Giving birth at home

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Dr Fiona McLellan
General Practitioner

When a woman presents to her GP with a positive pregnancy test after congratulations, we tend to talk them through the options for their pregnancy in terms of what we can do, investigations we may need and what sort of care the woman might want through their pregnancy. When the woman comes to me and expresses her interest in having a home birth, I would then put a referral into the hospital for her to be considered for that. Then that will get looked at by the obstetric team or a midwife and we’d decide if she’s eligible for a home birth.

For information on how to be referred in your area, check your local hospital and health service website.

How do I know if a Publicly Funded Home Birth (PFHB) is right for me?

Please note:

• The PFHB program follows Queensland Health and Hospital Service guidelines and your local hospital policies.
• The PFHB program places are not guaranteed due to individual and service constraints.
• Please consult with your healthcare team to determine if this program is suitable for you

Sarah Handby
Clinical Midwife

The types of women that would like a home birth are healthy, motivated, they’ve got no complications in their pregnancy. We expect that their babies are going to be born healthy and they’re motivated to have a natural birth.

What are Inclusion/Exclusion Criteria?

Publicly Funded Home Birth is provided under Queensland Health inclusion/exclusion criteria and may differ between health services.

Some common inclusion criteria include:

• Single baby pregnancy.
• Low risk pregnancy.
• Living within your local PFHB hospital's defined catchment area.
• No medical or other reasons that increase your risk level.

You can talk to your midwife/doctor about your individual circumstances and whether the Publicly Funded Home Birth program at your health service is a good fit for you.

Abby Meyer

I want to have a home birth because I’ve been quite influenced by the stories of my friends and family who have had really positive home births. I am involved in the midwifery group practice where I have a midwife that’s been assigned to me that I’ve seen throughout my whole pregnancy and I’ve just had the continuity of care from one midwife the whole time and I don’t need to rely on her and ask her every five seconds you know is this right, she’s given me the power to know what’s happening.

Nicola Hamilton
Clinical Midwife

We would do the usual checks that we do for any pregnant woman, check her blood pressure and that her baby is growing well and do all her bloods as normal, so it would be exactly the same but we would just need to make sure that she was staying in that low risk category. She would need to consider whether she feels safe at home, comfortable at home and if she feels that she won’t be requiring extra pain relief options that aren’t available at home.

For me it’s birthing at home would be the safest place where I have my dog, my family, my partner. In hospital I don’t feel I could really let myself go and that actually might have some implications on my labour.

What does a Publicly Funded Home Birth (PFHB) look like?

Part of a woman’s birth plan, and as the baby’s close to coming, the woman will choose to make the house as comfortable as she would like. So she could have music therapy, she could be in the bath, she could be in the shower. We will accommodate and enable her to birth that baby as she wants to.

The biggest plan that I have in place is to have a water birth. It’s your own journey. You’re in your own home. You’ve got all your comforts. I don’t have to worry about getting back to my dog. I’ve got higher chance of breastfeeding success.

During a home birth, the woman will go into spontaneous labour. Will be triaged over the phone. Once she feels she needs that additional support, the midwife will go to her house and set up and continue to observe her during the birth as we would in the hospital.

We would expect that the mum and baby to stay at home after the birth if everything goes to plan and then we can do all the postnatal care from home after birth as well.

Dr Adeline Foo
Obstetrics and Gynaecology

The role of the obstetrician at the time of home birth would be to provide additional support for women who require additional obstetric care. Midwives will be the primary carer for the women in labour and we all work as a team, but in the hospital, being the obstetrician on call, will be made aware of any concerns that our midwife has for the woman when she’s in labour.

What happens if transfer from home to hospital is recommended?

We have really good relationships with the Queensland Ambulance Service and we have procedures in place to facilitate that as smoothly as possible and in a timely manner.

Tony Hucker
Queensland Ambulance Service

The Queensland Ambulance has been involved. We have seen a group of very professional, dedicated, caring people come together and demonstrate a program that can be put in place. It’s going to take birthing into the community but doing it in a way that’s going to be so safe.

There are some things that may not go to plan in a home birth. For instance, a slow or lack of progress in labour, women wanting additional pain relief options in labour, bleeding issues after delivering a baby.

The emergencies that may come up would be unusual bleeding, excess bleeding, meconium staining of the liquor, things that can be discussed with the woman at the time.

We are very keen to come and support when we need to, knowing we’ve got a midwife there that is going to be very, very supportive and if there are other things that are needed from a clinical perspective we can add those as well.

Immediately after the baby’s been born, the midwife’s role is to make sure that the mother and the baby are both well and enable that mother to have some uninterrupted time with her baby. This also enables the physiological process of the placenta to be birthed.

Dr Lisa Hong
Neonatologist

Neonatologists are specialists that care for newborn babies. At any point in time through the home birth program if the midwife and the mum has any concerns that the baby is unwell or unhappy, they can call the neonatal team for advice on whether the birth can continue to occur at home or that it’s best for baby and mum to actually present to the hospital for ongoing management and assessment.

The important thing, you and bub will go together. That’s what we want to do. We’ll go into the back of an ambulance and then they’ll be a steady drive off to hospital with both the midwife and paramedics caring for you on the way.

I think having that close relationship with the woman and her family, it means that we can have those open and frank discussions about changes in risk status, if there’s any recommendation that we might have to go to the hospital, but it’s always an informed decision with informed consent. It’s a woman’s centred approach.

What happens if I decline recommended care?

• Your care team will discuss the risks and benefits of recommended care to help you make an informed choice.
• You can decline or withdraw consent for care at any time by speaking with your care team.
  Your care team will discuss next steps with you if you choose to decline care.
• For more information on declining recommended care, refer to Queensland Clinical Guidelines - Partnering with Women Declining Recommended Care.
• Consult with your midwife about your health service's specific arrangements for care in such cases.

I try not to put massive expectations on birth because anything could happen, but what I do expect from a home birth is very minimal intervention and that I’m sort of left alone to birth in the way that I want to birth. I will have the support there which is reassuring to know that my midwife is there. She’s monitoring me but she’s monitoring me from a distance and she’s just letting me get on with my birth and how I want to birth.

For further information on Publicly Funded Home Birth programmes in your area, check your local Queensland Health hospital and health service website and the Queensland Clinical Guidelines Consumer information.

Special thanks to Office of the Chief Midwife Officer, Clinical Excellence Queensland. Developed with funding from Clinical Excellence Queensland

Queensland Government logo.