Under new Safer Care Victoria guidance, women with low-risk pregnancies should have the option of a home birth and all pregnant women should have the option of water use during labour and water birth, if appropriate.
The guidance says health services and midwives have a responsibility to work in partnership with women to discuss birth choices.
The latest international and Australian evidence shows that offering homebirth as an option to women with low-risk pregnancies is safe for the right woman, with the right providers, in an integrated system.
Evidence comparing planned home births to hospital births for women identified as suitable for home birth shows that:
- the rates of unassisted vaginal birth are higher
- the rates of intrapartum caesarean section and instrumental birth are lower
- the rates of postpartum haemorrhage and severe perineal trauma are lower
- women having their first baby do not experience higher rates of adverse perinatal and maternal outcomes
- the rates of transfer to hospital during or after birth are higher for women having their first baby compared to women who were planning a homebirth who have already had a baby.
- the rates of stillbirth and neonatal death are similar.
In Victoria there were 131 homebirths in 2000, increasing to 322 in 2018. There were 11 fewer public homebirths in 2019 compared to 2018. Victoria’s homebirth rate of 0.5 per cent is low compared to New Zealand’s (3.4 per cent), the United Kingdom’s (2 per cent) and Canada’s (2 per cent).
The guidance says homebirth is a suitable option for women who have had a low-risk pregnancy and are having one baby, and:
- at the onset of labour the baby is head-down
- the term gestation is 37 to 41+6 weeks
- there has been no previous caesarean section or uterine surgery.
An assessment of the suitability of the home environment also needs to take place, to ensure the safety of the mother, baby and midwife.
Safer Care Victoria has also released guidance to support women in using water for pain relief in the early stage of labour or to birth in water, if appropriate. Download the water use for labour and birth guidance