Objective: To discuss provision of home births in Australia and make recommendations how to proceed in developing a regulated, safe home birth service.
Review methods: A narrative review of comparative home birth studies from other health systems was performed in order to inform recommendations.
Results: Delivery in a home setting in low risk women reduces some maternal complications but there exists a problem of increased perinatal/neonatal mortality seen in many studies. The risk is low in absolute terms however can be further reduced or nullified in well integrated systems. The perinatal/neonatal risk profile is increased in nulliparous verses multiparous women.
Discussion: The perinatal/neonatal risk is not consistent across all studies and in well integrated systems there is no excess risk identified. Key proposals to enhance accountability and safety are suggested:
Mandatory integration of all home births into a healthcare system, risk stratification and review of cases by an Obstetrician with a private midwife, standardized clinical guidelines should be agreed, a communication protocol between the midwife and hospital maternity team during labor should be agreed and implemented, informed refusal and documentation of discussions for women who do not accept professional advice, ongoing training and regulatory oversight including centraliszed registration with an affiliated hospital.
Establishing these measures will facilitate safer home birth practices and allow for comprehensive statewide monitoring, ultimately supporting informed choice while prioritizing the health of both mother and baby.
Conclusion: The regulation and integration of a home birth system is a necessary step in providing safe care for women who would like to deliver at home. Secondly the provision of a home birth service is an important step in reducing the current trend to freebirths seen in Australia.