Home-birth boost for expectant mothers

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VICTORIAN women will be able to give birth at home - with hospital back-up for the first time - under a pilot project starting at three hospitals next year.

This is not auite accurate as home birth women have always had hospital back-up. Midwives advise women to book into hospital so that the hospital can be available in the event that obstetric consultation or hospital transfer, tests or ultrasounds are needed.

... midwives employed in the one-year projects would be covered by their hospital's insurance ... women participating would have a midwife care for them throughout their pregnancy, with several back-up midwives available if their primary carer was sick or unavailable when they went into labour.

I'm puzzled by the fact that this project is only going for one year. Pregnancy lasts for 9 months and postnatal care is provided for a further 2 - 6 weeks. Considering that home birth transfer rates vary between 10% and 50%, just how many women are going to successfully brith through this program, and if the numbers are very low, will the criticism be along the lines of, "... although the results of this pilot study are promising, the numbers were too low to draw reliable conclusions about the safety of home birth"?

... The announcement is a boon for women in favour of home births, who up until now have had to pay between $1800 and $6000 for their own private midwives without organised access to hospitals if something went wrong.

Yes, it is a plus for women who will now be able to access home birth under State funding.

''The new pilot programs will give Victorian families greater choice in maternity care and provide women with greater control of their birthing experience,'' Mr Andrews said.

I disagree with this statement as Victorian women have always had access to home birth, through private midwives. What is changing is that home birth will now be available free to women who meet the criteria for publicly-funded home birth.

... Professor Euan Wallace, director of obstetrics at Southern Health ... said it was an excellent initiative that would probably appeal to women who had previously had uncomplicated births.

Actually, home birth appeals to women who have previously had a traumatic experience in hospitals that they do not wish to repeat, women who seek greater choice and control over their birth experience and women who are clased as high risk, and prefer to avoid the recommended interventions or advised surgery. These women will not be catered for on this program.

He said women and private midwives planning home births had complained about a lack of support from hospitals if something went wrong and hospitals had also been unhappy about last-minute referrals for care.

''If there's any problems during labour for women participating in the pilot, they can be brought into the hospital where they will be looked after by their midwives and hospital staff. Everything will be seamless. It's fantastic,'' he said.

I don't know about "fantastic" as cultural issues are always involved when birth centre or hospital-employed home birth midwives attend their clients in the delivery suite: those midwives do not work in the delivery suite ordinarily, their practices are often questioned by core delivery staff and some women are judged for having chosen home birth in the first place. It's not always rosey, however it is a step in the right direction to have the midwife be able to care for her client in the event of hospital transfer.

Professor Wallace said about 200 Victorian women had their babies at home each year - 0.3 per cent of all births in the state.

''Our expectation is that that number will go up as we make a high-quality home-birth service available that reports on all its outcomes in a transparent manner,'' he said. Mr Andrews said he hoped the pilots would attract privately practising midwives into the public system where there is a shortage, and that about 50 women would participate in each hospital's program next year.

Patrice Hickey, midwifery group practice mentor at Sunshine Hospital and Victorian president of the Australian College of Midwives, said midwives were thrilled about the pilot, which would make home birth a mainstream choice for women who wanted it and met the criteria for it.

... ''A lot of women don't want to have home births in an isolated fashion, but are more than happy to do it in a collaborative, seamless service for women like this.''

Melissa Maimann, Essential Birth Consulting 0400 418 448