Why home birth?

The Home Birth Aotearoa community believe the choice to birth at home is the best for women, babies, whānau and the wider community.

We also believe this is an active choice made with careful consideration. This page provides some factual information and testimony to help families make informed choices about how and where they birth. Throughout this section you will find links to more detailed resources on the home birth choice.

Statistics

Sometimes, it’s nice to know the numbers, and statistics are something we are often asked about.

Recent figures received from the New Zealand College of Midwives indicate that the rate of Home Births in New Zealand appears to be on the increase. The overall rate of home birth in New Zealand sits somewhere in the vicinity of 3-5% of all recorded births (3.37% the latest figure from the Ministry of Health in 2012, and 4.9% latest figure from Midwifery and Maternity Partners Organisation in 2011).

It is apparent that in some areas, where there is good local support from Home Birth associations and midwives, the rate is much higher such a 12.5% rate reported on the West Coast of the South Island in 2011.

How statistics are recorded, and where the information comes from is critical. At present in New Zealand, there is no holistic approach that captures planned home birth statistics. The Ministry of Health figures do not distinguish between planned and unplanned home birth. This means the statistics can include high risk and emergency circumstances. The Midwifery and Maternity Partners Organisation reports are based on data by midwives who are members of the New Zealand College of midwives who contribute to the maternity activities and outcomes database. Not all midwives or mothers are included in this database, although it is very comprehensive. Having identified these issues, we are currently working with the relevant parties to try and establish more robust reporting on home birth in Aotearoa.

The Maternity Consumer survey of 2011 found:

  • Women most likely to be ‘very satisfied’ overall, were those who had a planned home birth (78%)
  • Women who had a planned home birth were significantly more satisfied with the birth itself, with nine in ten (90%) ‘very satisfied’ with the care they received
  • Women who planned to have a home birth were more likely to be satisfied with the quality of information (97% rating ‘very satisfied’ or ‘quite satisfied’)
  • 90% of women who had a home birth were ‘very satisfied’ with individual aspects of care received during their home birth – this includes aspects such as having their choices respected by their LMC and the expertise available immediately after the birth.
  • Women who gave birth at home received more postnatal home visits and were more satisfied with their home visits

The Midwifery and Maternity Partners Organisation annual report of 2011 shows:

  • 4.9 % of babies were born at home.
  • The percentage increases for women having their second or subsequent child (6.7%)
  • Home birth babies had the highest number of ‘excellent’ (score of 9 or 10) Apgar scores of all birth place types (97%)
  • Transfer rates to neonatal care from home were 2.1%, just slightly lower than the transfer rate from primary birthing centres at 2.2.%
  • Babies born at home had the highest exclusive breastfeeding rate at 87%
  • Number and rate of perinatal related deaths by status at birth and birth place

Number and rate of perinatal related deaths by status at birth and birth place

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Notes on this table: Among the babies born to the MMPO registered women in 2011, a total of 171 babies were stillborn, with the majority occurring at secondary and tertiary facilities. When a baby has died during pregnancy the midwife refers to an obstetrician to discuss labour induction. Therefore the majority of women who had a fetal death may have been referred to a secondary or tertiary unit to give birth. Similarly not all homebirths are planned and can be the place of birth for precipitate and premature births. Of the 4 neonatal deaths in the home birth group 2 were at a very premature gestation.

“Home is where our hearts are and those that we love are. At home you can be yourself and feel confident with your surroundings and those who support you in labour. After having babies in all the different options from hospital, birth centre and home, I would choose home every time. I feel in control and safe there” ~ Laura

Other notable benefits of home birth activities:

  • 28.2 % of women used water immersion for pain management during labour and 7.1 % of babies were born in water.
  • Women who had active management of the third stage of labour experienced greater blood loss (more than 500mls) than those who had a physiological pathway for the third stage (9.7 %, versus 5.5 %)

Figures from The Ministry of Health’s Report on Maternity in 2010 show:

  • Women aged 30–34 years had the highest rate of home births (3.7%)
  • Pacific and Asian women had the lowest rate of home births (1.0%)
  • Women residing in the most deprived areas had the lowest rate of home births (2.6%)

You can find copies of regional DHB reports on Maternity Quality and Safety, along with other reports and information in our resources section

Benefits of home birth

There are physical, emotional, political and personal benefits to birthing your baby at home. The statistics indicate that home birth is a safe and positive choice for low risk pregnancies. This Cochrane review found that planned hospital birth is not any safer than planned home birth assisted by an experienced midwife with collaborative medical back up, but may lead to more interventions and more complications.

We believe that the empowerment of women to birth their babies in the way that they choose to do so, in the comfort and safety of their own home is so significant to be immeasurable. Home birth offers the best environment to an unmedicated birth with significantly less likelihood of unnecessary interventions. The benefits are felt by the whole whanau, partners and extended families are able to support fully and children can be as involved as is appropriate for your situation.

Top Ten benefits of home birth

  1. A higher chance of a natural vaginal birth which has flow on benefits for breathing and immunity for baby. The baby is born with the mother’s antibodies, passed through the placenta. These include immunity to the family’s household germs.
  2. Lower chance of infection at home than in hospital environment for both mum and baby. Because mothers and babies are never separated, the baby’s immature immune system is able to function optimally. Hospitals have unfamiliar bugs and microbes and a mother isn’t able to offer herself or her baby the same degree of immunity as she can from home.
  3. Bonding with mum AND dad. This bond is not broken for institutional routines and procedures and partners have autonomy to connect in, practice skin to skin and be fully included in the process.
  4. Easier establishment of breastfeeding and higher chance of breastfeeding success. Continuous and unbroken connection promotes successful breastfeeding, further supporting robust immunity.
  5. Committed, individualised and responsive midwifery care tailored according to your needs and requests. Homebirth midwives provide continuity of care and comprehensive care which differ vastly from the shift work nature of a hospital.
  6. Control and autonomy over your decisions, mind and body. Your home, your choice. Having a close and respectful relationship with your midwife and being informed and clear about your birth intentions within your own home, give you the best chance of retaining control and autonomy over your body, birth and baby.
  7. Increased chance of natural, active labour without unnecessary interventions. Psychologically in your home you are able to relax more deeply, and move more freely. Outside of the hospital, your labour and birth is happening on your time only, away from rigid routines, standard expected stage timeframes and hospital staff shifts which can all contribute to an unnecessary sense of urgency.
  8. Emotional and physical comfort after birth. After you’ve given birth you can snuggle up into your own bed, eat your own food, enjoy your home surroundings. There is no pressure to engage in further checks, move to another room or consider the next process of packing up to go another facility or home.
  9. Physiological third stage (natural birthing of placenta). Ensuring that your baby receives all the benefits that appropriate cord clamping  offers as well as the reaping the rewards of labour – an oxytocin hit for mum! Experiencing a natural third stage has significant health benefits for both mum and baby.
  10. Have who you want, when you want, around you. Birthing at home means self selected support people, as many or as few as you desire. There is the ability for siblings to be present for as much or as little of the process as appropriate. You can decide when to have visitors and make your birth announcement.

 

Dad's testimonies

I wanted a home birth because its normal, natural and logical to have a baby at home. Having a baby is hard enough without having to pack up and go somewhere else to do it ~ Sam

Home birth allowed me to have direct involvement in the whole process. I felt empowered not only to fully support my wife, but also to become a dad when we choose to birth at home ~ Simon

To me it was all about ensuring my wife was in the most comfortable environment for her, after all she is the one tasked with the hard job on the day. What is more comfortable than being in your own home and being able to curl up in your own bed after the ‘work’ is done. Not only that, during the birth you get to choose exactly what music, lighting, drink, food and other stuff you want, after all it is your house. ~ Rob

As a dad home birth is an easy way to get the reality of the situation to kick in a little faster, from my point of view – sorry being totally honest- the baby is not growing inside my body I am not feeling it grow, kick, or move. The first time you get up close and personal with your baby as a dad is after he/she is born, and on 4 occasions now that stands true, although with the home birth experience as you are physically helping rearrange your house the ‘shock’ is far less and it is not ‘WOW I have a new child’ it is more ‘WOW you’re finally here’. ~ Rob (again)

As long as you have a midwife that you trust, it is actually a very moving experience much more memorable than a hospital birth (I have experienced both). There is no having to pack or unpack for a hospital stay, you don’t feel like you should be moving out as soon as possible, it is not an ‘unknown’ environment, and you don’t have to take other peoples feelings into account. EVERYTHING is exactly as you want it and how you want it as a family. ~ More wisdom from Rob

From my perspective as a first time dad it was great – just us and the midwife, peaceful, our own music, surroundings, knowing help was not far away if we needed. We had an experienced home birthing midwife and she made us feel prepared for almost anything, she fitted in with the natural process and helped it along. We had hot towels for pain relief which I was supplying and I felt an integral part of the process, ensuring the room was warm etc. This was my first child so cannot compare it but we had a very positive experience. Mum and baby were very comfortable afterwards and had a lovely slumber without noise or distraction from other people as I would expect in many hospital situations. One thing which was important was limiting the visitors to the house in the first few days as it is easy for people to call round knowing there has been a new arrival, when that may not be what mum, dad and baby want, anticipate having to protect mum and babies space for the early hours / days. Overall I would choose a home birth again for sure! It is no way as scary as some people make it out to be as long as you have some good advice and prenatal checks. ~ Christian

I have to say, having experienced a hospital birth (a problem free / as natural as you can get in a hospital) and a home birth – I find myself almost unable to fathom why you might not want a home birth. Our home birth was such an experience for me, I felt a lot more connected to my partner as she was having our daughter, everything just seemed right. She was in our birth pool and I was on the outside cuddling her and encouraging her, trying to make sure that she felt cared for and loved as she progressed more and more. She seemed calm and very positive, very confident. There was no pain to be had as she was in the comfortable area that we had set up just for the birth. As her partner I couldn’t have been more proud of her, and as our daughter came out and actually started having a little swim around the birth pool I couldn’t help but be amazed. I remember thinking that I couldn’t have had this experience at a hospital. I also admit it’s hard not to smile as I walk into our bedroom (where the birth pool was set up), remembering the joy of it. As a father, having a home birth puts so much more flexibility into your hands as you can do as much as you feel is necessary, and because you’re at home you have all of those home comforts around you and your partner to help out and relax things. You don’t really get that sort of thing at a sterile hospital. Having gone through this I would not have it any other way now. As a small chunk of advice, I read The The Father’s Home Birth Handbook, and found it very helpful in the way it was able to address most of my questions about a home birth in a humorous yet informative way. ~ Mark

Initially, the decision to have a home birth was my wife’s choice. Before our first home birth experience, I must admit I was full of apprehension, but I couldn’t have wished for anything else. It is hard to put into words how special it is to be there for your wife during active labour as you brace your baby gently guiding her out of the birth canal. I have had the privilege to have delivered two of our four children at home and with our second home birth, felt confident enough to do everything from cleaning, coaching, applying hot towels and delivering our daughter. Not only did this feel natural, it gave Mum a place to rest in an environment where she felt most comfortable and relaxed. Plus, we were able to add to the experience with family sharing in a first birthday cake for both of home birth experiences. ~ Hadley

The maternity system in NZ

The Maternity system in New Zealand is based on the concept of having a Lead Maternity Carer (LMC) who coordinates your maternity care in a partnership with you. You are required to choose an LMC to be responsible for your care. Lead Maternity Carers can be midwives, GPs with a diploma in obstetrics, or obstetricians. LMCs are contracted through the Ministry of Health to provide a complete maternity service to you.

It is your choice where you give birth, and your midwife will help to advise you on any pregnancy complications that may put you at risk in the home setting. There are many advantages to giving birth outside of the full hospital setting, even if you don’t decide to give birth at home. Other types of facilities to give birth in are as follows:

Primary maternity facility

A primary facility is one that does not have inpatient secondary maternity services, or 24-hour on-site availability of specialist obstetricians, paediatricians and anaesthetists. Here you will still have your LMC present and involved in your birth, supported by other onsite midwives. This is your home away from home option, and includes birthing units.

Secondary maternity care facility

A secondary facility is one that provides additional care during the antenatal, labour and birth, and postnatal periods. These facilities are designed for women and babies who experience complications and who may require the services of an obstetrician, anaesthetist or paediatrician as well as a midwife. In many provincial centres and smaller cities around New Zealand secondary maternity facilities are the only birthing facilities available

Tertiary maternity care facility

A tertiary facility is one that provides a multidisciplinary specialist team for women and babies with complex or rare maternity needs; for example, babies with major fetal disorders requiring prenatal diagnostic and fetal therapy services, or women with obstetric histories that significantly increase the risks during pregnancy, labour and delivery. This includes neonatal intensive care units. There are six tertiary maternity facilities throughout New Zealand, two based in Auckland and one each in Hamilton, Wellington, Christchurch and Dunedin.

The Ministry of Health website provides an overview of the different facilities across Aotearoa here.
Our health system is based on the premise of informed consent. This means that you ultimately have the final say in the care you receive, and that your health practitioner is required to keep you informed about the care, the benefits and the risks of the care and their professional opinion about what the best course of care is for you. For details about your rights under the Code of Health and Disability Services Consumers Rights, please see this website

“Because I wanted a home birth midwife, they are prepared to go the extra mile, listen to their birthing women, empower them, give them choices, trust their bodies, and give them amazing strength. The continuation from there to birthing at home was a logical one” ~ Jaqui

 

The vast majority of whanau choose a midwife as their LMC. LMC Midwives work independently or within small groups or practices, and have arrangements for back up care with other LMCs. Midwives also work collaboratively with other health professionals to ensure your needs are met. This may be obstetricians, physiotherapists, chiropractors, acupuncturists, naturopaths, nutritionists, sonographers and many more.

The LMC system is ideally suited to home birth. The ability to select your midwife means you have agency from the beginning to plan your birth how you want it to be. Our Midwife database lists midwives who have specifically registered with us as home birth midwives.

When you choose a midwife as your LMC, regardless of where you plan to give birth, you can expect the following services. These expectations are furnished by the New Zealand College of Midwives. Further information about the college is available here

What you can expect from your Lead Maternity Carer

On booking or registration:
information regarding the role of the LMC and contact details including arrangements for ‘back up cover’ if unavailable

  • information about the standards of care to be expected, possible interventions, outcome, options for referral for additional care should you need it
  • a comprehensive pregnancy assessment including physical examination, assessment of general health, family and obstetric history
  • information about a range of screening tests (blood and ultrasound tests) and referral for these if you choose to have them
  • information about the availability of Pregnancy and Parenting Education courses
  • information about Paid Parental Leave
  • development and documentation of a Care Plan to be used and updated throughout your pregnancy, birth and after birth. (Your LMC will keep a copy and will give you one.)
  • a copy of your clinical notes (updated at each visit)

In the second trimester (12 to 28 weeks of pregnancy):

  • monitoring of your progress including early detection and management of any problems, including referral to other care providers if necessary
  • updating your Care Plan
  • one-to-one education regarding healthy pregnancy, childbirth and parenting preparation
  • booking into a maternity facility or birthing unit unless you are planning a homebirth

In the third trimester (28 weeks until labour begins):

  • monitoring of your progress including early detection and management of any problems
  • updating your Care Plan
  • one-to-one education regarding healthy pregnancy, childbirth and parenting preparation
  • specific education for labour and birth including the role of your support people, coping with the pain of labour, options for the birth itself, care of the afterbirth, immediate care of the baby and breastfeeding
  • instructions for making contact when labour begins
  • arranging for you to meet any other maternity carers who may be involved with your care

Labour and birth:

  • initial assessment at home (preferable) or at a Maternity Facility
  • regular monitoring of you and your baby’s progress, including referral to other care providers if necessary
  • all your primary care during your labour and the birth of your baby
  • all your primary care immediately following the birth including initial examination and identification of your baby, initiation of breastfeeding, care of the placenta, any suturing required and notifying your baby’s birth to the Registrar of Births

If you are having your baby at home:

  • arranging for a second practitioner to be available to attend the birth
  • maintaining the necessary equipment including neonatal resuscitation equipment
  • providing the delivery pack and other supplies

If you are having your baby in a birthing unit:

  • arranging for a second practitioner to be available to attend the birth
  • ensuring a practitioner remains with you until you are discharged

After your baby is born (from the birth until your baby is 4-6 weeks old):

  • detailed clinical examination of your baby within the first 24 hours
  • if you are in hospital, a daily postnatal visit prior to your discharge (unless another arrangement is made with you and with the facility)
  • one home visit within 24 hours of your discharge from hospital
  • a further detailed clinical examination of your baby within 5 days of the birth
  • a total of 5 – 10 midwifery home visits and more if clinically needed
  • a minimum of seven postnatal visits in total
  • assistance with and advice about breastfeeding and nutrition for mother and baby
  • assessment for risk of postnatal depression and/or family violence with appropriate advice and referral
  • provision of the Ministry of Health information on immunisation
  • access to screening programmes for your baby as outlined in the Well Child Tamariki Ora National Schedule advice about contraception

Parenting advice and education:

  • a final detailed clinical examination of the baby prior to transfer to the Well Child Provider (Plunket or other service)
  • a postnatal physical examination of you prior to discharge from the LMC service
  • transfer of your baby’s care from the LMC to the Well Child provider at a date agreed with you between 4-6 weeks after the birth, and formal notification of this transfer to the Well Child provider
  • notification to your General Practitioner of your discharge from LMC services

Once your midwife has discharged you from her care, she will usually handover to a Tamarki Ora provider. You can access more information about this service here

Other things to consider about midwifery/ LMC care during pregnancy and birth:

Many midwives have student midwives of different stages work with them on placement to gain valuable work experience. It may be worthwhile considering your level of comfort with this and speaking to your midwife about it.

With the opportunity to select your own midwife, you are entitled to interview and make a selection of someone who you believe will support your birth choices and who is appropriately experienced. For tips on selecting and interviewing a midwife please visit this page on interviewing a midwife.

You can change your LMC if you need to. If you are uncomfortable or dissatisfied with the care you have received, the first step is to speak to your midwife if at all possible. You can then decide to change if you want to. NZCOM have Midwifery Advisors available during office hours if you need further advice or support, contact them on 03 377 2732.

Please consider placing feedback on your midwife. Your midwife should provide you with an evaluation form, but you can also find ways to provide feedback on the NZCOM site

 

Cascade of intervention

The cascade of intervention refers to the likelihood of one medical intervention leading to another, to another and so on. Many women are unaware of the increased chances of further interventions when accepting initial intervention for convenience, or simply because they are available!

By interventions we are referring to many common and routine medical pregnancy and birth interventions, beginning with testing, working up to induction, fetal monitoring, pain medications and epidurals, assisted births (such as forceps and ventouse and episiotomy) to Caesarean Section operations. Many antenatal tests have high rates of false positives which can lead to additional testing and monitoring and often recommended induction. For this reason it is suggested that antenatal tests and interventions are carefully researched, considered and justified in your individual circumstance.

“I wanted to birth where I felt comfortable and I was the boss. How are you supposed to feel like an Amazonian wonder woman in a foreign, sterile scary place? Hospital’s are for sick people, and labour is the strongest and most in control I’ve ever felt” ~ Hayley

 

Consider these snippets from scholarly research:

This study confirms that One-to-One midwifery practice can provide a high degree of continuity of carer, and is associated with a reduction in the rate of a number of interventions, without compromising safety of care. It should be extended locally and replicated in other services under continuing evaluation.

The below flow diagram illustrates some of the potential impacts of unnecessary intervention.

cascade of interventions diagram

Flow diagram showing possible cascade of interventions in child birth

You may also like to read How to avoid a hospital birth

 

Politics of birth

It is a fundamental human right to determine where you give birth. The location, type of care and circumstances of birth is not just an individual physiological issue, it is part of a wider political context of feminism and human rights.

Birth culture over the course of the twentieth century has become shrouded in medicalisation. This removes agency of women and places their rights and choices into the hands of institutions which perpetuate violence against women. A culture of fear and risk aversion as well as litigious hospital environments mean a woman’s right to choice have been reduced to what she is ‘allowed and not allowed’. The physical and psychological harm to women during birth is always secondary to perceived risk to the foetus.

Historical family and cultural birthing practices have taken a back seat in favour of a technocratic and authoritative model. At the same time, advances in knowledge and life saving interventions are available only within predominantly western contexts, whereas women in the third world continue to die of treatable illness and disease in pregnancy and childbirth.

The political and social context of childbirth, obstetrics and midwifery and the challenges facing childbearing women offers an evaluation of practices and beliefs. Home birth delivers autonomy, rights and responsibility for birth back to women and their families.

The home birth movement in Aotearoa led to changes in our maternity care system to the model we have today. Despite this change, our movement is still highly relevant and has an important role to play in maternity policy, advocacy, provision of resources and wider education about home birth.

Please see our resource section for recommended reading on the politics of birth.

Photo credit and thanks:
Cover image: Emily Witten-Hannah

 

Birth isn’t something we suffer, but
something we actively do, and exalt in!

SHEILA KITZINGER

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