​What is Publicly Funded Homebirth?
​
Publicly funded homebirth (PFHB) is a model of maternity care provided & funded by public hospitals. Eligible women are assigned a primary midwife who cares for them throughout pregnancy, birth and post-partum and are supported to plan a homebirth. Midwives generally work in small teams with the other midwives serving as backup. These programs are usually available to women who are at low risk of medical or obstetric complications[1].
PFHB programs have existed in Australia for over 20 years, with the first program established in Western Australia in 1996[2].
 Currently there are at least 18 publicly-funded homebirth programs in Australia with a program available in every state except Tasmania.
  
Pros of Publicly Funded Homebirth in Australia
 
Cost 
PFHB programs are provided by the public hospital system generally at no cost to women, making homebirth potentially accessible to women who could not otherwise afford it. 

Continuity of Care 
Care is provided by one primary midwife (often with a small group of 2-5 back up midwives) throughout the duration of pregnancy, birth and postpartum. Continuity of care with a known midwife is linked to improved outcomes for both mother and baby including:
·      Less likely to experience caesarean section, instrumental birth or an episiotomy
·      Decreased risk of 3rd or 4th degree tears
·      Higher likelihood of spontaneous vaginal birth
·      More positive experiences of the antenatal period and birth reported by women[3] 

Lower intervention Rates
Both women’s stories and current research show concern that birth care in Australia has a current trend of ‘too much, too soon’ without improvement in the outcome for mothers and babies.[4] Compared to hospital births, homebirths are nearly six times more likely to result in normal labour and birth with no difference in stillbirth, baby well-being at 5 minutes or the risk of neonatal death[5] 

Ease of transition to hospital if transfer is required 
Midwives providing care in PFHB programs are employed by public hospitals. In the event that a woman is no longer eligible for homebirth or a transfer to hospital during labour occurs, her midwife can continue to provide care within the hospital and may be met with more cooperation than a Privately Practising Midwife (PPM) would receive.

Cons of Publicly Funded Homebirth in Australia
 
Limited Availability 
Currently only 18 PFHB programs are operating in Australia, the majority of which are in metropolitan areas. Many women will not have access to the very small number of places available on these programs. 

Strict Eligibility Criteria 
PFHB programs are subject to the policies and guidelines of the public hospitals that run them. These include very strict inclusion criteria and a requirement to follow standardised care pathways. If at any stage of pregnancy or birth women develop risk factors, even those that may generally be considered manageable, they are no longer considered eligible to have a homebirth and will be expected to birth in hospital or find alternative care. 
​
Limited Choice of Care Provider 
Women are generally assigned a midwife rather than being able to choose someone they are comfortable and align with.


Current Publicly Funded Homebirth Programs in Australia ​
For a list of currently active PFHB programs please see the PFHB section of our directory here. 

[1] Catling-Paull, C., Foureur, M., Homer, C. (2012). Publicly-funded homebirth models in Australia, Women and Birth, 25, 4, 152-158.
[2] Davis, S., Hoey, W. (2017). Publicly funded homebirth in Western Australia. Women and Birth, 30, 1, 44-45
[3] Sandall J, Fernandez Turienzo C, Devane D, Soltani H, Gillespie P, Gates S, Jones LV, Shennan AH, Rayment-Jones H. Midwife continuity of care models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews 2024, Issue 4. Art. No.: CD004667. DOI: 10.1002/14651858.CD004667.pub6.
 [4] Yu, S., Fiebig, D., Scarf, V., Viney, R., Dahlen, H., Homer, C. (2020) Birth models of care and intervention rates: The impact of birth centres, Health Policy, 124, 12, 1395-1402
[5] Homer CSE, Cheah SL, Rossiter C, et al, Maternal and perinatal outcomes by planned place of birth in Australia 2000 - 2012: a linked population data study. BMJ Open 2019;9:e029192. doi: 10.1136/bmjopen-2019-029192

Page last updated 3rd September 2024