Insights from a publicly funded homebirth program

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Midwifery

Background:

• High consumer demand for homebirth in Australia contrasts with limited access due to costs and few publicly funded models.
• Homebirth with a qualified, health-system-linked midwife is a safe option for low-risk pregnancies.

Purpose of the Study:

• To describe the implementation of a publicly funded homebirth service with an employed mentor.
• To compare outcomes of homebirths with hospital births within the same Midwifery Group Practice (MGP).

Main Methods:

• Retrospective comparative cohort study using electronic perinatal data (July 2018 - October 2021).
• Matched cohort of women receiving MGP care, comparing planned homebirths to hospital births.
• Matching criteria included parity, age, BMI, spontaneous labor, and gestation (37-42 weeks).

Main Results:

• Women planning homebirths had significantly higher rates of physiological birth (p<0.001) and intact perineums (p<0.0001).
• Homebirth group experienced significantly fewer postpartum hemorrhages (p<0.0001) and assisted/cesarean births after transfer (p<0.0001).
• No significant differences were observed in postpartum hemorrhage rates or Apgar scores <7 at 5 minutes between groups.

Conclusions:

• Publicly funded homebirth services, as implemented, demonstrate favorable outcomes compared to hospital births for low-risk pregnancies.
• The role of an employed mentor is crucial for the sustainability of publicly funded homebirth programs.
• Further research is recommended to evaluate the mentor's impact on program implementation and sustainability.