Homebirth midwives are what are known as primary care providers. This means they are the principal healthcare professional responsible for providing healthcare to women and their babies during pregnancy, birth and following birth.
Homebirth midwives can work independently or with other midwives as part of a group in a shared practice. This is generally a more practical arrangement, otherwise they would need to be on call permanently.
What's a midwife?
Midwives are nurses who have qualified for registration with their national governing healthcare and accreditation agency.
Midwives need to have completed a recognised course of training and formal study to then qualify as a registered midwife. It is important to understand that there are differences between midwives and birth attendants. Midwives have done a prescribed level of professional, formal training, usually as a registered nurse first and then by completing an additional midwifery qualification. Alternately they may have qualified through a direct entry midwifery course.
Midwives are very well trained healthcare professionals and governed by law to practice in an ethical, legal and consistently professional manner.
What's a homebirth midwife?
Homebirth midwives work either independently or in liaison with a hospital or community midwifery programme. They aim to meet the mother very early in her pregnancy, which enables them both to build a rapport and mutually respectful relationship.
Homebirth midwives share many of the same philosophies as any other qualified midwife to reduce anxiety around pregnancy and birth and to support mothers in giving birth in the most natural and non-invasive way possible.
Having an inherent belief in a woman's ability to give birth without undue intervention is what drives the homebirth midwives' passion. They also aim to ensure the mother and baby's safety at all times, and to know their own clinical practice limitations and when to refer for obstetric support.
Why would anyone want a homebirth?
Every woman and her pregnancy are unique. Her expectations around her baby's birth and the experience she would like to have are so individual that there is no one size fits all answer.
But there is a consistent pattern to why many mothers seek homebirth:
Avoiding unnecessary medical intervention. There is a higher rate of surgical intervention such as artificial rupture of the membranes, Syntocinon drip, forceps delivery and/or vacuum extraction, episiotomy and/or caesarean section delivery in hospitals.
A previous birthing experience that was disappointing. Homebirth can provide an opportunity for mothers to heal emotionally.
Birthing mothers may feel more in control of their body, their labour and birth
To be comfortable in their own home, which is more familiar than a hospital environment. Many women who choose to birth at home feel their labour and birth is more relaxed and calm than if they were in hospital.
Is a homebirth safe?
There have been many studies examining this very question. In 2009 the British Journal of Obstetrics and Gynaecology reported on a study, which had examined more than 500,000 low risk planned home and hospital births.
The study concluded that:
A homebirth does not increase the risks of perinatal mortality and severe perinatal 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.
It is vital that pregnant women and their partners make their own well-researched and informed decisions around what is right for them. Ask lots of questions, be an active participant in your own healthcare and, importantly, an advocate for yourself and your baby.
If a couple is planning a homebirth they should be informed of the risks. Evidence shows that approximately 12-43% of those identified as low risk in pregnancy will develop a complication necessitating transfer to care in a conventional birth centre. They should also be informed that although the absolute risk may be low, planned homebirth is associated with a two to threefold increased risk of neonatal death when compared to planned hospital birth.
A general framework of regular ante-natal visits occurs:
During pregnancy every month until 30 weeks of gestation. Depending on the individual midwife’s practice arrangements, this may happen at her rooms or in the mother’s home.
From 30 weeks until 36 weeks – fortnightly visits
From 36 weeks onwards – every week until the baby is born
If necessary, visits can be arranged more frequently.
Some midwives offer classes on birthing, relaxation techniques, active birthing and visualisation techniques. They may give out printed information or educational material, which helps expectant parents to boost their understanding of pregnancy and birth.
The midwife is called by the woman or her partner and advised that labour has started. There is usually decided, by mutual agreement, when the midwife will come to the family's home. This may be during the very early stages of labour but is generally when labour has started. The midwife will stay for the birth of the baby and delivery of the placenta. Once the midwife is satisfied that both the mother and the baby are stable, and she has had the opportunity to observe how they both are, she leaves. Homebirth midwives leave contact information in case of any problems.
In the case of transfer to hospital, the midwife accompanies the mother and will stay with her unless otherwise arranged.
Generally, once or twice a day for the first 3 days and then every second day until 10 days after birth. Postnatal check-ups are often done at 2 and 4 weeks after the birth. A final postnatal check is done at 6 weeks after the birth.
Most homebirth midwives provide a 24/7 telephone support service. If they are not available they will arrange locum support. In the event of an obstetric or medical emergency, pregnant women are always advised to go straight to their local maternity ward or hospital.
What does a homebirth midwife bring to the birth?
Her expertise, clinical judgement, training and sensitivity
All the necessary and legal paperwork including birth registration forms
A birthing pack, which includes a cord clamp, sterile scissors and gloves, swabs and cotton wool
A Doppler, Pinard or stethoscope for listening to the baby’s heartbeat
A sphygmomanometer for reading the mother’s blood pressure
Oxygen and suction equipment
Emergency resuscitation equipment
Ecbolic medications – such as Syntocinon and syntometrine, which assist with making the womb contract
Intravenous drip equipment
Syringes, tourniquet, and equipment to collect blood
Emergency contact information
Some will also provide a birthing pool, which needs to be prepared ahead of time
This varies according to the individual midwifes' rates for service. Some midwives are registered, but others are not. Pregnant women that engage the services of a homebirth midwife have a right to a transparent and honest explanation of costs. Some medical aids may provide a rebate for employing a homebirth midwife, but it is best not to assume you are covered and seek specific information from them.