week, and another visit at two weeks.
Your midwife will see you for a final visit when your baby is six weeks old. Assuming you are continuing to cope well at this time and you and your baby are both healthy, you will be officially “discharged” from your midwifery care at this visit.
My doctor told me that home births were unsafe, and that there was Australian research that confirmed this. Is this true?
Two studies, one published in 1990 and the other published in 1998, examining babies born at home up until 1990, found that in some circumstances, home births were not as safe as hospital births.3,21 However, even the authors of these studies clearly state that their results only pertain to “high risk” births. Since these studies were produced, admission criteria in Australia for women wishing to have a home birth have been reviewed. It is accepted practice that women who fall into a “high risk” category - for instance, women carrying a twin pregnancy, or who live in isolated rural areas some distance from hospital care - are not offered a home birth.
It is also important to note that several commentators have highlighted potential bias in these two studies,22 and in the 17 years since the studies stopped collecting data, their conclusions have not been supported by a single other study. That means that all subsequent research, both in our own country, and overseas, has stated overwhelmingly that giving birth at home is as safe as giving birth in a hospital, and carries with it the additional benefit of having a much lower risk of unnecessary medical intervention.1-4,23
I have been shown a statement from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists that says they do not endorse home births. Why not?
Unfortunately, the content of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) statement is based on only a few research studies.24 Of these few studies, several are from overseas, and only two studies actually support their claims - and even these only partially (see also My doctor told me that home births were unsafe, and that there was Australian research that confirmed this. Is this true?).
The RANZCOG statement ignores the entire body of research into home birth for the last seventeen years. It also erroneously claims that there are “increased risks of home birth in comparison to hospital birth for low risk women”, even though none of the research studies they refer to support this.
It is important to remember that the role of an obstetrician is as a surgical specialist in the care of a woman during pregnancy. An obstetrician should appropriately be involved in a birth where medical or surgical intervention is required.25 As the vast majority of births do not require any medical or surgical intervention, and therefore have no need of the involvement of an obstetrician (see also: What if I need to go to hospital? And What if I need a caesarean?) it is understandable that obstetricians would not necessarily agree with the concept of birth outside of a hospital. However, regardless of the opinion of the RANZCOG, the existing research and literature is overwhelmingly supportive of home birth.
1. Macvicar J, Dobbie G, Owen-Johnstone L, et al. Simulated home delivery in hospital: a randomised controlled trial. British Journal of Obstetrics and Gynaecology. vol 100, no 4, April 1993, pp 316-323.
2. Johnson KC, Daviss B. Outcomes of planned home births with certified professional midwives: large prospective study in North America. BMJ. 2005;330:1416.
3. Crotty M, Ramsay AT, Smart R. Planned homebirths in South Australia 1976-1987. MJA. 1990;153(11):664-671.
4. Olsen O. Meta-Analysis of the Safety of Home Birth. Birth. 1997;24(1):4-13.
5. 3 Centres Consensus. Guidelines on Antenatal Care. Available at: http://www.3centres.com.au/guide_frame.htm [Accessed December 1, 2007].
6. Maternal and Newborn Health / Safe Motherhood Division of Reproductive Health. Care in Normal Birth: a practical guide. 1st ed. Geneva: Worls Health Organisation; 1996.
7. Alfirevic Z, Devane D, Gyte GML. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour (Cochrane Review). (Date of most recent substantive amendment: 24 April 2006). The Cochrane Database of Systematic Reviews. issue 3, 2006.
8. Jong PR, Johanson RB, Baxen P, et al. Randomised Trial Comparing the Upright and Supine Positions for the Second Stage of Labour. BJOG: An International Journal of Obstetrics and Gynaecology. 1997;104(5):567-571.
9. Halpern SH, Leighton BL, Ohlsson A, and others. Effect of epidural vs parenteral opioid analgesia on the progress of labor: a meta-analysis. JAMA. vol 280, no 24, 23/30 December 1998, pp 2105-2110.
10. De Punzio C, Neri E, Metelli P, and others. The relationship between maternal relaxation and plasma B-endorphin levels during parturition. Journal of Psychosomatic Obstetrics and Gynecology. vol 15, no 4, December 1994, pp 205-210.
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13. Hodgkinson S. A family affair. Practising Midwife. vol 7, no 8, September 2004, p 46.
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20. The International Liaison Committee on Resuscitation (ILCOR) consensus on science with treatment recommendations for pediatric and neonatal patients: neonatal resuscitation. Pediatrics. 2006 May; 117(5): Supplement: e978-88. (118 ref).
21. Bastian H, Keirse MJNC, Lancaster PAL. Perinatal death associated with planned home birth in Australia: population based study. BMJ. vol 317, no 7155, 8 August 1998, pp 384-388.
22. Coory M. Commentary on perinatal death associated with planned home birth in Australia: population based study. Birth Issues. vol 7, no 4, December 1998/January 1999, pp 128-129.
23. Woodcock HC, Read AW, Bower C, et al. A matched cohort study of planned home and hospital births in Western Australia 1981-1987. Midwifery. vol 10, no 3, September 1994, pp 125-135.
24. Royal Australian and New Zealand College of Obstetricians and Gynaecologists. C-obs2.pdf (application/pdf Object). 2008. Available at: http://www.ranzcog.edu.au/publications/statements/C-obs2.pdf [Accessed November 1, 2008].
25. Obstetrics - Wikipedia, the free encyclopedia. Available at: http://en.wikipedia.org/wiki/Obstetrics [Accessed December 3, 2007].