Midwives in and around Melbourne have received a letter from the Women's Hospital in Parkville, telling us that backup bookings for women planning homebirth will now restricted to the local area. Women outside the catchment area for the Women's, who require transfer of care, are to "present to the local maternity hospital closest to your client's home."
Midwives attending homebirths privately in and around Melbourne have for many years had good collaborative arrangements with the Women’s Hospital and Monash Medical Centre in Clayton. If a woman or baby in the midwife’s care requires transfer to hospital, or referral for specialist assessment in pregnancy, the process is straight-forward, which is in the interest of the wellbeing of mother and baby. When the woman and midwife have completed the hospital booking-in process, the hospital gives the woman paperwork with the woman’s name on it, clearly marked ‘HOMEBIRTH BACK-UP’.
Other public hospitals that have, under this arrangement, been by-passed, will now be approached for back-up bookings. These include the Northern, Mercy, Box Hill, Angliss, Dandenong, Casey, Sandringham, Werribee Mercy, and Sunshine. Perhaps there are more.
The alternative is to present un-booked at a hospital. This practice is best avoided, for obvious reasons.
A midwife's commitment to the woman in her care is to always act to promote the wellbeing and safety of mother and child. There is no way to predict the possible need for transfer of care. Women who choose the care of a private midwife for planned homebirth are not a uniform group. Each pregnant woman has a unique personal story which sometimes includes aspects of risk. The group of women who plan homebirth are usually assessed as low risk, but there is no risk-free situation whether birth is planned at home or hospital. Risk may be associated with previous pregnancies, or weight, or something else.
The main hurdle faced in planning homebirth is to be able to labour spontaneously, without medical stimulants or pain relief. This fact is not trivial. Professional advice by the midwife, and the sort of decision-making that has to take place when a change of plan is being considered, are often strongly influenced by the woman's progress and ability to accept the work of labour.
A midwife who is confident in approaching a hospital when transfer of care is indicated is able to guide the woman without anxiety. Even though there is likely to be disappointment when the plan for home birth is no longer reasonable, the midwife continues 'with woman', and provides information and support as the woman negotiates a different journey.