What is homebirth?
Homebirth is giving birth to your baby in the comfort and privacy of your own home under the care of a Privately Practising Midwife (PPM). Homebirth is often misunderstood and confused with ‘freebirth’, which is when a woman gives birth at home without any qualified or registered health professional present.
Some hospitals have Publicly Funded Homebirth programs attached to their caseload service, which means that women will go to the hospital for their antenatal appointments and be under the care of a small team of hospital-based midwives, which offers continuity of care. These services are rare and like all continuity models, are in very high demand so book out quickly.
What is a Privately Practising Midwife?
A Privately Practising Midwife (PPM), is an registered midwife who has an endorsement on their registration from the Nursing and Midwifery Board of Australia (NMBA). This endorsement allows them to prescribe medicines, order diagnostics (including ultrasounds, blood tests and pregnancy screenings)and access the PBS and Medicare.
A PPM provides pregnancy, birth and postnatal care in collaboration with a woman’s medical team, which can include GPs and Obstetricians. They often conduct their antenatal appointments in their private clinic or in the woman’s home. They can also accompany women to the hospital for specialist appointments, if the woman desires.
Privately Practising Midwive’s scope of practice
PPMs must undergo the same training as any midwife who works in a hospital setting. To set up a private practice, midwives must have spent at least 5000 hours working in a hospital environment (within 6 years) and complete an approved postgraduate prescribing course. PPMs must also complete 30 hours per year of additional professional development training.
All PPMs are required by their regulatory body, the NMBA, to work within specified guidelines and will seek input from a medical practitioner or local health network if complications arise at any time for advice on the management of pregnancy or birth. It is a requirement that two PPMs be present during birth.
PPMs carry an extensive range of medical equipment to homebirths, including resuscitation equipment, IV cannulation and fluids, suturing, urinary catheterisation, blood sugar measurement, blood collection, as well as equipment for assisted births. They also carry medication necessary for treating postpartum haemorrhage (PPH). PPMs undergo regular auditing of their practice by the NMBA.
Can GPs refer to a Privately Practising Midwife?
A GP is well-positioned to discuss all birth and care provider options with their clients. When a woman presents to a GP to confirm their pregnancy and discuss birth options, homebirth can be suggested as an alternative to hospital birth if there are PPMs available to offer care, or a publicly funded homebirth service in their area.
Women do not need a referral to birth at home; however they will seek one if they wish to claim Medicare rebates for antenatal and postnatal care (Medicare does not currently cover intrapartum care at home).
Referral to a PPM should be treated like a referral to any other qualified specialist.
Why do women choose Homebirth?
The World Health Organization recommends midwife-led continuity of care as a health system intervention to improve the utilisation and quality of antenatal care. Women and their families are becoming increasingly aware of the benefits to themselves and their children of receiving their pregnancy and birth care with a known midwife.
Some of the reasons women choose to birth at home include:
Some women choose to have their antenatal and postnatal care with a PPM but choose to birth in hospital. In most cases, their PPM can attend the birth with them.
Is Homebirth suitable for everyone?
Women have the right to choose the maternity model of care best for their needs. Even if the woman has risk factors, she still has the right to decide where and with whom she will give birth.
Women who choose homebirth are generally very well informed about the psychological process of birth and alternative pain relief methods such as water immersion.
PPMs conduct risk assessments with their clients to determine their suitability to give birth at home. Factors such as pregnancy complications and distance from the hospital may play a part in deciding whether homebirth is a recommended option.
How do you find a Privately Practising Midwife?
A directory of PPMs who attend home births in Australia can be found here.
PPMs usually book out quickly due to the high demand for their services, either at home or in the hospital. It is recommended that women planning a homebirth begin considering their options during the preconception period if possible, to increase their likelihood of finding a PPM available in their area if they choose that model of care for their pregnancy and birth.
It is not uncommon for women to be able to secure the services of a PPM later in their pregnancy. Still, considering that most of the benefits of homebirth are closely linked to the establishment of a trusting relationship between the woman and their PPM, the earlier in their pregnancy they can book, the better.
Antenatal care
During pregnancy, check ups are regularly given during antenatal appointments. The schedule for appointments is similar to standard hospital care, increasing in frequency towards the end. The appointment location is usually within a PPM’s clinic or in a woman's home. PPMs can check blood pressure, order diagnostics and refer to the GP for medical care or hospital for specialised pregnancy care. The best outcomes for women come when health professionals work collaboratively to support the birthing woman.
Antenatal appointments with a PPM are typically much longer than those with care providers in the hospital setting (usually at least an hour), allowing more time for the woman to develop a trusting relationship with their PPM.
A woman may develop a complication during pregnancy, meaning that birthing at home is no longer recommended. The midwife providing care is the best person to assess and monitor suitability for homebirth and make recommendations.
It is recommended that women are 'booked in' to their local hospital so there is a record of their pregnancy, medical history and they are prepared to receive the woman safely at any point during pregnancy, labour or postpartum.
Intrapartum care
Most women planning a homebirth will be in regular contact with their midwife throughout their pregnancy, particularly at the onset of labour. The PPM will come to the woman’s home when called and will remain there throughout the labour until a few hours after the birth, once the baby and mother have been checked and breastfeeding has been established.
A PPM will regularly assess mother and baby's well-being throughout labour using a doppler, observation, blood pressure and temperature monitoring, and vaginal exams where indicated. Medical pain relief is not available for women having a homebirth, so alternative methods such as water immersion and acupressure are typically used.
When birth is near, a second midwife is called to attend for additional support (as per NMBA requirements).
A PPM is qualified to grade perineal tearing and suture at home. For significant tears, such as third degree tears, the PPM would recommend hospital transfer. . A PPM can also perform an episiotomy at home if required and carries the medications and equipment necessary to treat PPH and to resuscitate mother and/or baby if required.
Transfer to hospital during labour
During a woman’s pregnancy, they will discuss a transfer plan with their PPM if labour is not progressing as expected or the woman decides she would rather give birth in hospital.
Decisions around transfer are risk-averse and consider the distance and time needed for safe transfer. In the unlikely event of an emergency situation, an ambulance will be called.
If transfer to the hospital is required, the PPM will attend with the woman to provide a verbal handover to hospital staff. Progress notes and history of care will also be transferred with the woman. Under normal circumstances, hospital staff will then lead care with the midwife present for support. However, some PPMs do have collaborative agreements with obstetricians which allows them to provide care in that setting.
Postnatal care
PPMs will conduct daily visits with their clients for the first week after birth, usually followed by weekly visits up until discharge around 6 weeks. The midwife will assess the newborn's health, provide vitamin K, and assist with breastfeeding. The midwife completes the newborn heel prick (blood spot) screening at home.
The number of visits is determined by the needs of the woman and baby. Women can contact their midwife at any time for support or advice.
How much does a PPM cost?
The cost of a homebirth supported by a PPM, including pregnancy and postpartum care, ranges from $5000 to-$8000. A Medicare rebate is available for a portion of the antenatal and postnatal appointments. It is recommended that women discuss directly with each midwife what payment options they accept. A small number of private health insurers rebate the cost of a homebirth.
Homebirth is giving birth to your baby in the comfort and privacy of your own home under the care of a Privately Practising Midwife (PPM). Homebirth is often misunderstood and confused with ‘freebirth’, which is when a woman gives birth at home without any qualified or registered health professional present.
Some hospitals have Publicly Funded Homebirth programs attached to their caseload service, which means that women will go to the hospital for their antenatal appointments and be under the care of a small team of hospital-based midwives, which offers continuity of care. These services are rare and like all continuity models, are in very high demand so book out quickly.
What is a Privately Practising Midwife?
A Privately Practising Midwife (PPM), is an registered midwife who has an endorsement on their registration from the Nursing and Midwifery Board of Australia (NMBA). This endorsement allows them to prescribe medicines, order diagnostics (including ultrasounds, blood tests and pregnancy screenings)and access the PBS and Medicare.
A PPM provides pregnancy, birth and postnatal care in collaboration with a woman’s medical team, which can include GPs and Obstetricians. They often conduct their antenatal appointments in their private clinic or in the woman’s home. They can also accompany women to the hospital for specialist appointments, if the woman desires.
Privately Practising Midwive’s scope of practice
PPMs must undergo the same training as any midwife who works in a hospital setting. To set up a private practice, midwives must have spent at least 5000 hours working in a hospital environment (within 6 years) and complete an approved postgraduate prescribing course. PPMs must also complete 30 hours per year of additional professional development training.
All PPMs are required by their regulatory body, the NMBA, to work within specified guidelines and will seek input from a medical practitioner or local health network if complications arise at any time for advice on the management of pregnancy or birth. It is a requirement that two PPMs be present during birth.
PPMs carry an extensive range of medical equipment to homebirths, including resuscitation equipment, IV cannulation and fluids, suturing, urinary catheterisation, blood sugar measurement, blood collection, as well as equipment for assisted births. They also carry medication necessary for treating postpartum haemorrhage (PPH). PPMs undergo regular auditing of their practice by the NMBA.
Can GPs refer to a Privately Practising Midwife?
A GP is well-positioned to discuss all birth and care provider options with their clients. When a woman presents to a GP to confirm their pregnancy and discuss birth options, homebirth can be suggested as an alternative to hospital birth if there are PPMs available to offer care, or a publicly funded homebirth service in their area.
Women do not need a referral to birth at home; however they will seek one if they wish to claim Medicare rebates for antenatal and postnatal care (Medicare does not currently cover intrapartum care at home).
Referral to a PPM should be treated like a referral to any other qualified specialist.
Why do women choose Homebirth?
The World Health Organization recommends midwife-led continuity of care as a health system intervention to improve the utilisation and quality of antenatal care. Women and their families are becoming increasingly aware of the benefits to themselves and their children of receiving their pregnancy and birth care with a known midwife.
Some of the reasons women choose to birth at home include:
- Personalised, continuous care from a midwife throughout pregnancy, birth and postnatally
- Care in the comfort of their own home
- Birth in comfortable, familiar surroundings
- Previous traumatic birth experience in hospital
- A desire for no unnecessary medical interventions and drugs
- Ability to choose who is present at your birth (including existing children)
- Freedom to choose birth positions including water birth
- Improved breastfeeding success rates
- Ability to practice cultural/spiritual birth rituals as desired
- Much higher vaginal birth after caesarean (VBAC) rates
- Reduced exposure to COVID-19 by avoiding the hospital environment
Some women choose to have their antenatal and postnatal care with a PPM but choose to birth in hospital. In most cases, their PPM can attend the birth with them.
Is Homebirth suitable for everyone?
Women have the right to choose the maternity model of care best for their needs. Even if the woman has risk factors, she still has the right to decide where and with whom she will give birth.
Women who choose homebirth are generally very well informed about the psychological process of birth and alternative pain relief methods such as water immersion.
PPMs conduct risk assessments with their clients to determine their suitability to give birth at home. Factors such as pregnancy complications and distance from the hospital may play a part in deciding whether homebirth is a recommended option.
How do you find a Privately Practising Midwife?
A directory of PPMs who attend home births in Australia can be found here.
PPMs usually book out quickly due to the high demand for their services, either at home or in the hospital. It is recommended that women planning a homebirth begin considering their options during the preconception period if possible, to increase their likelihood of finding a PPM available in their area if they choose that model of care for their pregnancy and birth.
It is not uncommon for women to be able to secure the services of a PPM later in their pregnancy. Still, considering that most of the benefits of homebirth are closely linked to the establishment of a trusting relationship between the woman and their PPM, the earlier in their pregnancy they can book, the better.
Antenatal care
During pregnancy, check ups are regularly given during antenatal appointments. The schedule for appointments is similar to standard hospital care, increasing in frequency towards the end. The appointment location is usually within a PPM’s clinic or in a woman's home. PPMs can check blood pressure, order diagnostics and refer to the GP for medical care or hospital for specialised pregnancy care. The best outcomes for women come when health professionals work collaboratively to support the birthing woman.
Antenatal appointments with a PPM are typically much longer than those with care providers in the hospital setting (usually at least an hour), allowing more time for the woman to develop a trusting relationship with their PPM.
A woman may develop a complication during pregnancy, meaning that birthing at home is no longer recommended. The midwife providing care is the best person to assess and monitor suitability for homebirth and make recommendations.
It is recommended that women are 'booked in' to their local hospital so there is a record of their pregnancy, medical history and they are prepared to receive the woman safely at any point during pregnancy, labour or postpartum.
Intrapartum care
Most women planning a homebirth will be in regular contact with their midwife throughout their pregnancy, particularly at the onset of labour. The PPM will come to the woman’s home when called and will remain there throughout the labour until a few hours after the birth, once the baby and mother have been checked and breastfeeding has been established.
A PPM will regularly assess mother and baby's well-being throughout labour using a doppler, observation, blood pressure and temperature monitoring, and vaginal exams where indicated. Medical pain relief is not available for women having a homebirth, so alternative methods such as water immersion and acupressure are typically used.
When birth is near, a second midwife is called to attend for additional support (as per NMBA requirements).
A PPM is qualified to grade perineal tearing and suture at home. For significant tears, such as third degree tears, the PPM would recommend hospital transfer. . A PPM can also perform an episiotomy at home if required and carries the medications and equipment necessary to treat PPH and to resuscitate mother and/or baby if required.
Transfer to hospital during labour
During a woman’s pregnancy, they will discuss a transfer plan with their PPM if labour is not progressing as expected or the woman decides she would rather give birth in hospital.
Decisions around transfer are risk-averse and consider the distance and time needed for safe transfer. In the unlikely event of an emergency situation, an ambulance will be called.
If transfer to the hospital is required, the PPM will attend with the woman to provide a verbal handover to hospital staff. Progress notes and history of care will also be transferred with the woman. Under normal circumstances, hospital staff will then lead care with the midwife present for support. However, some PPMs do have collaborative agreements with obstetricians which allows them to provide care in that setting.
Postnatal care
PPMs will conduct daily visits with their clients for the first week after birth, usually followed by weekly visits up until discharge around 6 weeks. The midwife will assess the newborn's health, provide vitamin K, and assist with breastfeeding. The midwife completes the newborn heel prick (blood spot) screening at home.
The number of visits is determined by the needs of the woman and baby. Women can contact their midwife at any time for support or advice.
How much does a PPM cost?
The cost of a homebirth supported by a PPM, including pregnancy and postpartum care, ranges from $5000 to-$8000. A Medicare rebate is available for a portion of the antenatal and postnatal appointments. It is recommended that women discuss directly with each midwife what payment options they accept. A small number of private health insurers rebate the cost of a homebirth.
Page last updated 2nd September 2024
