Why Home Birth

New Zealand Maternity System

Many home birth midwives and whānau fought for midwifery autonomy and were successful, in 1990 the Nurses Amendment Act reintroduced autonomous midwifery practice in New Zealand. The Act affirms midwifery is a separate and distinct profession, with specific expertise and training, that does not require prior nursing qualifications. Therefore educational institutions were able to offer direct-entry midwifery education. In addition, midwives won the statutory right to prescribe medications, order and interpret diagnostic tests. The Act provided statutory recognition for midwives as “safe and competent practitioners in their own right.”

The number of independent midwives increased from just 50 in 1991 to 350 in 1993. Sometimes midwives worked in partnership with general practitioners (GPs). Both were paid the same hourly rate and this became expensive. As a result, from 1996 women had to choose a single practitioner (a lead maternity carer, or LMC) who offered support during pregnancy and birth and provided post-natal care for up to six weeks. Independent midwives work as LMCs in small midwifery practices in the community. LMCs are contracted through Te Whatu Ora to provide free maternity services to eligible women and cannot charge these clients additional fees. They receive lump sum payments which they can claim after a client has completed their second trimester, third trimester, has given birth or when postnatal care is completed.

Some commentators expected the number of home births to increase significantly after 1990, but this did not happen. A large majority of women continued to give birth in hospitals. Planned home births increased from 0.04% of all births in 1973 to 2% in 1993 and 4.6% in 2020 It has been argued that midwifery care and home births would make birth less safe. A 1997 study concluded that home births were safe in New Zealand – infant death rates were comparable to those for low-risk women at National Women’s Hospital in Auckland during the same period.

The New Zealand College of Midwives filed a pay equity claim in the High Court in September 2015, asserting that the round-the-clock hours of LMCs meant that their hourly rate was below the minimum wage. The average yearly taxable income for an independent midwife was $53,728. In May 2017, the College of Midwives reached an agreement with the Ministry of Health to work collaboratively on a funding model that would pay community LMC midwives equitably for their work, provide greater income certainty, recognise business operating costs, and include payments for being on-call.  While the Ministry agreed to an interim fee increase for LMC midwives, negotiations with the College of Midwives stalled and a new co-design funding model was not developed.

New Zealand LMC Midwives

The vast majority of whānau 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. 


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.
  • 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
  • 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

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
  • one home visit within 24 hours of your discharge from hospital
  • a further detailed clinical examination of your baby around 7 days old
  • 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
  • a final detailed clinical examination of the baby and a postnatal physical examination of you prior to discharge 
  • transfer of your baby’s care to the Well Child provider of your choice and notify your General Practitioner

Place of Birth in New Zealand

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:


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.


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


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.

Home Birth

Community Groups

Here at Home Birth Aotearoa Trust, we find it very important to connect expectant mothers who are interested in home birthing to home birth community groups so that they can connect with other home birth whānau to gain support and information surrounding natural home births.