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Home birth risks and choices

Home birth provides choice
Photo: Home birth provides choice
The latest statistics on childbirth in Australia show of the 294,814 women who gave birth in 2010, just 1,345 gave birth at home. Home births in Australia are steeped in controversy but some of Australia’s leading midwives say a home birth offers much more than just a bricks and mortar location, writes Karen Keast.

The Australian Institute of Health and Welfare’s Australia’s Mothers and Babies 2010 report reveals just 0.5 per cent of all births took place in Australian homes in 2010.

In comparison, 96.9 per cent of women, or 285,617 women, gave birth in hospitals and 2.2 per cent, or 6,367 women, gave birth in birth centres.

Of the mothers who had a home birth, 25.2 percent had their first baby and 74.3 per cent were multiparous, the main method of birth for 99.3 per cent was non-instrumental vaginal while the presentation was vertex for 97.2 per cent of women.
Western Sydney University Professor Hannah Dahlen, a privately practising midwife and spokesperson for the Australian College of Midwives, says while just small numbers of women opt for a home birth it’s important to provide women with a choice of where and how they give birth.

“There are some midwives who might do one or two home births a year,” she says.

“There are probably more births that occur unattended by a midwife or a doula than professionally planned births with a midwife.”

Professor Dahlen, who estimates she’s attended about 50 home births in the course of her midwifery career, says a home birth is worlds apart from a hospital birth.

“Unless you have ever been to one you can’t really express how different it is,” she says.

“I have had over 20 years working in mainstream midwifery care and there’s nothing in the world quite like it.

“I think it’s about more than a place of birth. It’s around the whole model of care and philosophy.

“You know the couple you are working with and you know the home well and you know what’s important to them.

“It’s everything that comes with the package as opposed to the bricks and mortar.

“They are in their own space. It’s just very, very natural.

“I think my very favourite part is watching the mother and baby meet for the first time and watching a family born.”

Professor Dahlen says hospital births, in comparison, come with continual assessments and often escalating medical intervention.

“In hospitals, we are doing things to interrupt that,” she says.

“We are doing its weight and its checks, and the baby and mum just don’t get separated at home.

“They have that time to connect and fall in love.

“It’s you and the woman and a mutual partnership and agreement. It’s very mutual.

“It’s about you and her as opposed to the system hovering.”

Griffith University Professor Jenny Gamble, a practising midwife of 30 years who estimates she’s attended more than 100 home births, says a home birth is safe for healthy, low-risk women with a competent registered midwife, well networked into a responsive health service.

She believes women with high risk factors should give birth in hospital.

“The risk factors for home births aren’t specific to home births,” she says.

“For most healthy women, having a baby at home will decrease their risk of having unnecessary and avoidable medical intervention…and they are less likely to have a caesarean section.

“It isn’t suitable for all women because some women need inductions, caesarean sections, epidurals – those needs can’t be provided at home.”

Professor Gamble says midwives will have a plan to change settings and transfer the woman to hospital if either her condition requires it or the fetal heart rate shows the baby is in distress.

“Some people get the idea when you have a home birth that the duress of the woman or the baby are similar to hospital and they will all fall off the cliff at a moment’s notice,” she says.

“You are not inducing her, you are not giving her medication to make her contractions harder, you are not giving her epidurals and pain relief – you are not scaring her as much.

“It doesn’t play out the same way it does in hospital.”

Professor Gamble says with a lack of medical intervention and a providing a decreased risk of infection for babies, home birth has a lot to offer women and their babies.

Professor Dahlen agrees, and says recent Coronial investigations into the deaths of babies in home births have unfairly tarnished home births.

“There’s been very negative media around what were clearly not planned home births and those attended by unregistered midwives,” she says.

“I think if you have got risk factors in pregnancy, there’s no doubt that hospital is the best place for you to be.

“I think if you are low risk and you have got a system in place, it’s very, very safe - it is as safe for the baby and safer for the mother.”

In Australia, privately practising midwives have access to Medicare for antenatal and postnatal care but not for a home birth.

Private midwives also have access to insurance but again, not for a home birth.

Under national law, Australian midwives can practise in a range of settings, including homes, as long as specific registration conditions are met.

Since the collapse of HIH in 2001, no insurance has been available for privately practising midwives providing home birthing services.

Without commercial professional indemnity insurance, Australia’s Health Ministers last year recommended extending the professional indemnity insurance exemption for private midwives until June 2015, enabling midwives to continue to practise home births.

Professor Dahlen says home births in Australia need to be fully supported, fully funded and fully insured.

“In that sense, it’s not being recognised here - there’s no funding, there’s no insurance,” she says.

“There’s very few midwives who are doing it because they are not willing to take the risk and financially it becomes really unviable.

“We need women to have access without having to have huge amounts of money. We need midwives who feel safe because they are insured.

“We need to make sure we set up systems so it’s done in the safest way possible and midwives are supported and women are supported. We need to make it a safe and viable option.”

Professor Gamble says publically-funded home births should be available in every Australian state and territory.

“The professional indemnity insurance products need to cover privately practising midwives providing home births,” she says.

“I think we need to provide women with genuine, well-supported options and hope women understand the important factors to consider in making the decisions that are theirs to make.”

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Karen Keast

Karen Keast is a freelance health journalist who writes news and feature articles for HealthTimes.

Karen regularly writes for some of Australia’s leading health news websites and magazines.  In a media career spanning 20 years, Karen has worked as a senior journalist in newspapers and television. She has covered the grind of daily news and worked as a politics reporter at countless state and federal elections.

Since venturing into freelance writing five years ago, Karen has found her niche in writing about the health sector for editors, businesses and corporations.

Karen has interviewed the heads of peak health organisations in Australia and overseas, and written hundreds of news and feature articles covering the dedicated work of health professionals who tread the corridors of hospitals and health services, universities, aged care facilities and practices, day in and day out.

Follow Karen Keast on Twitter @stylemywords