Home birth or hospital birth - which is right for me?
For those of you familiar with my philosophy on birth, you'll know that the cornerstone of my approach is advocating for choice.
One of the most pivotal decisions in pregnancy is where to give birth. Whether it’s a hospital, a home, or somewhere a bit more unusual, every woman deserves the right to CHOOSE — and to have that choice respected. In this post, I aim to present home and hospital births as equally valid options, avoiding any bias that paints one as 'better' than the other. For a deeper dive into the wider birthing options available in Perth, please click here for more information.
Despite 97% of Australian women giving birth in hospitals and only a mere 0.5% at home, this disparity doesn’t necessarily imply that hospitals are the superior choice. Let's delve deeper into the factors influencing these choices…
There are pros and cons to both - the most important thing to remember is that it’s your choice to make!
The shift from home to hospital
The rise of obstetrics has dramatically reshaped the landscape of childbirth, transitioning it from a predominantly home-based, midwife-led experience to a medicalised process closely monitored and managed within hospital settings. This evolution began in earnest during the 19th century as the medical community sought to improve maternal and infant survival rates through scientific and technological advances. The field of obstetrics has since focused on “optimising” the birthing process (i.e. making the female body more efficient) and the prevention and management of complications. Home births have become a rarity, leading to a cultural shift where birthing in the hospital is now considered the norm.
Home birth is still a controversial topic, with the biggest question being “is it safe?”. I could quote an abundance of research studies which have proven home birth to be a safe option, even for high-risk women, but ultimately it comes down to what feels right for you. The word “safe” is open to individual interpretation. For some women, feeling safe means giving birth in the sanctuary of their own home, whilst for others it means having immediate access to medical facilities.
To give you some food for thought, I’ve listed five reasons why home birth is worth considering, and five reasons why a hospital birth might be a better fit. Of course there are more, but the most important point to take away from this post is that yes, you do have a choice! Trust yourself to make the decision which is best for you.
Five reasons why women choose to birth at home:
Home birth services, whether publicly funded or with a private midwife, offers continuity of care from a known midwife/team of midwives. This gives a more personalised feel to your maternity care.
Birthing in the comfort and security of a familiar environment promotes the physiology of birth.
Women have complete control over their birth space.
Midwives who are experienced with home births have a greater respect and understanding of birth physiology, and women are therefore less likely to require interventions.
There are no limitations on who can be present at the birth, including children and pets!
Home birth doesn’t appeal to everyone, and that’s OK! A lot of the debate in support of and in opposition to home birth is exactly the same as the dialogue discussing hospital birth, only in reverse - one is portrayed as “safe” and the other as “dangerous”. Advocates of home births often cite concerns about over-medicalisation and unnecessary interventions in hospitals, which they argue could lead to adverse outcomes Those who speak out against home birth voice concerns over how emergency situations may be managed and how delayed access to hospital facilities may lead to adverse outcomes. Ultimately, the decision of where to give birth is deeply personal. It comes down to where you feel safest and most supported. Reflect on all factors important to you, trust your instincts, and choose the environment that best aligns with your vision for your birth experience.
Now, let's explore the other side of the spectrum. Here are some reasons why women opt for a hospital birth...
Five reasons why women choose to birth in a hospital:
A hospital environment may provide a greater sense of security knowing that medical interventions are readily available.
Hospitals offer more options for pain relief.
24/7 care is available for the duration of your stay.
Their chosen care provider is an obstetrician.
Fear of judgement/lack of support from others if they were to choose a home birth.
Birth centres - the best of both worlds?
Home or hospital aren’t the only two options on the table, with birth centres providing (almost) a happy medium between the two. Women are still cared for by a known midwife/midwives in a home-like setting, but with easy access to hospital services if required. However, the major downside to accessing a birth centre is their strict exclusion criteria - if you’re risked out of a publicly funded home birth programme, then chances are you won’t be able to access a birth centre for the same reason. This is very frustrating.
Why I would love to see an overhaul of the “low risk” and “high risk” criteria.
If we are to see the provision of true choice in maternity care, then exclusion criteria for services such as home birth programmes, midwifery group practices and birth centres would be abolished entirely. This would be the dream, but in reality, it’s never likely to happen due to institutional guidelines and policies which dictate clinical practice, and the fear of litigation. Let’s get real here - what the system is saying is that only women who fit a very narrow set of parameters are able to choose their place of birth. If there is even a whiff of “risk”, they want to funnel you into the hospitals and under the care of an obstetrician. If you’re lucky enough to receive the “low risk” label at the beginning of your pregnancy, the pressure is then on to keep it.
Here are 5 reasons why you would be denied access to midwifery-led care, publicly funded home birth services, and birth centres:
If you’re under the age of 18 or over the age of 35.
If you’ve had a previous Caesarean.
If your BMI is over 35.
If you are having more than one baby.
If you have a history of mental health problems.
These criteria, among others, significantly limit the choices of many women regarding where they can give birth, and who cares for them (in the public system these are all automatic referrals to an obstetrician). Consider the demographics: in 2021, the average age of mothers was 31.1 years — a figure that continues to rise. Additionally, the national Caesarean rate was 38% and is also climbing. Furthermore, 24% of women were classified as obese, with a BMI over 30, and multiple births (the birth of more than one baby from a single pregnancy) accounted for 2.7% of all births. Shouldn’t these women also have the right to choose where they birth their babies?
Where can I go to find out more about home birth?
One of the best ways to find out more about home birth, and whether it may be the right option for you, is to get involved with your local home birth community. Chat to other women and their families about their experiences. If you’re looking for facts and statistics, here are my favourite sources of reliable, evidence-based information on home births:
Dr Sara Wickham’s website
Kim Woodard Osterholzer’s books
Stream the documentary “Birth Time” using my affiliate link and coupon code CICADA20 for 20% off!
What about hospitals in my area?
Getting information or statistics about individual hospitals is often like trying to get blood out of a stone! The best ways to get a feel for a hospital are talking with other women who have birthed there, check out consumer feedback on the Care Opinion website and reflecting on how you feel during your appointments - do you feel valued and respected, or were things a bit rushed and impersonal? It’s never too late to change care providers if you feel it’s not the right place or person for you.
If you choose to birth in a public hospital, your GP will refer you to the one which falls within your geographical area - click here to find out which hospital you will be referred to. If there is a particular hospital you wish to be referred to, or one you wish to avoid, you can discuss this with your GP.
Public Hospitals in the Perth Metro area (north to south):
Joondalup Health Campus, Joondalup.
Osborne Park Hospital, Stirling.
St John of God Public Hospital, Midland.
King Edward Memorial Hospital, Subiaco.
Fiona Stanley Hospital, Murdoch.
Armadale Health Services, Mount Nasura.
Rockingham General Hospital, Rockingham.
If you choose to birth in a private hospital, then you can choose which one you would like to book with regardless of where you live. A referral from your GP is usually required. You can either choose your hospital and then the GP will refer you to one of the obstetricians, or you can choose your preferred obstetrician and the GP will refer you directly to them. Please keep in mind that your chosen obstetrician is subject to availability, so it is a good idea to research a few options just in case your first choice is fully booked.
Private Hospitals in the Perth Metro area (north to south):
Joondalup Private Hospital, Joondalup.
Peel Health Campus Private Maternity Ward, Mandurah.
To finish off…
In choosing between a home birth and a hospital birth, the decision ultimately rests with you. Both options come with their distinct advantages and potential drawbacks, and the right choice for one woman may not be the best for another. Home births can offer a more intimate, personalised experience with fewer medical interventions, while hospital births provide immediate access to medical care and pharmacological pain management. It's crucial that your decision aligns with your own values and what you feel is best for you and your family. Navigating this decision can be challenging, especially when facing conflicting opinions, but trust in yourself and ensure you have a supportive birth team who will respect and uphold your choices.