O4 - Insights gained from the first three years of a newly established publicly funded homebirth program

Abstract

There are high levels of consumer demand for homebirth however access is limited due to associated costs and limited numbers of sustainable publicly funded models. BackgroundHomebirth with a qualified midwife, networked into a health system, is a safe option for women with a low-risk pregnancy. This paper has two aims, the first is to describe the implementation of a publicly funded homebirth services with an employed mentor to ensure sustainability. The second is to provide the outcomes from a matched cohort of women (who received care from the same MGP) who gave birth at home compared with those who gave birth in hospital. Findings100 women gave birth at home during the study period, they were more likely to have a normal birth (p <0.001), intact perineum (p<0.0001), less likely to have a postpartum haemorrhage (p<0.0001) compared to the matched cohort of women who birthed in hospital. There were less assisted births and caesarean section births for women who transferred from home to hospital (p<0.0001). Babies born at home were less likely to have an Apgar score of <7 at 5minutes compared to the matched cohort of babies who were born in hospital ConclusionThe improved outcomes for women receiving MGP and choosing to birth at home demonstrate place of birth makes a difference. Implementation of a publicly funded homebirth model requires a specifically employed mentor midwife to enable midwives to transition from providing intrapartum care from hospital to a homebirth setting and ensures the sustainability of the service.The first three years have found improved outcomes for women through a matched cohort study who received care from the same MGP midwives.