Well, homebirth has been in the news alot this week. Mainly for the purpose of getting slammed by people who don't understand what homebirth actually means.

Its not a case of staying at home crossing your fingers that nothing goes wrong and if it does go wrong just waiting till a dead baby comes out. But it seems that some people think this is the case. Why would anyone do that?

Homebirth is starting your labour at home and then instead of jumping in the car to continue the labour at the hospital, you continue the labour at home. If there are no complications you stay there until the baby is born, same as you would in the birth suite in hospital. Planned homebirth, (as opposed to 'whoops the baby came too quick and was born on the bathroom floor') is attended by a trained professional midwife who is paid for her services, has full qualifications as a midwife and often also works at the hospital delivering babies. In some cases (including my own) there are two midwives in attendance from the start to the finish and then they visit postnatally for a few weeks afterward.

So, once you go into labour, you call your midwife and she calls the backup midwife and they come to your house. In my case it was four o'clock in the morning. These midwives have seen you throughout your whole pregnancy, for every visit, they have made every note on your card, they know your history, they know your birth plan, they know your family and have a thorough knowledge of your pregnancy. This is unlike hospital where you get the midwife who happens to be on shift and she stays for the duration of her shift and then you get the next one, and so on. These are usually different midwives than those you have seen throughout the pregnancy. Some people are lucky enough to get a caseload program where they are assigned a midwife, but sadly, this is the exception rather than the rule in Australia at the moment. For my pregnancy with Baden I saw over ten different midwives during the pregnancy, plus a GP because I did GP Shared Care and then I had three different midwives during the labour.

Homebirth includes a 'plan to transfer'. This is in the case of complications that mean the labour is not safe to continue without obstetric intervention. Same as in hospital, if there are complications requiring a transfer to theatre for a caesarean then that's what you do.

In HOSPITAL a midwife will spot the deviation from normal and arrange the transfer to theatre where the obstetrician will take over.

At HOME a midwife will spot the deviation from normal and arrange the transfer to theatre where the obstetrician will take over.

In hospital this usually requires that the obstetrician on shift comes in to confirm, or in some cases the obstetrician is called in from home. In homebirth this call is made by the midwife, and then the transfer is made straight to hospital.

A homebirth midwife is unlikely to get it wrong - she is trained in spotting the deviation from normal childbirth and she will have seen many many many normal childbirths in her career. So she knows what is normal, and what isn't. Occasionally a trip to hospital will be made for further monitoring, sometimes the birthing woman decides to transfer because she wants more pain relief, sometimes the complications mean she needs to stay in for an instrumental delivery, sometimes she will return home to continue the labour.

My homebirth included a plan to transfer. Of course! I trust my midwife, she knows me, she cares about me, I am paying her to take care of me. If she could see my labour wasn't progressing as it should then she would have told me, same as in hospital.

So, in the news this week, all over the telly and in the newspaper Dannii Minogue has been criticised for her decision to trial her labour at home. She used her back up plan because it was needed due to complications. This isn't "homebirth gone wrong". This is homebirth using the back up plan that is always in place. It was always a possibility, it would have been agreed upon and discussed. Transfers aren't necessarily 'an emergency dash', most consist of a drive to hospital, sometimes in the midwife's car, sometimes in your own car, or if there is heavy traffic, in an ambulance to be able to get there in good time. There is no more "drama" than there would be at the hospital.

Once the call is made in hospital for a caesarean then this is discussed, forms are signed and then there is the transfer to theatre. Many emergency caesareans that really are an emergency are caused by an induction that has gone haywire. Induction doesn't happen in a home trial of labour, it only happens in hospital trial of labour so in a homebirth that complication is eliminated completely.

A prominent obstetrician (I won't say his name) who has never attended a homebirth, openly hates midwives and is actively trying to prevent women being able to access homebirth. He has stated this during a recent review of maternity services. He is on the telly spouting figures about a baby being four times more likely to die in a planned homebirth. In the next TV interview that figure had jumped to seven times more likely. No one asked him where he got those figures so lets examine what he is actually saying and where he got the figures from.

Note he said "planned homebirth". So this includes births that were originally planned at home but ended up being in hospital BEFORE labour began. The PREGNANCY was transferred to hospital based care. The outcome of that is that the babies were four times more likely to die than other hospital births. But thats the crux of it isn't it? if your pregnancy is considered risky before the labour even starts, then you are considered a 'high risk pregnancy'. Homebirth is only recommended for 'low risk pregnancies'.

If your pregnancy turns high risk then your midwife will no longer recommend (or agree) that you have a trial of labour at home. Its off to hospital for you from the get-go, same as everybody else. Babies born from a high risk pregnancy might be four times more likely to die during birth buddy, but that's not what you are trying to get us all to believe are you??? Or is it seven times? make up your mind. These babies die in hospital, but because the original "plan" was to homebirth all those months ago at the start of the pregnancy then they are "planned homebirths". Ugh.

Incidentally when this 'switch of care' happens during pregnancy this is not the 'transfer rate' that this obstetrician is spouting about for transfer from homebirths. He is saying 50% of women transfer from homebirth to hospital. That particular figure is from one government funded homebirth program where half of the women who ask for a homebirth are 'risked out' of the possibility during their PREGNANCY. But he wants us to believe it means that half of all the homebirths being attempted at home are rushed to hospital during the labour. Not true. Sneaky. Lies. The government program will risk women out to many factors, gestational diabetes, strep B positive, over 40 weeks+10 days gestation, first time mothers, older mothers, mothers with a high body mass index. Most of these women would be perfectly fine and have a natural delivery anyway, but its their program and they run it how they want to.

And why is that when other countries who readily accept homebirth and have homebirth programs with every maternity  hospital show that outcomes of homebirth for low risk pregnancy (remember its not recommend for high risk pregnancy anyway) are the same as outcomes for hospital births? Countries such as the Netherlands (where a third of women birth at home) and the UK, and NZ. The studies have been done using a proper sample size of ACTUAL homebirths. The facts are there in black and white. Homebirth for low risk woman attended by a trained midwife with a back up plan for transfer is completely safe.

A baby born by caesarean after an attempted vaginal birth that started in hospital isn't considered a "hospital birth gone wrong". So why say it after a trial of labour at home?

I am sure Dannii Minogue is disappointed that she didn't get the natural delivery she obviously wanted, that disappointment is completely normal and "allowed". Women who end up with caesareans after a labour that started in hospital feel this way too.

A healthy baby at the end of a labour  is never "wrong" and in this case its a 'homebirth using the back up plan' gone absolutely right.

Why do I care? Well, obviously I had a homebirth and I don't particularly enjoy people saying I am irresponsible, an idiot, selfish or saying that I care more about candles and music than I do about the safe birth of my baby.

Who, incidentally was born after a four hour labour, into the water and caught by me. Nobody rescued us, nobody put us in danger and then saved us from it, and yes it was lovely, and ecstatic and beautiful and I did have candles (but no music, just silence please) but most of all it was the SAFEST way for my baby to be born. No interference because none was needed.


Thank you.