Home birth and the National Australian Maternity Services Review: too hot to handle?

In February 2009 the Improving Maternity Services in Australia - The Report of the Maternity Services Review (MSR) was released, with the personal stories of women making up 407 of the more than 900 submissions received. A significant proportion (53%) of the women were said to have had personal experience with homebirth. Little information is provided on what was said about homebirth in these submissions and the decision by the MSR not to include homebirth in the funding and insurance reforms being proposed is at odds with the apparent demand for this option of care.

Data for this study comprised 832 submissions to the MSR that are publicly available on the Commonwealth of Australia Department of Health and Aging website. All 832 submissions were downloaded, coded and then entered into NVivo. Content analysis was used to analyse the data that related to homebirth.

450 of the submissions were from consumers of maternity services (54%). Four hundred and seventy (60%) of the submissions mentioned homebirth. Overall there were 715 references to home birth in the submissions. The submissions mentioning homebirth most commonly discussed the 'Benefits' and 'Barriers' in accessing this option of care. Benefits to the baby, mother and family were described, along with the benefits obtained from having a midwife at the birth, receiving continuity of care and having a good birth experience. Barriers were described as not having access to a midwife, no funding, no insurance and lack of clinical privileging for midwives.

Many positive recommendations have come from the MSR, however the decision to exclude homebirth from these reforms is perplexing considering the large number of submissions describing the benefits of and barriers to homebirth in Australia. A concerning number of submissions discuss having had or having considered an unattended birth at home due to these barriers. Overall there is the belief that not enabling access to funded, insured homebirth in Australia is a violation of human rights. It appears that homebirth was considered by the MSR as 'too hot to handle' and by dismissing it as a minority issue the government sought to avoided dealing with homebirth as a 'sensitive and controversial issue.'