Research Article| Volume 33, ISSUE 5, e420-e428, September 2020

A pathway to establish a publicly funded home birth program in Australia

Published:October 24, 2019DOI:



      Home births provide women a birth choice where they may feel more comfortable and confident in their ability to give birth.


      Most women in Victoria do not have publicly funded access to appropriately trained health professionals if they choose to give birth at home.


      This paper describes the process of setting up a publicly funded home birth service and provide details of description of the set up and governance. We also report outcomes over 9 years with respect to parity, transfer to hospital, adverse maternal and neonatal outcomes.


      Of the 191 women who were still booked into the home birth program at 36 weeks gestation, 148 (77.5%) women gave birth at home and 43 (22.5%) women were transferred into the hospital. The overall rate of vaginal birth was also high among the women in the home birth program, 185 (96.9%) with no added complications ascribed to home births. Such as severe perineal trauma [n = 1] 0.6% PPH [n = 4] 2.7%, Apgar score less than 7 at 5 min [n = 0] admissions post home birth to special care nursery [n = 2] 1.35%.


      This unique study provides a detailed road map of setting up a home birth practice to facilitate other institutions keen to build a publicly funded home birth service. The birth outcome data was found to be consistent with other Australian studies on low risk home births.


      Well-designed home birth programs following best clinical practices and procedures can provide a safe birthing option for low risk women.


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        • Jackson M.
        • Dahlen H.
        • Schmied V.
        Birthing outside the system: perceptions of risk amongst Australian women who have freebirths and high risk homebirths.
        Midwifery. 2012; 28: 561-567
        • Preis H.
        • Gozlan M.
        • Dan U.
        • Benyamini Y.
        A quantitative investigation into women’s basic beliefs about birth and planned birth choices.
        Midwifery. 2018; 63: 46-51
        • Forster D.A.
        • McKay H.
        • Davey M.A.
        • Small R.
        • Cullinane F.
        • Newton M.
        • et al.
        Women’s views and experiences of publicly-funded homebirth programs in Victoria, Australia: a cross-sectional survey.
        Women Birth. 2019; 32: 221-230
        • Coxon K.
        • Chisholm A.
        • Malouf R.
        • Rowe R.
        • Hollowell J.
        What influences birth place preferences, choices and decision-making amongst healthy women with straightforward pregnancies in the UK? A qualitative evidence synthesis using a ‘best fit’ framework approach.
        BMC Pregnancy Childbirth. 2017; 17: 103
        • Davies-Tuck M.L.
        • Wallace E.M.
        • Davey M.A.
        • Veitch V.
        • Oats J.
        Planned private homebirth in Victoria 2000-2015: a retrospective cohort study of Victorian perinatal data.
        BMC Pregnancy Childbirth. 2018; 18
        • Walker J.J.
        Planned home birth.
        Best Pract Res Clin Obstet Gynaecol. 2017; 43: 76-86
        • Catling-Paull C.
        • Coddington R.L.
        • Foureur M.J.
        • Homer C.S.
        Publicly funded homebirth in Australia: a review of maternal and neonatal outcomes over 6 years.
        Med J Aust. 2013; 198: 616-620
        • Scarf V.L.
        • Rossiter C.
        • Vedam S.
        • et al.
        Maternal and perinatal outcomes by planned place of birth among women with low-risk pregnancies in high-income countries: a systematic review and meta-analysis.
        Midwifery. 2018; 62: 240-255
        • Comeau A.
        • Hutton E.K.
        • Simioni J.
        • et al.
        Home birth integration into the health care systems of eleven international jurisdictions.
        Birth. 2018; 45: 311-321
      1. Home Births. [internet] 2017,

        • Rigg E.C.
        • Schmied V.
        • Peters K.
        • Dahlen H.G.
        Why do women choose an unregulated birth worker to birth at home in Australia: a qualitative study.
        BMC Pregnancy Childbirth. 2017; 17: 99
        • Broda A.
        • Krüger J.
        • Schinke S.
        • Weber A.
        Determinants of choice of delivery place: testing rational choice theory and habitus theory.
        Midwifery. 2018; 63: 33-38
      2. Australian Medical Association [Internet] position statement on maternal decision making. Available from:

      3. Australian Institute of Health Welfare [Internet]. Australia’s mothers and babies. Available from:

      4. National Health Services, UK [internet] Where to give birth: the options-Your pregnancy and baby guide. Available from:

      5. UTS Centre for midwifery, child and family health nationally funded homebirth consortium [Internet]. Available from:

        • Hollowell J.
        • Rowe R.
        • Townend J.
        • et al.
        Health Services and Delivery Research. The Birthplace in England national prospective cohort study: further analyses to enhance policy and service delivery decision-making for planned place of birth.
        NIHR Journals Library, Southampton (UK)2015
        • 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
        • McLachlan H.
        • McKay H.
        • Powell R.
        • et al.
        Publicly-funded home birth in Victoria, Australia: exploring the views and experiences of midwives and doctors.
        Midwifery. 2016; 35: 24-30
        • Jouhki M.R.
        Choosing homebirth—the women’s perspective.
        Women Birth. 2012; 25: e56-61
        • Forster D.A.
        • McLachlan H.L.
        • Davey M.A.
        • et al.
        Continuity of care by a primary midwife (caseload midwifery) increases women’s satisfaction with antenatal, intrapartum and postpartum care: results from the COSMOS randomised controlled trial.
        BMC Pregnancy Childbirth. 2016; 16: 28
        • Newton M.S.
        • McLachlan H.L.
        • Forster D.A.
        • Willis K.F.
        Understanding the ‘work’ of caseload midwives: a mixed-methods exploration of two caseload midwifery models in Victoria, Australia.
        Women Birth. 2016; 29: 223-233
        • B.B
        The benefits of home birth: evidence of safety effectiveness and women’s experience.
        2012 ([Accessed 20 June 2019])
        • Kumar A.
        • Wallace E.M.
        • Smith C.
        • Nestel D.
        Effect of an in-situ simulation workshop on home birth practice in Australia.
        Women Birth. 2018; 32: 346-355
        • Kumar A.
        • Nestel D.
        • Stoyles S.
        • East C.
        • Wallace E.M.
        • White C.
        Simulation based training in a publicly funded home birth programme in Australia: a qualitative study.
        Women Birth. 2016; 29: 47-53
        • Rossi A.C.
        • Prefumo F.
        Planned home versus planned hospital births in women at low-risk pregnancy: a systematic review with meta-analysis.
        Eur J Obstet Gynecol Reprod Biol. 2018; 222: 102-108
      6. Australian College of Midwives [internet] Transfer from Planned Home Births Guidelines. Available from: https://wwwmidwivesorgau/resources/australian-college-midwives-transfer-planned-birth-home-guidelines, 2016.

      7. Implementing a public home birth program: guidance for Victorian public health services 2015. [Internet]. Avaliable from:

        • Homer C.S.E.
        • Thornton C.
        • Scarf V.L.
        • et al.
        Birthplace in New South Wales, Australia: an analysis of perinatal outcomes using routinely collected data.
        BMC Pregnancy Childbirth. 2014; 14
        • Fox D.
        • Sheehan A.
        • Homer C.
        Birthplace in Australia: processes and interactions during the intrapartum transfer of women from planned homebirth to hospital.
        Midwifery. 2018; 57: 18-25
        • Sosa G.A.
        • Crozier K.E.
        • Stockl A.
        The experiences of midwives and women during intrapartum transfer from one-to-one midwife-led birth environments to obstetric-led units.
        Midwifery. 2018; 65: 43-50
        • Coddington R.
        • Catling C.
        • Homer C.S.E.
        From hospital to home: Australian midwives’ experiences of transitioning into publicly-funded homebirth programs.
        Women Birth. 2017; 30: 70-76
        • Petersen A.
        • Köhler L.M.
        • Schwarz C.
        • Vaske B.
        • Gross M.M.
        Outcomes of planned out-of-hospital and low-risk hospital births in Lower Saxony.
        Z Geburtsh Neonatol. 2017; 221: 187-197
        • Noble S.
        Promoting homebirth: intermediate homebirth report.
        Br J Midwifery. 2015; 23: 276-280
        • Bachilova S.
        • Czuzoj-Shulman N.
        • Abenhaim H.A.
        Effect of maternal and pregnancy risk factors on early neonatal death in planned home births delivering at home.
        J Obstet Gynaecol Can. 2018; 40: 540-546
        • Jensen S.
        • Colmorn L.B.
        • Schroll A.M.
        • Krebs L.
        Quality assessment of home births in Denmark.
        Dan Med J. 2017; 64
        • De Jonge A.
        • Geerts C.C.
        • Van Der Goes B.Y.
        • Mol B.W.
        • Buitendijk S.E.
        • Nijhuis J.G.
        Perinatal mortality and morbidity up to 28 days after birth among 743 070 low-risk planned home and hospital births: a cohort study based on three merged national perinatal databases.
        BJOG Int J Obstet Gynaecol. 2015; 122: 720-728
      8. https://

        • Fahy K.
        • Hastie C.
        • Bisits A.
        • Marsh C.
        • Smith L.
        • Saxton A.
        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
        • Eto H.
        • Hasegawa A.
        • Kataoka Y.
        • Porter S.E.
        Factors contributing to postpartum blood-loss in low-risk mothers through expectant management in Japanese birth centres.
        Women Birth. 2017; 30: e158-e164
        • Miller S.
        • Skinner J.
        Are first-time mothers who plan home birth more likely to receive evidence-based care? A comparative study of home and hospital care provided by the same midwives.
        Birth. 2012; 39: 135-144
        • Edqvist M.
        • Blix E.
        • Hegaard H.K.
        • et al.
        Perineal injuries and birth positions among 2992 women with a low risk pregnancy who opted for a homebirth.
        BMC Pregnancy Childbirth. 2016; 16