Publicly funded homebirth in Australia: a review of maternal and neonatal outcomes over 6 years

Christine Catling-Paull, Rebecca L Coddington, Maralyn J Foureur and Caroline S E Homer, on behalf of the Birthplace in Australia Study and the National Publicly-funded Homebirth Consortium
Med J Aust 2013; 198 (11): 616-620. || doi: 10.5694/mja12.11665


Objective: To report maternal and neonatal outcomes for Australian women planning a publicly funded homebirth from 2005 to 2010.

Design, setting and subjects: Retrospective analysis of data on women who planned a homebirth and on their babies. Data for 2005–2010 (or from the commencement of a program to 2010) were requested from the 12 publicly funded homebirth programs in place at the time.

Main outcome measures: Maternal outcomes (mortality; place and mode of birth; perineal trauma; type of management of the third stage of labour; postpartum haemorrhage; transfer to hospital); and neonatal outcomes (early mortality; Apgar score at 5 minutes; birthweight; breastfeeding initially and at 6 weeks; significant morbidity; transfer to hospital; admission to a special care nursery).

Results: Nine publicly funded homebirth programs in Australia provided data accounting for 97% of births in these programs during the period studied. Of the 1807 women who intended to give birth at home at the onset of labour, 1521 (84%) did so. 315 (17%) were transferred to hospital during labour or within one week of giving birth. The rate of stillbirth and early neonatal death was 3.3 per 1000 births; when deaths because of expected fetal anomalies were excluded it was 1.7 per 1000 births. The rate of normal vaginal birth was 90%.

Conclusion: This study provides the first national evaluation of a significant proportion of women choosing publicly funded homebirth in Australia; however, the sample size does not have sufficient power to draw a conclusion about safety. More research is warranted into the safety of alternative places of birth within Australia.

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  • Christine Catling-Paull1
  • Rebecca L Coddington2
  • Maralyn J Foureur3
  • Caroline S E Homer4
  • on behalf of the Birthplace in Australia Study and the National Publicly-funded Homebirth Consortium

  • Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, NSW.


We acknowledge and thank the members of the National Publicly-funded Homebirth Consortium. The Chief Investigators of the Birthplace in Australia Study are: Caroline Homer, Maralyn Foureur and David Sibbritt (University of Technology Sydney); David Ellwood (Australian National University); Jeremy Oats (University of Melbourne); Della Forster and Helen McLachlan (La Trobe University); and Hannah Dahlen (University of Western Sydney). This study was part of the Birthplace in Australia Study, funded through a National Health and Medical Research Council Project Grant (2012–2015).

Competing interests:

No relevant disclosures.

  • 1. Ellwood D. The debate about place of birth. Aust N Z J Obstet Gynaecol 2008; 48: 449.
  • 2. Dahlen HG, Homer CSE, Tracy SK, Bistis AM. Planned home and hospital births in South Australia, 1991-2006: differences in outcomes [letter]. Med J Aust 2010; 192: 726-727. <MJA full text>
  • 3. Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009. Canberra: Commonwealth of Australia, 2009.
  • 4. Sweet M. The AMA says we are “shooting the messenger” re homebirth critique. Croakey: the Crikey health blog. 21 Jan 2010. (accessed Mar 2013).
  • 5. Keirse MJ. Home birth: gone away, gone astray, and here to stay. Birth 2010; 37: 341-346.
  • 6. Laws PJ, Lim C, Tracy S, Sullivan EA. Characteristics and practices of birth centres in Australia. Aust N Z J Obstet Gynaecol 2009; 49: 290-295.
  • 7. Tracy SK, Dahlen H, Laws P, et al. Birth centers in Australia: a national population-based study of perinatal mortality associated with giving birth in a birth center. Birth 2007; 34: 194-201.
  • 8. Tracy SK, Hartz D, Nicholl M, et al. An integrated service network in maternity — the implementation of a midwifery-led unit. Aust Health Rev 2005; 29: 332-339.
  • 9. Tracy S, Sullivan E, Dahlen H, et al. Does size matter? A population based study of birth in lower volume maternity hospitals for low risk women. BJOG 2006; 113: 86-97.
  • 10. Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Home births. College Statement: C-Obs 2. Melbourne: RANZCOG, 2009. (accessed Feb 2013).
  • 11. Australian College of Midwives. Maternity Services Review submissions. Submission 380. Canberra: Department of Health and Ageing, 2008.
  • 12. Royal College of Obstetricians and Gynaecologists, Royal College of Midwives. Home births. Joint statement No. 2, April 2007. London: RCOG and RCM, 2007. HomeBirths2007.pdf (accessed May 2013).
  • 13. Kennare RM, Keirse MJ, Tucker GR, Chan AC. Planned home and hospital births in South Australia, 1991-2006: differences in outcomes. Med J Aust 2010; 192: 76-80. <MJA full text>
  • 14. Bastian H, Keirse MJ, Lancaster PA. Perinatal death associated with planned home birth in Australia: population based study. BMJ 1998; 317: 384-388.
  • 15. Pesce A. Planned homebirths in Australia: art, science or politics? O&G Magazine 2009; 11: 29-30.
  • 16. Pesce AF. Planned home birth in Australia: politics or science? [editorial]. Med J Aust 2010; 192: 60. <MJA full text>
  • 17. Newman LA. Why planned attended homebirth should be more widely supported in Australia. Aust N Z J Obstet Gynaecol 2008; 48: 450-453.
  • 18. Olsen O, Clausen JA. Planned hospital birth versus planned home birth. Cochrane Database Syst Rev 2012; (9): CD000352.
  • 19. McLachlan H, Forster D. The safety of home birth: is the evidence good enough? CMAJ 2009; 181: 359-360.
  • 20. Li Z, Zeki R, Hilder L, Sullivan EA. Australia’s mothers and babies 2010. Canberra: Australian Institute of Health and Welfare National Perinatal Epidemiology and Statistics Unit, 2012. (AIHW Cat. No. PER 57; Perinatal Statistics Series No. 27.) (accessed May 2013).
  • 21. Live births in England and Wales by characteristics of birth, 2010. UK: Office for National Statistics. (accessed Oct 2012).
  • 22. MacDorman MF, Declercq E, Mathews TJ. United States home births increase 20 percent from 2004 to 2008. Birth 2011; 38: 185-190.
  • 23. Davis D, Baddock S, Pairman S, et al. Planned place of birth in New Zealand: does it affect mode of birth and intervention rates among low-risk women? Birth 2011; 38: 111-119.
  • 24. EURO-PERISTAT project; SCPE, EUROCAT, EURONEONET. European perinatal health report. 2008. (accessed May 2013).
  • 25. Australian Government Department of Health and Ageing. Improving maternity services in Australia. Report of the Maternity Services Review. Canberra: Commonwealth of Australia, 2009. review-report (accessed May 2013).
  • 26. Dahlen H, Jackson M, Schmied V, et al. Birth centres and the National Maternity Services Review: response to consumer demand or compromise? Women Birth 2011; 24:165-172.
  • 27. Catling-Paull C, Foureur MJ, Homer CS. Publicly-funded homebirth models in Australia. Women Birth 2012; 25: 152-158.
  • 28. ALSO. Advanced life support in obstetrics [website]. (accessed Mar 2013).
  • 29. Homer C, Caplice S. Evaluation of the publicly-funded homebirth program in South East Sydney Illawarra Area Health Service. September 2007. Sydney: Centre for Midwifery, Child and Family Health, Faculty of Nursing, Midwifery and Health, University of Technology Sydney, 2007.
  • 30. McMurtrie J, Catling-Paull C, Teate A, et al. The St. George Homebirth Program: an evaluation of the first 100 booked women. Aust N Z J Obstet Gynaecol 2009; 49: 631-636.
  • 31. Thiele B, Thorogood C. Community based midwifery program in Fremantle WA. Fremantle: Centre for Research for Women and the Fremantle Community Midwives, 1997.
  • 32. Hider K. Evaluation of the Casey Hospital Home Birth Pilot. Melbourne: Centre for Clinical Effectiveness, Southern Health, 2011.
  • 33. Nixon A, Bryne J, Church A. The Community Midwives Project: an evaluation of the set-up of the Northern Women’s Community Midwives Project. June 1998 – November 2000. Adelaide: Northern Metropolitan Community Health Service, 2003.
  • 34. Bastian H. Commentary: Why are researchers surprised when there is not a smooth transition from research into practice? BMJ 1998; 317: 1230.
  • 35. Gyte G, Dodwell M, Newburn M, et al. Estimating intrapartum-related perinatal mortality rates for booked home births: when the ‘best’ available data are not good enough. BJOG 2009; 116: 933-942.
  • 36. Johnson KC, Daviss BA. Outcomes of planned home births with certified professional midwives: large prospective study in North America. BMJ 2005; 330: 1416-1422.
  • 37. de Jonge A, van der Goes BY, Ravelli AC, et al. Perinatal mortality and morbidity in a nationwide cohort of 529,688 low-risk planned home and hospital births. BJOG 2009; 116: 1177-1184.
  • 38. Murphy PA, Fullerton J. Outcomes of intended home births in nurse-midwifery practice: a prospective descriptive study. Obstet Gynecol 1998; 92: 461-470.
  • 39. Janssen PA, Saxell L, Page LA, et al. Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician. CMAJ 2009; 181: 377-383.
  • 40. Wax JR, Pinette MG, Cartin A, Blackstone J. Maternal and newborn morbidity by birth facility among selected United States 2006 low-risk births. Am J Obstet Gynecol 2010; 202: e1-e5.
  • 41. Wax JR, Lucas FL, Lamont M, et al. Maternal and newborn outcomes in planned homebirth vs planned hospital births: a metaanalysis. Am J Obstet Gynecol 2010; 203: e1-e8.
  • 42. Vedam S, Janssen PA, Lichtman R. Science and sensibility: choice of birth place in the United States. Medscape News [internet] 2010; 25 Feb. (accessed Jan 2013).
  • 43. Birthplace in England Collaborative Group, Brocklehurst P, Hardy P, Hollowell J, et al. Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. BMJ 2011; 343: d7400. doi: 10.1136/bmj.d7400.
  • 44. Lindgren HE, Hildingsson IM, Christensson K, Rådestad IJ. Transfers in planned home births related to midwife availability and continuity: a nationwide population-based study. Birth 2008; 35: 9-15.
  • 45. Hatem M, Sandall J, Devane D, et al. Midwife-led versus other models of care for childbearing women. Cochrane Database Syst Rev 2008; (4): CD004667.
  • 46. Fahy K, Hastie C, Bisits A, et al. Holistic physiological care compared with active management of the third stage of labour for women at low risk of postpartum haemorrhage: a cohort study. Women Birth 2010; 23: 146-152.
  • 47. Cameron CA, Roberts CL, Olive EC, et al. Trends in postpartum haemorrhage. Aust N Z J Public Health 2006; 30: 151-156.
  • 48. Nove A, Berrington A, Matthews Z. Comparing the odds of postpartum haemorrhage in planned home birth against planned hospital birth: results of an observational study of over 500,000 maternities in the UK. BMC Pregnancy Childbirth 2012; 12: 130.
  • 49. NSW Health. Maternity — towards normal birth in NSW. [Policy directive.] Sydney: NSW Health, 2010. (accessed May 2013).
  • 50. Australian Bureau of Statistics. Australian Health Survey: health service usage and health related actions, 2011-2012. Canberra: ABS, 2013. (ABS Cat. No. 4364.0.55.002.) au/ausstats/abs@.nsf/Lookup/6664B939E49 FD9C1CA257B39000F2E4B?opendocument (accessed Apr 2013).
  • 51. Australian College of Midwives. National midwifery guidelines for consultation and referral. 2nd ed. Canberra: ACM, 2008. and%20Referral%20Guidelines%202010.pdf (accessed Mar 2013).
  • 52. Government of South Australia. Policy for planned birth at home in South Australia. 4 July 2007. Adelaide: South Australian Department of Health, 2007. (accessed May 2013).
  • 53. NSW Health. Maternity — public homebirth services. [Policy directive.] Sydney: NSW Health, 2006. (accessed May 2013).
  • 54. Crotty M, Ramsay AT, Smart R, Chan A. Planned homebirths in South Australia 1976-1987. Med J Aust 1990; 153: 664-671.


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