A pathway to establish a publicly funded home birth program in Australia

Sustainability of rural Victorian maternity services: 'We can work together'

BACKGROUND

Rural maternity service closures and service level reductions are continually increasing across Victoria. There is limited understanding of how rural board members and executives make decisions about their maternity service's operations and sustainability.

AIM

To examine perspectives of rural Victorian board members and executives on the sustainability of rural maternity services.

METHODS

This was a qualitative study. Interviews were conducted via Zoom™ with 16 rural Victorian hospital board members and executives. Data were thematically analysed.

FINDINGS

Severe shortages in the rural maternity workforce, primarily midwives, have contributed to service sustainability decisions. Challenges in offering midwifery workforce incentives cause difficulty in overcoming workforce shortages. A rural maternity workforce strategy harnessing connection with regional services was called for. Innovative models of maternity care were often actioned at the point of service suspension or closure. Participants requested a government policy position and funding for innovative, safe, and sustainable models of care in rural settings.

DISCUSSION

There is an opportunity for workforce planning to occur between regional and rural services to ensure the development of sustainable maternity models such as midwifery group practice and incentivise the workforce to address current deficits and sustain service provision.

CONCLUSION

Models of care developed with rural communities, in collaboration with regional services, have the potential to strengthen the delivery of safe, sustainable maternity services. Workforce modelling and centralised government policies aimed at arresting workforce deficits are suggested to provide rural health service leaders with strategic and operational directions to support the delivery of safe, sustainable maternity services.

The financial impact of offering publicly funded homebirths: A population-based microsimulation in Queensland, Australia

BACKGROUND

Despite strong evidence of benefits and increasing consumer demand for homebirth, Australia has failed to effectively upscale it. To promote the adoption and expansion of homebirth in the public health care system, policymakers require quantifiable results to evaluate its economic value. To date, there has been limited evaluation of the financial impact of birth settings for women at low risk of pregnancy complications.

OBJECTIVE

This study aimed to examine the difference in inpatient costs around birth between offering homebirth in the public maternity system versus not offering public homebirth to selected women who meet low-risk pregnancy criteria.

METHODS

We used a whole-of-population linked administrative dataset containing all women who gave birth in Queensland (one Australian State) between 01/07/2012 and 30/06/2018 where publicly funded homebirth is not currently offered. We created a static microsimulation model to compare the inpatient cost difference for mother and baby around birth based on the women who gave birth between 01/07/2017 and 30/06/2018 (n = 36,314). The model comprised of a base model - representing standard public hospital care, and a counterfactual model - representing a hypothetical scenario where 5 % of women who gave birth in public hospitals planned to give birth at home prior to the onset of labour (n = 1816). Costs were reported in 2021/22 AUD.

RESULTS

In our hypothetical scenario, after considering the effect of assumptive place and mode of birth for these planned homebirths, the estimated State-level inpatient cost saving around birth (summed for mother and babies) per pregnancy were: AU$303.13 (to Queensland public hospitals) and AU$186.94 (to Queensland public hospital funders). This calculates to a total cost saving per annum of AU$11 million (to Queensland public hospitals) and AU$6.8 million (to Queensland public hospital funders).

CONCLUSION

A considerable amount of inpatient health care costs around birth could be saved if 5 % of women booked at their local public hospitals, planned to give birth at home through a public-funded homebirth program. This finding supports the establishment and expansion of the homebirth option in the public health care system.

Relationships are the key to a successful publicly funded homebirth program, a qualitative study

BACKGROUND

In Australia, publicly-funded homebirth is a relatively new option for women and their families. Two years after the inception of two publicly funded homebirth services in Victoria in 2009, a study found that midwives' experiences were more positive than doctors. There is no recent evidence on the perspectives of midwives and doctors of publicly-funded homebirth programs.

AIM

To explore the experiences of midwives and doctors participating in or supporting one publicly-funded homebirth program in Australia.

METHODS

An interpretive descriptive approach was used following individual in-depth interviews via 'Zoom'. Participants included midwives and doctors who provide or support the homebirth service at a large metropolitan health service in Melbourne's western suburbs. Data were thematically analysed.

FINDINGS

Interviews were conducted with 16 homebirth midwives, six hospital-based midwives, and nine doctors. One central theme and three sub-themes demonstrate that effective relationships are critical to a successful publicly-funded homebirth program. Collaboration, teamwork, and mutual respect across professions were reported to be integral to success. The midwife-woman relationship was highly valued and especially important to provide continuity during transfers to the hospital where this occurred.

DISCUSSION

Effective relationships underpin collaborative practice and are critical for safe healthcare. Shared common learning opportunities such as simulation training sessions and multi-professional forums to discuss cases were perceived to assist the development of these relationships.

CONCLUSION

Effective relationships within and between midwives and doctors are key to collaborative practice, which underpins a successful publicly-funded homebirth service. Health services can support this by maintaining a respectful and supportive culture amongst staff.

Birth cultures: A qualitative approach to home birthing in Chile

BACKGROUND

Birth cultures have been transforming in recent years mainly affecting birth care and its socio-political contexts. This situation has affected the feeling of well-being in women at the time of giving birth.

AIM

For this reason, our objective was to analyse the social meaning that women ascribe to home births in the Chilean context.

METHOD

We conducted thirty semi-structured interviews with women living in diverse regions ranging from northern to southern Chile, which we carried out from a theoretical-methodological perspective of phenomenology and situated knowledge. Qualitative thematic analysis was used to analyse the information collected in the field work.

FINDINGS

A qualitative thematic analysis produced the following main theme: 1) Home birth journeys. Two sub-categories: 1.1) Making the decision to give birth at home, 1.2) Giving birth: (re)birth. And four sub-categories also emerged: 1.1.1) Why do I need to give birth at home? 1.1.2) The people around me don't support me; 1.2.1) Shifting emotions during home birth, 1.2.2) I (don't) want to be alone.

CONCLUSION

We concluded that home births involve an intense and diverse range of satisfactions and tensions, the latter basically owing to the sociocultural resistance surrounding women. For this reason, they experienced home birth as an act of protest and highly valued the presence of midwives and their partners.