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Decision Making for Home Birth

Decisions! Decisions! Decisions! There is so much to think about. With EVERY step along the way there are decisions to be made. Choices to be explored. Research to be examined.

Keep in mind there are pros and cons with EVERY choice along the way. The main thing for you to do is explore your options and then weigh up the risks and the benefits of your choices, with reference to your own family needs and values and that which you believe is best for you and your baby. A great acronym to remember is BRAN - Benefits, Risks, Alternatives and Nothing. In other words: what are the benefits of doing this, what are the risks of doing this, are there any alternatives to this choice and what happens if we do nothing at all.

To start off, have a look at the model of care which you have chosen to work with you on your path. If it is not appropriate for you - it is NEVER to late to change. This day, the birth of your baby should take WAY more planning than events such as weddings, parties etc. This day will stay with you, your baby and your family FOREVER and will affect every facet of your life. Take your time and explore all of your choices.

The following table outlines your average maternity service with reference to each model of care in Brisbane, Queensland. Individual choices of lead maternity carer and/or individual hospitals can have wide variations to these averages. For further details on individual practitioners / hospital policies, please check with each organisation / practitioner separately. 

MODEL OF CARE IN BRISBANE (QLD) Midwife in Private Practice for Homebirth Birth Centre Care with Midwives Hospital Based Case Load / Team Model of Care Doula Assisted Care for Birth Share Care arrangement for birth in public hospital eg GP Share Care Public Hospital Birth Private Obstetric Care
Choice of lead carer to match your needs, values and personality ü ûNot usually ûNot usually Doula is for support and education only – not the lead carer  Multiple carers across the entire perinatal time (GP not there for the birth) û  ü
Continuity of carer across the entire antenatal period, labour, birth and postnatally (up to 6 weeks) ü ü ü üPlus other carers across perinatal time Fragmented.Multiple carers across the entire perinatal time (GP not there for the birth) û  Fragmented. Obstetric antenatal and birth care only (from the time the head is crowning).Shiftwork midwives for the labour.
In-home care available for antenatal, labour, birth, & postnatal care ü Some visits may be in-home Some visits may be in-home Most visits would be in-home. Doulas attend birth as support person û  ûUp to 3 in-home postnatal visits usually offered û 
Personal contact by phone (for urgent enquiries) 24 hours a day, 7 days a week ü ü ü ü ûOnly to hospital midwife on duty ûOnly to hospital midwife on duty ûSometimes
Postnatal care including breastfeeding assistance for up to 6 weeks ü ü ü ü Only the postnatal care provided by the hospital, and clincial checkups for baby and mother ûUp to 3 in-home postnatal visits usually offered to women in catchment area. ûFor extra charge the on-duty hospital midwife may visit – limited service
Primarily a midwifery model of care (Gold Standard)* ü ü ü Only if assisting a midwifery model of care  û  û  û 
Registered & licensed practitioners, recognised in legislation ü ü ü û  ü ü ü
Assessed at university level as competent birth attendants ü ü ü û  ü ü ü
Up to date with skills such as mother/baby resuscitation techniques, breastfeeding etc ü ü ü û  GP may not have updated skills for maternity services (including breastfeeding) for some time ü May not be up to date with skills such as breastfeeding and parenting skills
Higher chance of normal vaginal birth* ü ü ü ü û  û  û 
Safe and legal model of care according to research ü ü ü üOnly if birth is attended by a midwife / doctor ü ü ü
Encourage women to birth in whatever position they choose ü ü ü ü Depends on staff for labour & birth Depends on staff for labour & birth ûRarely
Lower or no intervention during normal birth* ü ü ü Depends on lead carer û  û  û 
Increased participation of partners at birth ü ü ü Depends on lead carer Depends on staff for labour birth Depends on staff for labour birth û 
Partner / support person allowed to stay overnight following birth ü Early discharge encouraged on the day of the birth Early discharge encouraged on the day of the birth Depends on lead carer û  û  ü
Few, if any exclusion criteria provided the woman makes an informed decision (ie Individualised Care Planning) ü ûExclusion criteria can be extensive ûExclusion criteria can be extensive Depends on lead carer üAll risk model. Encouraged to conform to policy üAll risk model. Encouraged to conform to policy üAll risk model. Encouraged to conform to policy
Offers choices for EVERY aspect of care and respects woman’s decision without bullying ü Usually Sometimes Depends on lead carer ûRarely  ûRarely ûRarely
Less chance of forceps or vacuum assisted birth* ü ü ü Depends on lead carer û  û  û 
Less chance of caesarean section* ü ü ü Depends on lead carer û  û  û 
Lower or no episiotomy rates* ü ü ü Depends on lead carer û  ûSometimes û 
Offers natural birth of the placenta (without Syntocinon) ü Sometimes Sometimes Depends on lead carer ûRarely  ûRarely ûRarely
Water birth supported ü ü ûNot usually Depends on lead carer ûRarely ûRarely ûRarely
VBAC supported & promoted ü ûUsually excluded Sometimes Depends on lead carer Only with high intervention Only with high intervention ûSometimes
Lower or no requirement for pain relief* ü ü ü ü û  û  û 
Increased feelings of control for women* ü ü ü ü û  û  û 
Increased breastfeeding rates* ü ü ü ü ûMost GPs have little/no training in breastfeeding û  û 
Lower rates of antenatal admissions to hospital* ü ü ü Depends on lead carer û  û  û 
Service provided free of charge (fully covered by Medicare) û ü ü Two accounts – one for doula, one for lead carer Only if GP bulk bills ü û 
 * Hatem M, Sandall J, Devane D, Soltani H, Gates S. Midwife-led versus other models of care for childbearing women. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD004667. DOI: 10.1002/14651858.CD004667.pub2.

 

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