Photo by Sarah Fowler
Homebirth is a safe and valid choice for most Australian women.
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. Freebirth is a form of homebirth, but not all homebirths are freebirths.
Some hospitals have Publicly Funded Homebirth programs attached to their MGP or 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.
Is Homebirth Safe?
There is a wealth of high-quality evidence from around the world and here in Australia supporting the safety of planned, assisted homebirth. This data suggest that homebirth for women with low risk pregnancies is as safe for babies and their mothers as birthing in hospital (1), (2), (3).
These studies found that:
Homebirth = less interventions
A recent Australian study examining outcomes of planned place of birth found that the odds of normal labour and birth (physiological vaginal birth) was over six times as high with women who planned a homebirth compared to women who planned a hospital birth (3).
A meta-analysis of 16 studies providing data on 500,000 planned homebirths reported that among low-risk women, those intending to birth at home experienced fewer birth interventions and untoward maternal outcomes. They found that women who planned to give birth at home (compared to women who planned to give birth in hospital) were less likely to experience interventions such as caesarean section, operative vaginal birth, epidural analgesia, oxytocin augmentation and maternal infection, regardless of whether they actually gave birth at home or in hospital. They were also less likely to suffer a 3rd or 4th degree perineal tear or postpartum haemorrhage (2).
Another Australian study found that if all low-risk women gave birth at home in 2017, cesarean rates would have reduced from 13.4% to 2.7%. This same study concluded that significant health resource savings could occur by shifting low-risk births from hospitals to home birth and birth center services (6).
More than a healthy baby
The emotional and psychological wellbeing of birthing women must be considered when considering your intended place of birth. Continuity of midwifery carer has been linked to:
The latest birth statistics in Australia show that homebirth is the most popular choice for women who have had 1 or more previous children. It can be argued that the high birth trauma rates in hospital (10) have contributed towards this.
The desire for vaginal birth after caesarean (VBAC) in Australia is increasing as women become more educated on the benefits of vaginal birth to mother and baby, and also on the risks of repeat operative deliveries. A 2015 study titled 'Women's Reasons for, and Experiences of, Choosing a Homebirth Following a Caesarean Section' is suggested reading for anyone planning a homebirth after caesarean (HBAC).
There is also some research to suggest that babies born at home have more diverse microbiome than those born in hospital (9).
The ongoing benefits of homebirth
The benefits of homebirth extend beyond the birth itself. Homebirth is strongly associated with improved breastfeeding outcomes (7)
Why do women choose homebirth?
A 2020 survey of women who have planned a homebirth in Australia found that In choosing homebirth, women disclosed that they wanted to avoid specific medical interventions and the medicalised hospital environment. 32% described their previous hospital birthing experiences as traumatic. The majority of women indicated a preference to give birth at home with a registered midwife. However, if a midwife was not available, half of the respondents indicated they would give birth without a registered midwife (freebirth) or find an unregistered birthworker. A further 30% said they would plan a hospital or birth centre birth. (11)
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. Freebirth is a form of homebirth, but not all homebirths are freebirths.
Some hospitals have Publicly Funded Homebirth programs attached to their MGP or 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.
Is Homebirth Safe?
There is a wealth of high-quality evidence from around the world and here in Australia supporting the safety of planned, assisted homebirth. This data suggest that homebirth for women with low risk pregnancies is as safe for babies and their mothers as birthing in hospital (1), (2), (3).
These studies found that:
- In low-risk pregnancies, place of birth had no statistically significant impact on infant mortality (1).
- The lower odds of maternal morbidity and obstetric intervention support the expansion of birth centre and home birth options for women with low-risk pregnancies (1).
- There were significantly lower odds of admission to NICU for babies of women planning a home birth than those of women planning hospital births (1).
- There were no statistically significant differences in the proportion of intrapartum stillbirths, early or late neonatal deaths between the three planned places of birth (3).
- Babies born at home were less likely to require resuscitation at birth and less likely to have meconium aspiration (5)
Homebirth = less interventions
A recent Australian study examining outcomes of planned place of birth found that the odds of normal labour and birth (physiological vaginal birth) was over six times as high with women who planned a homebirth compared to women who planned a hospital birth (3).
A meta-analysis of 16 studies providing data on 500,000 planned homebirths reported that among low-risk women, those intending to birth at home experienced fewer birth interventions and untoward maternal outcomes. They found that women who planned to give birth at home (compared to women who planned to give birth in hospital) were less likely to experience interventions such as caesarean section, operative vaginal birth, epidural analgesia, oxytocin augmentation and maternal infection, regardless of whether they actually gave birth at home or in hospital. They were also less likely to suffer a 3rd or 4th degree perineal tear or postpartum haemorrhage (2).
Another Australian study found that if all low-risk women gave birth at home in 2017, cesarean rates would have reduced from 13.4% to 2.7%. This same study concluded that significant health resource savings could occur by shifting low-risk births from hospitals to home birth and birth center services (6).
More than a healthy baby
The emotional and psychological wellbeing of birthing women must be considered when considering your intended place of birth. Continuity of midwifery carer has been linked to:
- higher overall satisfaction with birth experience (8)
- feeling more in control during labour (8)
- less anxiety around childbirth (8)
- a more positive experience of pain during childbirth (8).
The latest birth statistics in Australia show that homebirth is the most popular choice for women who have had 1 or more previous children. It can be argued that the high birth trauma rates in hospital (10) have contributed towards this.
The desire for vaginal birth after caesarean (VBAC) in Australia is increasing as women become more educated on the benefits of vaginal birth to mother and baby, and also on the risks of repeat operative deliveries. A 2015 study titled 'Women's Reasons for, and Experiences of, Choosing a Homebirth Following a Caesarean Section' is suggested reading for anyone planning a homebirth after caesarean (HBAC).
There is also some research to suggest that babies born at home have more diverse microbiome than those born in hospital (9).
The ongoing benefits of homebirth
The benefits of homebirth extend beyond the birth itself. Homebirth is strongly associated with improved breastfeeding outcomes (7)
Why do women choose homebirth?
A 2020 survey of women who have planned a homebirth in Australia found that In choosing homebirth, women disclosed that they wanted to avoid specific medical interventions and the medicalised hospital environment. 32% described their previous hospital birthing experiences as traumatic. The majority of women indicated a preference to give birth at home with a registered midwife. However, if a midwife was not available, half of the respondents indicated they would give birth without a registered midwife (freebirth) or find an unregistered birthworker. A further 30% said they would plan a hospital or birth centre birth. (11)
Sources:
- Scarf, V. L., Rossiter, C., Vedam, S., Dahlen, H. G., Ellwood, D., Forster, D., ... & Homer, C. S. (2018). Maternal and perinatal outcomes by planned place of birth among women with low-risk pregnancies in high-income countries: a systematic review and meta-analysis. Midwifery, 62, 240-255.
- Reitsma, A., Simioni, J., Brunton, G., Kaufman, K., Hutton, E.K. (2020). Maternal outcomes and birth interventions among women who begin labour intending to give birth at home compared to women of low obstetrical risk who intend to give birth in hospital: A systematic review and meta-analyses
- Homer CSE, Cheah SL, Rossiter C, et al (2019). Maternal and perinatal outcomes by planned place of birth in Australia 2000 – 2012: a linked population data study
- Davies-Tuck, M. L., Wallace, E. M., Davey, M. A., Veitch, V., & Oats, J. (2018). Planned private homebirth in Victoria 2000–2015: a retrospective cohort study of Victorian perinatal data. BMC pregnancy and childbirth, 18(1), 1-8.
- Janssen, P. A., Saxell, L., Page, L. A., Klein, M. C., Liston, R. M., & Lee, S. K. (2009). Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician. Cmaj, 181(6-7), 377-383.
- Callander, EJ, Bull, C, McInnes, R, Toohill, J. The opportunity costs of birth in Australia: Hospital resource savings for a post–COVID-19 era. Birth. 2021; 48: 274– 282. https://doi.org/10.1111/birt.12538
- Quigley, C., Taut, C., Zigman, T., Campbell, H., Zgaga, L. (2016). Association between home birth and breast feeding outcomes: a cross-sectional study in 28 125 mother–infant pairs from Ireland and the UK
- McLachlan, H.L., Forster, D.A., Davey, A., Farrell, T., Flood, M., Shafiei, T., Waldenstrom, U. (2015). The effect of primary midwife-led care on women's experiences of childbirth: results from the COSMOS randomised controlled trial
- Combellick, J.L., Shin, H., Shin, D., Cai, Y., Hagan, H., Lacher, C., Lin, D.L., McCauley, K., Lynch, S.V., Dominiguez-Bello, M.G. (2018. Differences in the fecal microbiota of neonates born at home or in the hospital
- Reed, R., Sharman, R., Inglis, C. (2017). Women's descriptions of childbirth trauma relating to care provider actions and interactions
- Sassine, R., Burns, E., Ormsby, S., Dahlen, H. (2020). Why do women choose homebirth in Australia? A national survey
Page last updated: 7th March 2024
