IMAGE CREDIT: JERUSHA SUTTON
ACCESsIBILITY TO HOMEBIRTH IN NSW
Within New South Wales we are fortunate to have a number of Privately Practising Midwives (PPM) and six Publicly Funded Homebirth (PFHB) Programs. There are different ways to access these different models of care. To access homebirth services with a PPM you would contact and employ the midwife privately, obtain a referral from a GP or OB to get Medicare rebatable care and pay some out of pocket costs (dependent on health insurance). To access homebirth services with a PFHB program you would contact the hospital and lodge your interest with them, would obtain a referral from your GP to seek care through the local hospital and, if that hospital offers a PFHB program, would then see the midwives through the hospital for your homebirth care.
ACCESsIBILITY TO HOMEBIRTH AROUND australia
There are a number of Privately Practising Midwives (PPMs) and Publicly Funded Homebirth (PFHB) programs available throughout Australia, but they unfortunately do not cover all areas in Australia. To get an idea of what services are available near you take a look at this website. In addition to availability of PPMs and PFHB programs there are different restrictions on homebirth in different states. Homebirth with a PPM is legal in all states except the Northern Territory, where PPMs are unable to practice (in this instance, it is still legal to have a homebirth through a PFHB program). Additionally, different PPMs have different collaborative arrangements set up, so for some of them you are required to obtain a referral from a GP/OB in order to receive Medicare rebatable care, while with others they have already got arrangements set up with local healthcare services. Likewise, some PPMs have practising rights at local hospitals, so can attend your birth and provide all of your care through the hospital as well, whereas others do not have these practising rights and so can only provide emotional and physical support, not medical assistance, at the hospital (contact the individual PPMs to determine whether they have these care options arranged).
PROS AND CONS OF DIFFERENT MODELS OF CARE
PPM - By hiring a PPM you are employing the specific midwife or midwifery group you want to receive care from, are typically provided ongoing, stable, continuous support, even if certain issues crop up during your pregnancy, can be certain that the same midwife you’ve employed will support you throughout your pregnancy, birth and postpartum and typically receive antenatal/postnatal care at your home or at the midwifery clinic (not at the hospital). In addition, PPMs service large areas, so you are more likely to find a PPM that will provide you support. This support comes at a financial cost however, with each midwife having different fees – some of this cost can be covered by Medicare, and some by health insurance, but there is typically some out-of-pocket costs associated.
PFHB – PFHB programs are publicly funded, so they don’t have the out-of-pocket costs associated with them that PPMs do and they enable a larger range of women to be able to access homebirth due to being more affordable. However, PFHB programs are heavily restrictive based on location (they only service a certain radius around the hospital) and health criteria, so many women are not able to access these services due to where they live and any pre-existing risk factors. Furthermore, PFHB programs have strict criteria governing when women are able to continue with their plans to homebirth, so many women will not end up being able to birth at home dependent on potential risks that crop up during their pregnancy.
To determine whether you are able to birth at home with a PFHB program it is best to look at their hospital policies and contact the hospital directly. To determine whether you are able to birth at home with private midwives, contact the midwife. PPMs look at the Australian College of Midwives Guidelines for Consultation and Referral and from that, will determine whether they feel comfortable supporting you to birth at home. Not all PPMs have the same criteria for acceptance, so you're best of speaking to a number of midwives in your area to determine whether a homebirth with a PPM in attendance is an option for you. Likewise, each hospital that provides a PFHB program is governed by different policies specific to that particular hospital, so speaking with the midwives running that specific program will give you the best idea of whether homebirth through that program is an option for you.
PFHB – PFHB programs are publicly funded, so they don’t have the out-of-pocket costs associated with them that PPMs do and they enable a larger range of women to be able to access homebirth due to being more affordable. However, PFHB programs are heavily restrictive based on location (they only service a certain radius around the hospital) and health criteria, so many women are not able to access these services due to where they live and any pre-existing risk factors. Furthermore, PFHB programs have strict criteria governing when women are able to continue with their plans to homebirth, so many women will not end up being able to birth at home dependent on potential risks that crop up during their pregnancy.
To determine whether you are able to birth at home with a PFHB program it is best to look at their hospital policies and contact the hospital directly. To determine whether you are able to birth at home with private midwives, contact the midwife. PPMs look at the Australian College of Midwives Guidelines for Consultation and Referral and from that, will determine whether they feel comfortable supporting you to birth at home. Not all PPMs have the same criteria for acceptance, so you're best of speaking to a number of midwives in your area to determine whether a homebirth with a PPM in attendance is an option for you. Likewise, each hospital that provides a PFHB program is governed by different policies specific to that particular hospital, so speaking with the midwives running that specific program will give you the best idea of whether homebirth through that program is an option for you.