A home birth midwife

Homebirth midwives are what are known as primary care providers. This means they are the principal health care 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 permanently be on call.

What’s a midwife?

Midwives are nurses who have qualified for registration with their national governing healthcare and accreditation agency. In Australia this is with the Australian Health Practitioner Regulation Agency (APRHA) and in New Zealand The Midwifery Council of New Zealand. (See links below).

Midwives need to have completed a recognized course of training and formal study to then qualify as a registered midwife. This is now offered through universities, but there are many practicing midwives who gained their qualifications through the “old” hospital training system.

It is important to understand that there are differences between midwives, doulas 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 health professionals and are legislated to complete a prescribed number of continuing professional education points each year. They are 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.

In Australia
One objective of many independent midwives is to gain clinical access rights to public maternity hospitals. This would mean that mothers have the option of having their own midwife caring for them through the pregnancy but still be in hospital to give birth. Each state and territory has their own arrangements and there is, as yet, no consistency regarding homebirth practice across Australia.

In New Zealand
There is a greater proportion of homebirths than in Australia and there is also a different system of maternity care. Pregnant women choose a Lead Maternity Carer (LMC) who coordinates their care throughout their pregnancy. More than 75% of women and their families choose a midwife as their LMC and the remainder generally choose a general practitioner. These LMC midwives work in liaison with their midwife colleagues and partners and also the midwives who are employed to work in the local maternity unit.

According to Home Birth Aotearoa, it is difficult to accurately assess the number of homebirths which occur in NZ. Numbers vary from region to region but it does appear the overall numbers are increasing to around 7%. This has been measured to be higher in some regions, where there may be good local support structures for homebirthing.

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.

These are:

• 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 caesarian section delivery in hospitals.
• Safety.
• A previous birthing experience which 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:
A home birth 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 health care and importantly, an advocate for yourself and your baby.

A general framework of regular ante natal visits occurs:

Antenatally

• 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.

Antenatal classes
Some midwives offer classes on birthing, relaxation techniques, active birthing and visualisation techniques. They may give out printed information; have DVDs to lend and other educational material which helps expectant parents to boost their understanding of pregnancy and birth.

Birth
The midwife is called by the woman or her partner and advised that labour has started. There is usually a mutually agreed and pre-arranged stage of labour progression 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 become active. 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 they baby are stable and she has had the opportunity to observe how they both are, then 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.

Postnatal support
Generally one or two times each day for the first three days and then every second day until 10 days after birth. Postnatal checks are often done at two and four weeks after the birth. A final postnatal check is done at six weeks after the birth.

On-Call support
Most homebirth midwives provide a 24 hour/7 day 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 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 and sterile scissors.
• Sterile 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.
• A thermometer.
• Oxygen and suction equipment.
• Emergency resuscitation equipment.
• Ecbolic medications – such as Syntocinon and syntometrine which assist with making the uterus contract.
• Intravenous drip equipment.
• Syringes, tourniquet, and equipment to collect blood.
• Suturing material.
• Phone and emergency contact information.
• Some will also provide a birthing pool, which needs to be prepared ahead of time.

Cost
This varies according to the individual midwives rates for service. Some midwives are registered with Medicare but others are not. Pregnant women who engage the services of a homebirth midwife have a right to a transparent and honest explanation of costs. A general fee structure is between $3000-$4500. Some private health insurance companies may provide a rebate for employing a homebirth midwife, but it is best not to assume you are covered and seek specific information from your own health insurance provider.

Within Australia, there have been recent changes allowing independent midwives to collaborate with hospitals rather than individual doctors. Previously, many midwives needed to establish a professional relationship with private obstetricians who they could call in the event of problems. This created medico legal problems for all concerned. But now there is more freedom and scope for midwives to develop license agreements and individual contracts with hospitals. This means that any doctor who is present and available within the hospital can accept a referral of a mother who needs medical assessment and intervention.

References/more information:

Australia and New Zealand
www.ahpra.gov.au
www.midwivesaustralia.com.au
www.joyousbirth.info/articlesa-z.html
www.midwives.org.au/scripts/cgiip.exe/WService=MIDW/ccms.r

New Zealand
www.health.govt.nz/yourhealth-topics/maternity/pregnancy/your-lead-maternity-carer
www.homebirth.org.nz
www.midwiferycouncil.health.nz