Sunshine Coast publicly funded home birth information

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).

Who can I ask if I have more questions?

You can 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:

• Queensland Clinical Guidelines and SCHHS policies and procedures for maternity care
• Queensland Clinical Guidelines document ‘Publicly funded homebirth’ Guideline: Publicly funded homebirth (health.qld.gov.au)
• Queensland Clinical Guidelines document ‘Normal birth’ Guideline: Normal birth (health.qld.gov.au)
• Australian College of Midwives National Guides for Consultation and Referral (4th Edition 2021)
• RANZCOG ‘Intrapartum Fetal Surveillance Guideline’ 4^th Edition 2019:Intrapartum Fetal Surveillance Clinical Guideline – Fourth Edition 2019 (ranzcog.edu.au)
• RANZCOG ‘Maternal suitability for models of care, and indications for referral within and between models of care’
• RANZCOG Home Birth Policy Home Births (C-Obs 2) (ranzcog.edu.au)