O23 - Ten years of a publicly funded homebirth in Victoria: maternal and neonatal outcomes

Abstract

The majority of Australian women birth in a hospital, with approximately 1% of women having a homebirth. There are currently 15 publicly-funded homebirth services in Australia. The clinical outcomes of homebirth services are rarely reported. To report maternal and neonatal outcomes of the first ten years of operation of a single publicly funded homebirth program in a large metropolitan health service in Australia, 2009-2019. Retrospective analysis of clinical outcome data of women and their babies who intended to have a homebirth. Case records of all women (n=827) who were identified as wanting a homebirth were included. Maternal, birth, and neonatal outcomes were compared for: (a) women who birthed at home; and (b) those who were referred to the program but did not birth at home. Descriptive statistics and non-parametric tests were conducted. Of the 827 women seeking homebirth, 621 remained eligible at 36 weeks’ gestation, 562 commenced labour at home, and 483 birthed at home. The women who had a homebirth were more likely to be multiparous, be married or in a de facto relationship, have a normal vaginal birth, have an intact perineum, and less likely to require suturing compared to those who wanted a homebirth but gave birth in hospital. Infants born at home were less likely to require resuscitation and to be of low birth weight, and more likely to be exclusively breastfed in the early days after birth than the infants born in hospital. There was one neonatal death of a baby born at home before arrival of a midwife. The outcomes for women accepted into the publicly funded homebirth program are reassuring and suggest appropriate triaging and case selection. A publicly funded homebirth program, with appropriate governance and clinical guidelines, is a safe option for women experiencing low-risk pregnancies.