Home births are on the rise in WA but access is limited for people who want one

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2 days ago

Laura Incognito still remembers the feeling of sharing her birth story with her mother's group.
"We went around the circle of these 12 women and a lot of them had traumatic, negative experiences in the hospital system," Ms Incognito recalled.
"Some didn't, some were fine, but as soon as I said that I had a homebirth I just felt a shift in the room to judgement.
She is not alone in receiving that kind of reaction to the decision to give birth at home.
Eliza Huck was confident in her choice to have a home birth with her first child last year after one of her sisters, a doctor, decided to have her fourth child at home, after not great experiences in hospital with her first few births, resulting in emergency caesareans.
"Everywhere, except within my family, I had people saying, 'That's so risky,'" Ms Huck told Jo Trilling on ABC Radio Perth.
But perceptions about the safety of home births are slowly changing and both women are part of a growing number choosing to give birth at home.
Nationally, home births — where people deliver at home under the supervision of a medical professional — are increasing and in some states such as Western Australia, the numbers have more than doubled in the past five years.
There were 477 home births in WA last year, compared to 195 in 2019, according to the WA Department of Health.
Although home birth numbers are increasing, they still only make up a small percentage of births, about 1.5 per cent in WA and about 0.6 per cent in Australia.
Academic and private midwife Clare Davison said this increase was in part triggered during the pandemic, when there were restrictions on who could attend births in hospitals, so more women chose to stay at home.
"There's also rising awareness of the impact of the medicalisation of birth," she said.
"Because most women actually want to have an uncomplicated vaginal birth, with the national caesarean rate of over 35 per cent, many women feel that their chances of this are reduced if they give birth in hospital."
One of the biggest misunderstandings midwives who offer home births say they encounter is that the births are unsafe.
Alison Weatherstone, chief midwife at the Australian College of Midwives (ACM) said an Australian study found planned home births for low-risk pregnancies had comparable safety outcomes to hospital births, including low rates of perinatal mortality.
"Intervention rates are significantly lower [in home births], c-section rates are lower and patient experience, which really matters for women, is better," Ms Weatherstone said.
Nisha Khot, president-elect of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) acknowledges the increased chances of interventions in a hospital setting and says that home-birth programs for low-risk pregnancies are safe.
"The research tells us that things like stillbirth, death of babies after they're born, or mothers having significant complications, are as rare in a home situation as they are in a hospital situation, so there isn't really an increased risk of outcomes from a baby's perspective or the mother's perspective," Dr Khot said.
"The real risk though is needing to transfer into hospital and what the research shows us is that for women who are having their first baby [at home] around 30 per cent, so 30 out of every hundred, will need a transfer into hospital for a variety of different reasons."
But Dr Khot said the majority of those women transferring to hospital would not have life-threatening circumstances.
"They'll be transferred in for other things, like needing an epidural for pain relief. That's not going to make your outcomes worse," she said.
"I think home birth is a very safe option if that is what you want.
"It's all about choice, it's about informed consent and it's about making sure that there are pathways of escalation if required."
Dr Khot points out that the research is based on women who are deemed to have low-risk pregnancies, as policies preclude those who fall into the higher-risk category, which can range from factors like pre-existing medical conditions, complex pregnancies, and maternal age.
RANZCOG does not support those with high-risk pregnancies birthing at home.
Ms Weatherstone also said there was evidence that women who planned a home birth were less likely to experience birth trauma, an issue that has been in the spotlight since a NSW parliamentary inquiry into birth trauma concluded last year, after receiving 4,000 submissions and holding six public hearings.
Among the report's 43 recommendations was ensuring women have access to continuity of care, allowing them to see the same health professional throughout pregnancy and birth.
"One of the biggest factors [in choosing home birth] is that women want continuity of care and a relationship with their caregiver," Dr Davison said.
"They want to trust that care provider and know who's going to be with them during birth and know that that person knows what's important to them."
Both Eliza Huck and Laura Incognito say that having the same person support them throughout pregnancy, labour and postpartum was one of the biggest driving factors in deciding to go down the home birth route.
"We just knew that we were going to be working with someone who would 100 per cent be able to support us throughout our entire journey, and make us feel really safe and comfortable, and we just loved the idea of being able to do everything from the comfort of our home," Ms Incognito said.
Midwives who offer home births will start seeing patients at home from about 10–13 weeks gestation.
This continues regularly throughout the pregnancy, where they bring all equipment needed to the home, as well as being able to prescribe approved medications, order ultrasound scans, or make referrals as required.
The home visits continue for up to six weeks after giving birth.
"I built such a strong relationship with my midwife because there was never any rushing," Ms Huck said.
"My midwife was with us until six weeks postpartum so when I had issues with breast-feeding she lined up a lactation consultant for me."
The ACM estimates a home birth with a private midwife costs about $5,000 in out-of-pocket expenses.
Medicare rebates are available for antenatal and postnatal appointments, but the birth itself is not covered and the ACM is advocating for a Medicare item number for home birth.
There are publicly funded home-birth programs in every state and territory except Tasmania, where public hospitals assign a midwife to assist women in planning and having a home birth, but places are limited.
There are also public hospital Midwifery Group Practice (MGP) programs, in which women deliver in hospital but are supported by the same midwife throughout pregnancy and birth.
They are free to access, but availability is also limited.
"While AIHW [the Australian Institute of Health and Welfare] tells us that 42 per cent of maternity services in Australia have an MGP or equivalent model, only 8–15 per cent of women birthing in Australia can access these models of care," Ms Weatherstone said.
Dr Khot agrees with calls to make continuity of care more accessible, whether that be in a midwife or obstetric model and says more funding is needed, as well as boosting the workforce.
"Absolutely continuity of care is the key to it. There are free continuity-of-care models, which are hospital-based, but they often exclude women who have risk factors, which I think leaves women who have any risk factors with not a lot of choices.
"So I think if we are going to support women we need to have an all-risk model for continuity of care for hospitals, as well as for midwifery and medical continuity of care."
Ms Weatherstone said the increased demand for home births in Australia meant government support should be extended.
"There definitely needs to be an expansion of publicly funded home birth and also access to privately practising midwives in Australia to meet this demand," she said
Dr Davison said she believed that if home birth was accessible to more people, the numbers would be higher.
She said her phone runs so hot with people enquiring about home-birth services, that she seldom answers calls.
"The demand is huge compared to the number of midwives providing home-birth services," she said.
"Most women can't access a private midwife or don't have the money to pay for it.
"What happens to us during birth impacts that early postnatal period and that mothering period.
"If you start that journey feeling empowered, then it's going to go on into your parenting and your life."