Publicly funded home birth

Published: 25 September 2024

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Dr Fiona McLellan
General Practitioner

When a woman presents to her GP with a positive pregnancy test after congratulations, we tend to talk them through the options for their pregnancy in terms of what we can do, investigations we may need and what sort of care the woman might want through their pregnancy. When the woman comes to me and expresses her interest in having a home birth, I would then put a referral into the hospital for her to be considered for that. Then that will get looked at by the obstetric team or a midwife and we’d decide if she’s eligible for a home birth.

For information on how to be referred in your area, check your local hospital and health service website.

How do I know if a Publicly Funded Home Birth (PFHB) is right for me?

Please note:

  • The PFHB program follows Queensland Health and Hospital Service guidelines and your local hospital policies.
  • The PFHB program places are not guaranteed due to individual and service constraints.
  • Please consult with your healthcare team to determine if this program is suitable for you

Sarah Handby
Clinical Midwife

The types of women that would like a home birth are healthy, motivated, they’ve got no complications in their pregnancy. We expect that their babies are going to be born healthy and they’re motivated to have a natural birth.

What are Inclusion/Exclusion Criteria?

Publicly Funded Home Birth is provided under Queensland Health inclusion/exclusion criteria and may differ between health services.

Some common inclusion criteria include:

  • Single baby pregnancy.
  • Low risk pregnancy.
  • Living within your local PFHB hospital's defined catchment area.
  • No medical or other reasons that increase your risk level.

You can talk to your midwife/doctor about your individual circumstances and whether the Publicly Funded Home Birth program at your health service is a good fit for you.

Abby Meyer

I want to have a home birth because I’ve been quite influenced by the stories of my friends and family who have had really positive home births. I am involved in the midwifery group practice where I have a midwife that’s been assigned to me that I’ve seen throughout my whole pregnancy and I’ve just had the continuity of care from one midwife the whole time and I don’t need to rely on her and ask her every five seconds you know is this right, she’s given me the power to know what’s happening.

Nicola Hamilton
Clinical Midwife

We would do the usual checks that we do for any pregnant woman, check her blood pressure and that her baby is growing well and do all her bloods as normal, so it would be exactly the same but we would just need to make sure that she was staying in that low risk category. She would need to consider whether she feels safe at home, comfortable at home and if she feels that she won’t be requiring extra pain relief options that aren’t available at home.

For me it’s birthing at home would be the safest place where I have my dog, my family, my partner. In hospital I don’t feel I could really let myself go and that actually might have some implications on my labour.

What does a Publicly Funded Home Birth (PFHB) look like?

Part of a woman’s birth plan, and as the baby’s close to coming, the woman will choose to make the house as comfortable as she would like. So she could have music therapy, she could be in the bath, she could be in the shower. We will accommodate and enable her to birth that baby as she wants to.

The biggest plan that I have in place is to have a water birth. It’s your own journey. You’re in your own home. You’ve got all your comforts. I don’t have to worry about getting back to my dog. I’ve got higher chance of breastfeeding success.

During a home birth, the woman will go into spontaneous labour. Will be triaged over the phone. Once she feels she needs that additional support, the midwife will go to her house and set up and continue to observe her during the birth as we would in the hospital.

We would expect that the mum and baby to stay at home after the birth if everything goes to plan and then we can do all the postnatal care from home after birth as well.

Dr Adeline Foo
Obstetrics and Gynaecology

The role of the obstetrician at the time of home birth would be to provide additional support for women who require additional obstetric care. Midwives will be the primary carer for the women in labour and we all work as a team, but in the hospital, being the obstetrician on call, will be made aware of any concerns that our midwife has for the woman when she’s in labour.

What happens if transfer from home to hospital is recommended?

We have really good relationships with the Queensland Ambulance Service and we have procedures in place to facilitate that as smoothly as possible and in a timely manner.

Tony Hucker
Queensland Ambulance Service

The Queensland Ambulance has been involved. We have seen a group of very professional, dedicated, caring people come together and demonstrate a program that can be put in place. It’s going to take birthing into the community but doing it in a way that’s going to be so safe.

There are some things that may not go to plan in a home birth. For instance, a slow or lack of progress in labour, women wanting additional pain relief options in labour, bleeding issues after delivering a baby.

The emergencies that may come up would be unusual bleeding, excess bleeding, meconium staining of the liquor, things that can be discussed with the woman at the time.

We are very keen to come and support when we need to, knowing we’ve got a midwife there that is going to be very, very supportive and if there are other things that are needed from a clinical perspective we can add those as well.

Immediately after the baby’s been born, the midwife’s role is to make sure that the mother and the baby are both well and enable that mother to have some uninterrupted time with her baby. This also enables the physiological process of the placenta to be birthed.

Dr Lisa Hong
Neonatologist

Neonatologists are specialists that care for newborn babies. At any point in time through the home birth program if the midwife and the mum has any concerns that the baby is unwell or unhappy, they can call the neonatal team for advice on whether the birth can continue to occur at home or that it’s best for baby and mum to actually present to the hospital for ongoing management and assessment.

The important thing, you and bub will go together. That’s what we want to do. We’ll go into the back of an ambulance and then they’ll be a steady drive off to hospital with both the midwife and paramedics caring for you on the way.

I think having that close relationship with the woman and her family, it means that we can have those open and frank discussions about changes in risk status, if there’s any recommendation that we might have to go to the hospital, but it’s always an informed decision with informed consent. It’s a woman’s centred approach.

What happens if I decline recommended care?

  • Your care team will discuss the risks and benefits of recommended care to help you make an informed choice.
  • You can decline or withdraw consent for care at any time by speaking with your care team.
    Your care team will discuss next steps with you if you choose to decline care.
  • For more information on declining recommended care, refer to Queensland Clinical Guidelines - Partnering with Women Declining Recommended Care.
  • Consult with your midwife about your health service's specific arrangements for care in such cases.

I try not to put massive expectations on birth because anything could happen, but what I do expect from a home birth is very minimal intervention and that I’m sort of left alone to birth in the way that I want to birth. I will have the support there which is reassuring to know that my midwife is there. She’s monitoring me but she’s monitoring me from a distance and she’s just letting me get on with my birth and how I want to birth.

For further information on Publicly Funded Home Birth programmes in your area, check your local Queensland Health hospital and health service website and the Queensland Clinical Guidelines Consumer information.

Special thanks to Office of the Chief Midwife Officer, Clinical Excellence Queensland. Developed with funding from Clinical Excellence Queensland

Queensland Government logo.

Congratulations on your pregnancy. Giving birth at home can be a fulfilling and safe experience for you and your family

This article will help answer questions you may have if you are considering expressing interest in the Sunshine Coast publicly funded homebirth service, commencing in the second half of 2024. Your midwife can also help to answer any questions you have.

Who can have a homebirth?

Women who are healthy with a low-risk pregnancy, could be considered for a homebirth. This will be decided through discussion and assessment of your pregnancy and previous birth experiences. The option of a homebirth will also depend on availability and your location.

Through the Sunshine Coast University Hospital, a publicly funded homebirth could be available to women who:

  • Are healthy
  • Are anticipating a low-risk labour and birth
  • Would birth within the included geographic area, in a suitable home environment

During your pregnancy, you and your midwife will monitor your health. The final decision to commence labour with the intention of birthing at home can be made later in your pregnancy.

Are there any advantages of having a homebirth?

Homebirth with a registered midwife is a safe option for many women, with many benefits. Women often report that they felt more comfortable and in control while labouring and birthing in their own environment.

How do I express my interest in a homebirth?

Contact either your General Practitioner (GP) and/or your midwife and let them know you are interested in homebirth. You can express your interest for a homebirth by sending an email to sc-mgp@health.qld.gov.au and / or ask your GP to include your interest with your referral to the Sunshine Coast University Hospital (SCUH)

You can also decide at any stage during your pregnancy that you are interested in a homebirth. If you are receiving care in the homebirth service, you can also decide that homebirth is no longer right for you. Please discuss with your midwife or health care provider.

What is the process once I’ve expressed my interest in a publicly funded homebirth?

Confirmation of a place in the homebirth service at Sunshine Coast University Hospital (SCUH) will be finalised when a midwife has met with you and assessed your suitability for a homebirth.

Who attends homebirths?

Two midwives will attend each homebirth. The first midwife will be the 'primary midwife' and will be the midwife who has provided you with (some/most of) your antenatal care.

As with hospital births, the primary midwife calls a second midwife when birth is imminent. This additional midwife is known as the support midwife.

Are water births available in the Sunshine Coast Homebirth service?

Yes. Water births are supported within Homebirth service and can be discussed with your midwife.

What is the role of my midwife when I am in labour?

Your midwife’s role during a labour and birth at home is very similar to their role if you were birthing in hospital. With your consent, they will closely monitor you and your baby by listening to your baby’s heartbeat and regularly checking your blood pressure, pulse, temperature, and progress of labour.
Your midwife will offer professional and emotional support throughout your labour and you should talk openly with each other about any changes that might be needed to ensure you have a positive birth experience that is safe for you and your baby.

What options are available to manage my pain during a home birth?

As with hospital births there are a number of options available for you including simple analgesia (such as paracetamol), massage, heat packs, movement and positioning, breathwork or using a personal TENS machine.

Most other pain management medicines (such as opioids or regional analgesia eg epidural) are not able to be accessed in the home environment. Please talk to your midwife about your pain management plan.

What happens if I need to be transferred to hospital during my homebirth?

You may decide, during your labour, that you don’t want to birth at home any more. The most common reason women transfer from home to hospital is to access pain relief options that are not available at home.

Your midwife will also advise you if you or your baby need to transfer to hospital for safety reasons.

Depending on the situation, you may transfer to the hospital in your car, or the midwife may decide to call an ambulance.

Will my midwife stay with me if I am transferred to hospital?

The midwife will continue your care if you are transferred to hospital.

What happens if I change my mind about homebirth? Can I change my mind and go to hospital at any point during my pregnancy or during labour?

If during pregnancy and/or your labour, you decide that you would prefer a hospital birth rather than a homebirth, you can raise your concerns at any point with your midwife and they will discuss the option to transfer to the hospital.

You will continue to receive care in the hospital from your known midwife or an MGP midwife. In some circumstances you may have care from midwives that normally work in birth suite if your known midwife is unavailable to provide ongoing care.

Can my family be with me during my homebirth?

Yes, you can discuss and plan with your midwife who you would like to support you during labour, birth and after your baby is born.

What happens after the birth?

Your midwife will stay with you until you and your baby are safe, comfortable, and feeding well, usually about four to six hours. A midwife will continue to be available by phone and will visit you regularly at home in the six weeks after birth.

Will my baby be checked by a doctor?

No, our midwivesare qualified to assess your baby’s health after birth.

If the midwife has any concerns, they will speak with a medical professional who specialises in caring for newborn babies (neonatologist) and/or transfer to hospital if required. If you wish to have your baby checked by a doctor, you can visit your GP at any stage.

How will problems be dealt with during my pregnancy, labour and birth?

It is important to note that problems can arise in any pregnancy, labour and birth. Ongoing assessments throughout your pregnancy, labour and birth will occur, to monitor you and your baby. The midwife may assess and recommend that homebirth is no longer a safe option for you.

We have a detailed plan should you need to be transferred to the Sunshine Coast University Hospital (SCUH) during your labour or you or your baby after birth. In the event of an emergency, the Queensland Ambulance Service (QAS) will attend as quickly as possible to assist your midwife with this transfer.

You may also require urgent transfer to hospital if your baby needs closer monitoring, or to have a caesarean section to help you give birth. Some pain management may not be available at home, and it will be necessary to move to hospital if you choose these forms of pain management.

What are the risks associated with having a homebirth?

There are risks associated with every birth, including homebirth.

When having a homebirth, these risks are low because women who are eligible for the program have an uncomplicated pregnancy and birth history.

While they occur infrequently the most common needs to transfer during labour include prolonged labour or a need for pain relief. Some pain relief options are not available at home, and it may become necessary to move to hospital if you choose these forms of pain management.

After birth there is a small risk of emergency transfer for excessive bleeding or if baby has difficulty breathing. Transfer may also be required if any additional treatment is needed for perineal trauma or fever.

Your homebirth midwives have the training and equipment to provide support until extra help arrives. In the event of an emergency, the Queensland Ambulance Service (QAS) will attend as quickly as possible to assist your midwives to safely transfer you and your baby to Sunshine Coast University Hospital
(SCUH).

How to access this service

Find out more about our maternity services and how to access them.

Who can I ask if I have more questions?

You can view the Queensland Health Parent information: Publicly funded homebirth information sheet which aims to answer some commonly
asked questions about publicly funded homebirth.

You can also talk to your midwife and ask any questions you may have. Some of these questions might include:

  • Do I need a referral from a GP?
  • What is a suitable home environment?
  • I want my other children to be at my homebirth. What do I need to consider?
  • Where, and with who, will my antenatal appointment be?
  • What equipment do I need for a homebirth?
  • What equipment do the midwives carry?
  • What training and experience do the midwives have?
  • What are my options for the baby’s placenta after birth?
  • What if I rely on an interpreter?

Resources

Each woman’s level of risk is determined using the following documents:

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Last updated: 06 November 2024