Right: A group of demonstrators at a recent Canberra pro-home birth rally
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Background information
A home birth in developed countries usually takes place in a residence and not in a clinical setting such as a hospital or birth centre. Natural childbirth methods are normally used and the birth is usually attended by a midwife or lay attendant with expertise in managing home births.
Women with access to high-quality medical care may choose home birth because they prefer the intimacy of a home and family-centred experience or desire to avoid the medically-centred experience typical of a hospital or clinical setting. Professionals attending home births can be obstetricians, certified midwives or doulas.
Home birth was, until the advent of modern medicine, the only method of delivery. In developing countries, where women may not be able to afford medical care or it may not be accessible to them, a home birth may be the only option available, and the woman may or may not be assisted by a professional attendant of any kind.
The evidence regarding safety is difficult to interpret. The United Kingdom National Institute for Health and Clinical Excellence reports that mortality in labour or childbirth for booked home births, regardless of their eventual place of birth, is the same as, or higher than for birth booked in obstetric units. The American College of Obstetricians and Gynaecologists advises that 'although the absolute risk may be low, planned home birth is associated with a twofold to threefold increased risk of neonatal death when compared with planned hospital birth.'
A prior caesarean delivery significantly increases the risk of uterine rupture and other dangerous complications and women wishing to attempt a vaginal birth after caesarean are advised do so only in a hospital with ready access to emergency care. Due to a greater risk of peri natal death, the American College of Obstetricians and Gynaecologists advises women who are post term (greater than 42 weeks gestation), carrying twins, or have a breech presentation not to attempt home birth.
A large 2009 study reported that, in the Netherlands, planned home birth led by a midwife at onset of labour 'does not increase the risks of peri natal mortality and severe peri natal morbidity among low-risk women, provided the maternity care system facilitates this choice through the availability of well-trained midwives and through a good transportation and referral system.'
International trends regarding home birth
In many developed countries, home birth declined rapidly over the 20th century. In the United States home birth declined from 50% in 1938 to fewer than 1% in 1955; in the United Kingdom a similar but slower trend happened with approximately 80% of births occurring at home in the 1920s and only 1% in 1991. In Japan the change in birth location happened much later, but much faster: home birth was at 95% in 1950, but only 1.2% in 1975.[11]
Midwifery, the practice supporting a natural approach to birth, showed a revival in the United States during the 1970s. However, although there was a steep increase in midwife-attended births between 1975 to 2002 (from less than 1.0% to 8.1%), most of these births occurred in the hospital and the United States rate of out-of-hospital birth has remained steady at 1% of all births since 1989 with 27.3% of these in a free-standing birth centre and 65.4% in a residence. Hence, the actual rate of home birth in the United States has remained remarkably low (0.65%) over the past twenty years.[13]
Home birth in the United Kingdom has also received some media attention over the past few years as there has been a movement, notably in Wales, to increase home birth rates to 10% by 2007. Between 2005 to 2006, there was an increase of 16% of home birth rates in Wales, but the total home Welsh birth rate is still 3% (double the national rate) and in some other counties of Great Britain the home birth rate under 1%.
In the Netherlands, in 1965, two-thirds of Dutch births took place at home, but currently that figure has dropped to less than a third, about 30%
In Australia, birth at home has fallen steadily over the years and is currently 0.3%, ranging from nearly 1% in the Northern Territory to 0.1% in Queensland. The New Zealand rate for births at home is nearly three times Australia's with a rate of 2.5% and increasing.
The legal and funding situation in Australia
The 2009 Federal Budget provided additional funds to Medicare to allow more midwives to work as private practitioners, allow midwives to prescribe medication under the Medicare Benefits Schedule, and assist them with medical indemnity insurance. However, this plan only covers hospital births. There are no current plans to extend Medicare and PBS funding to home birth services in Australia.
As of July 2010, all health professionals must show proof of liability insurance. Midwives who attend home births will be excluded from the indemnity requirement for two years while the government seeks to make affordable insurance available.