COVID-19 has impacted almost every aspect of our lives, and giving birth has been no different. Lockdowns and health protocols have meant restrictions on the number of people visiting hospitals, including being present during a birth.

According to Liz Wilkes, Managing Director of private midwifery practice, My Midwives, these restrictions have resulted in an increase in home births.

“There are lots of restrictions and many women are choosing home birth to try to avoid the restrictions placed on visitors and what you can and cannot do in labour,” Ms Wilkes says.

“We have also seen many women wanting to have more control as a result of COVID, potentially because their lives have been impacted in so many ways, and they are trying to gain some control back. 

“This has led to our numbers increasing quite a lot.”

But home birth doesn’t come without controversy. Ms Wilkes believes that’s due to a lack of understanding more than anything else.

So, to clear things up, we asked Ms Wilkes some of the most frequently asked questions about home birth.

What is the percentage of home births compared with hospital births?

Generally, in the community home births are a tiny percentage – less than 1 per cent of births in Australia. 

Home births are controversial - should they be?

They absolutely should not be controversial in the right circumstances.  Women should have the right to choose where they have their baby, and as long as there are plans for any unexpected consequences – then it should not be controversial.

What are the misconceptions about home birth?

I think that there is a thought that it is risky.  Most of the situations you encounter in birth, you can see the problem before you actually get to the end – so there is time to make decisions about it. 

Where women have a very unexpected situation – a baby not breathing, or the woman is bleeding or something similar – midwives at home birth are trained and have equipment to deal with it until an ambulance arrives. 

The other thing that women often say is “isn’t it messy” and I laugh at that – birth is not messy!  Everything is very well contained in most instances – so it is a very easy clean-up process.

What advice do you give clients, asking your advice about home and hospital birth?

Birth is a very personal thing – there are lots of things that you need to consider, and my advice generally is to choose a practitioner that you want to work with and then make your place of birth choice later in pregnancy – when you know how things are going.

It is important to really interview your midwife/doctor and make sure their views and your views align.  Then if things are going really well and you want to have a home birth you know that you will be in good hands and can really trust your care provider.

Are there any circumstances where home birth is not recommended?

Yes, there are reasons why a home birth is not recommended.  Where a woman has complexities in their medical history that means they are more likely to have a complication such as bleeding, then home birth is not a good idea. 

Other things like multiple pregnancies, baby not in a head down position and previous birth complications also mean that home birth would not be recommended. 

It is a case by case discussion and there are a range of guidelines to refer to, along with seeking additional input around risk factors if that is needed.

What happens with follow up care after a home birth?

We see women at least once a day for a week after birth – regardless of where that birth is, then again on about Day 10, and then weekly. 

All the various documentations and referrals are followed up exactly the same way, regardless of home or hospital. 

Where any complexities have arisen, we may liaise with other practitioners and, of course, things like suturing and so forth are dealt with by the midwives in the home.

If a client has chosen a home birth, should they keep an open mind in case circumstances change?

Definitely!  This is one of the key things!  Things change – even during the birth – and it is important that there is a partnership in decision making between the client and the midwife to make sure both are flexible to make a change.

Would you ever refuse a home birth?

Yes – but I hope it would not come to us refusing a home birth.  It is better that the decision is made between the client, the partner, and the midwife/midwives that hospital is a better choice. 

Sometimes hospital is a better choice, and sometimes not.  So, it is really important that the reasons the midwife would want to transfer the location are discussed, and that everyone understands that at times the situation might change.

What are the pros/cons of hospital, home, and other birth places?

Birth is a very, very personal event.  For all women it is important that they birth in the circumstances and place where they feel most safe.  This could range from hospital to home to an operating theatre!  So, it is the job of the midwife involved to unpack all of this and help the woman make the best decision possible for them.

Pros of home
Your space, you can do what you like, eat your own food, have whoever you want there, possibly less pressure and timelines, it’s calm, hormones tend to flow better, you don’t have to move in labour, don’t have to worry about other kids, epidural and other drugs are not there so it’s less likely you’ll use them, better outcomes than hospital birth, no policies to follow (except what midwives recommend and then it is a mutual conversation about what is recommended).

Cons of home
If there is a problem you need to escalate quickly, you need to rely on the skills of the practitioner you have chosen, there are no other practitioners to come and help easily so you need to make sure you have the right person available, if something goes wrong you may have less ability to get quick assistance, if both partners are not on same page it can cause conflict.

Pros of hospital
Lots of staff available, can change track for different types of pain relief easily, you can deal with most emergencies, all types of birth and risks can be accommodated for.

Cons of hospital
Not private, lots of people, medicalised, can make it easier to accept pain relief because it’s easily available, worse outcomes on pretty much all measures for mother and baby.

Do midwives have a location preference?

Midwives are like women – we all feel differently.  Most midwives who have been involved in home birth like it a lot, but some don’t.  It is a personal thing.  Home birth is a beautiful experience for many midwives and many women.