Homebirth practitioners (usually an independent midwife) often believe that having a baby is a normal physical process and if nature is left to its own devices, most pregnancies and births will happen normally without medical interventions. They also believe that when a woman is in the familiar surroundings of her own home, being loved and supported by her family (and sometimes friends), she is more relaxed and at ease, facilitating the progress of her labour, reducing the likelihood of her baby becoming distressed and reducing her need for medical interventions.
Women (and their partners) who choose homebirth will often state their reasons as:
- Wanting a natural birth and feeling they have the best chances of this at home with a supportive caregiver.
- Wanting to have 'one-to-one continuity of care' and a trusting relationship with one caregiver for all their pregnancy care, labour and birth care and postnatal care in their own home.
- Wanting more control over any decision-making about their care, feeling more empowered and knowledgeable about what is happening and why.
- Wishing to avoid unnecessary medical interventions and being fearful of having these in a hospital environment.
- Wanting a caring, positive, personal, intimate and private environment to have their baby. Not being surrounded by strangers.
- Feeling more relaxed, comfortable and confident at home, reducing family separation and separation from their baby by not being in a hospital environment.
- Having had a past negative experience in hospital or having concerns about infections or diseases from hospitals.
Homebirth in New Zealand is not very socially accepted by the general community, nor is it well supported by the medical profession. Medical practitioners and caregivers will often discourage homebirth or make efforts to talk women out of her decisions. Australian women choosing homebirth will also be faced with very biased opinions from relatives, friends and caregivers. As one woman said, "When you say you are having a homebirth people say 'how nice'. Here people say 'how brave'." If the woman does require transfer or she experiences complications, (which is possible for any birth) she may come in contact with attitudes such as "I told you so."
In New Zealand, only about 4% of all births are planned to happen at home.
The medical criteria for having a homebirth generally relies on a woman's pregnancy, labour and birth to be progressing relatively normally, anticipating that the baby will be healthy and born at term. This will generally be the case for up to 80 to 85% of women. The circumstances under which you would need to transfer to a hospital will vary from woman to woman and practitioner to practitioner.
Homebirth practitioners work through the government health funding and usually set their own individual guidelines for what is acceptable to them. For example, some midwives will care for twins and breech babies at home but others will not.
Room and equipment
Your birth room is your home. Many women will organise to have a mattress or large pillows on the floor to kneel on (perhaps with plastic sheeting), using their bed or lounge with pillows to lean over (or a beanbag if they have one). You may want to purchase or borrow massage oils and implements, aromatherapy burners, play music and have heat packs as natural ways to help with labour pain. You homebirth practitioner may have a birth stool and/or physio ball you can use to help with comfortable positioning.
Many women use water for pain relief and find being in the shower or bath helps. You may need to buy or hire a birthing pool if you want the option of using the deep water for pain relief or for a water birth. Also you may need to organise to have your water supply changed from 'off-peak' to 'on-peak' so you don't run out of hot water in the shower.
The room you give birth in needs to be a comfortable temperature. This may entail having a fan or heater, depending on the time of year and possibly towels to place over your new baby soon after they are born to keep them warm.
Homebirth practitioners should be equipped with most of the medical equipment available in delivery suites or birth centres. They will use hand held Doppler or a Pinard's to intermittently monitor the baby's heart rate during labour. Basic emergency equipment, oxygen and injections of Syntocinon (for the mother to minimise bleeding) are also brought to the birth, ready for use if required.
Homebirth practitioners usually promote the use of natural forms of pain relief. This includes heat packs, showers, the bath, and massage as well as acupressure/acupuncture, homoeopathy, herbal remedies, hypnosis, visualization and music etc. Depending on where you live, your midwife may be able to access medical forms of pain relief such as gas and narcotic injections, or you may be able to ask your local doctor to authorise this. You would need to transfer to the hospital's delivery suite if you want or need an epidural.
When you have a homebirth you have total control over who is with you at the birth. Support people play an integral role in helping the woman through her birthing process and they are not asked to leave the house for any reason.
Most homebirth practitioners encourage the presence of siblings in the house during the labour and birth (if this is what the parents would like). However, it is usually asked that your child(ren) have an extra support person to meet their needs during this time, so your partner is not distracted from supporting your needs.
If complications do arise you will need to transfer to the nearest hospital delivery suite. If you are booked into a hospital further away and your transfer is not a medical emergency, then an ambulance may take you to your booked hospital. Ideally, you should not be more than 30 minutes away from your booked hospital. Booking into a hospital in case of transfer should be organised during your pregnancy. It may also be a good idea to have a tour of the hospital and talk with the staff, to familiarise yourself with the delivery suite in case transfer does eventuate.
An independent midwife is a registered member of the New Zealand Midwifery Council therefore if a hospital transfer is necessary they can continue to provide the woman's care in the delivery suite.
Soon after the birth
Your homebirth practitioner will usually stay at your home for about 2 to 3 hours after the birth (but a minimum of 1 hour after the placenta has come away). They should be 'on call' and contactable 24 hours a day for at least the following week (or nominate someone else or a hospital for the parents to call if concerned). The homebirth practitioner will usually return for their 1st postnatal visit within 12 to 24 hours after the birth (for about 1 hour) and then daily for 7 to 10 days (or more/less often, or for a shorter/longer period, depending on yours and your baby's needs).