What is it?
A Homebirth is usually defined as being attended by a qualified midwife. in Australia that means having been to university, are usually also a qualified nurse and have worked in a hospital setting for many years before attending homebirths. A Freebirth is the intention to give birth without any medically qualified professional. Some women choose to do this alone or just with their partner. Others with a Doula or Birthkeeper. A Doula is not medically trained and is there for the emotional support. All the decisions are then made by the mother and her responsibility. Is it legal? Yes. In Australia, women have the legal right to birth wherever they like and with whomever they choose, or don’t choose. There is NO legal requirement to have a medical professional in attendance. However laws in WA, SA and pending in QLD where fines may apply to anyone attending and misrepresenting themselves medically. Yes it is legal for a Doula to attend or your friend to attend but if they are to claim they can manage any medical emergency when that is not their job, fines may apply to them. This is why it is essential to know your Doulas role, and contracts include what we are able and unable to do. Doulas do not check babies heart rate or monitor bleeding etc. Why do women choose Freebirth? Statistically safer- while some small studies on freebirth are happening, there are no large studies on the safety on birth with no attendance. However, when looking at attended homebirth for low-risk women planning a homebirth vs their same counterparts planning a hospital birth- Homebirthing women have lower intervention rates, lower cases of haemorrhage, lower rates of epidurals or medical pain relief, lower caesarean rates, higher rates of breastfeeding, and NO CHANGE in the rates of still birth. Countries who have high homebirth rates also have a lower overall caesarean rate.“But you can’t have a caesarean at home so of course those number are low!” I hear you cry- these statistics are based on and include those women who transfer care to hospital both during pregnancy and labour for the caesarean but starts with the base line of planning to be at home. Those that do transfer from home to hospital are low and most commonly are non emergency situations- the most common being mum has requested pain relief or dehydration. In this case, the family can drive themselves into hospital. Lack of access- so when we look at these studies a lot of women will decided to go down the route of an attended homebirth with a midwife. In Perth we have a publicly funded homebirth program known as the CMP, or a private midwife can be hired. CMP is free but comes with restrictions including location. Some of these restrictions are NOT based on individual medical assessment or with low/ questionable supporting evidence. Women “risk out” sometimes at the very end of their pregnancy but would still qualify to birth with private midwife (that are then fully booked making transferring care unavailable). CMP staff have been removed from homebirth to attend hospital births(sometimes while the women is in labour after 9 months of planned homebirth care). The alternative is a private midwife who can attend “higher risk” homebirths like VBAC, but come at an out of pocket cost between $4-$6,000 after a small Medicare rebate of $1-2,000. Financial cost is another factor as many can’t afford this. Most GPs do not discuss these options with women and they are often booked out before women have exited their 1st trimester, which is usually the time women start to look at their birthing location options. While we are VERY lucky to have a publicly funded option, it is flawed and in need of more support. Trauma- around 1 in 3 women describe their birth experience as traumatic. A reported 60% of this is not from the physical experience but how they are treated or spoken to, including coercion into decisions or without proper information for informed consent. Many hospitals policy around birth isn’t backed by evidence or latest research. It takes an average of 17years from research to policy changes. Birth Trauma becomes a contributing factor in post partum depression and PTSD. Women are leaving birth experiences with the same mental health conditions as people in war zones. One of the highest reasons for maternal death in the 1st year postpartum is suicide. WA currently has the highest caesarean rate In Australia, sitting at just under 38%. World Health Organisation recommends a 15% rate. It is estimated under 5% of women in Australia are having a “physiological’ birth which is meaning no medical interference, yet a very large portion are wanting to birth this way. If ALL of this medical intervention was truly needed, we would have become extinct by now due to our lack of ability to reproduce. Studies show more often than not, these interventions truly aren’t required and are more reflective of our legal system/ fear of being sued, than our bodies. Restrictions and covid- lockdowns and restrictions have seen birth partners limited to 1 person. Cutting out family, friends, siblings, photographers and doulas. Dads/ partners have also been required to leave within hours of the birth. This has all been in place despite borders being open, football games taking place and other restrictions lifted. It has added to trauma rates. Women have also wanted to avoid being in the same building as sick people and exposing themselves to covid. The demand for homebirth in the past 2 years has more than doubled further reducing access. Having adequate support in labour not only eases the workload for struggling and understaffed midwives in a hospital setting but reduces intervention rates, yet the request to ease restrictions in the maternity system have been gaslit, ignored or buck passed by hospitals, health department and politicians. Previous fast labours or accidental unassisted births- Those with a history of accidental unassisted sometimes go on to plan an unassisted birth. Victoria once had a higher rate of babies born accidently at home/ on route (including in car and side of the road etc) than it had planned homebirths- 0.4% unplanned vs 0.3% of total births planned. Confidence in their birthing body- sometimes its more simple. They want to freebirth. That appeals to them. They trust their bodies to do what it is designed to do. There are no obstacles and it is choice number 1. Women have only birthed in hospitals for just over 100 years. The history of birthing shows this move to hospital was directed by wealth. Queens started to go to hospital or have doctors present for pain medication so those that could, wanted to follow the trend. Just like some people running out to purchase the latest product a celebrity is wearing. Study after study shows the less we interfere with a birthing body, the better the outcomes for the majority of women (in developed countries where health/ malnutrition isn’t a factor). Both Homebirth and Freebirth come with a “back up plan” for how to access medical care in a hospital or via ambulance. Even in a hospital setting, nothing is ever 100% safe. But we simply don’t see those stories being broadcast in the same way that homebirth is. Women who freebirth often explore their own views on death and negative outcomes and take responsibility for those outcomes. Freebirth and homebirth are not for everyone. Some people will never want to do this, and that is fine. Every family needs to make a choice that suits their emotional and physical needs the most. Weather that is a scheduled caesarean, birth centre or a freebirth. But pointing fingers, judgment and ignoring the gaps that currently face birthing women does not help anyone. Adding options and support will only benefit. If you can, I encourage you to show your support for all women by signing petitions or contacting your local politicians showing support for adding more birthing options. If you have come to this article simply to understand women’s choices, I say a big thank you for taking the time to understand someone else’s journey. What we all need in our vulnerable birthing times is a little understanding and less judgment on the road less travelled. Further Reading: https://www.bellybelly.com.au/birth/homebirth-myths-about-homebirth-debunked/ https://www.homebirthaustralia.org/media.html
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October 2023
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