Demographics of Home Birth

in North Coast Area Health Service

by Spain, M. & Gulliver, H & (2005-06)

A review of Home Birthing in the Northern Rivers Health Catchment area was undertaken in 2004 by the then Clinical Midwife Consultant. The following comes from the introduction of that review.

‘The NRAHS has significant home birthing community and records the highest homebirth rate in the state outside of Metropolitan Sydney. To date, reliable data on the numbers of women choosing to birth at home has been difficult to quantify. The NSW Mothers and Babies Report (2002) ¹ recorded 99 homebirths in the state or (0.1%) of total births, and in the Northern Rivers 14 homebirths were recorded (0.5% of total births). The real figure for the NRAHS is more likely to be around 100 (approx 3%) based on advice from many sources accessed confidentially during 2004. Thus we can assume that this area has a significant home birthing community and will continue to do so.’ (Ref: Home birthing in the NRAHS – Issues Paper Dec 2004 – Sue England Area CMC).

Following this report an amalgamation of Area Health Services has occurred. This extended the catchment population under consideration to include Coffs Harbour, Bellingen & Port Macquarie areas. Bellingen and its environs is known to a have a similar socio culture community as the North coast where Homebirth is actively sought out.  Empirical data from that area indicates there to be approximately 30 planned homebirths per annum being attended.

Statistics taken from the Register of Births Deaths & Marriages for the North Coast Area Health Service post codes 2463 – 2483 offer the following data sets of births recorded to have occurred out of hospital.  In 2004 a total of 58 births and increase in 2005 to a total of 65 births were registered to have occurred out of hospital. (Ref: Register of Birth Deaths & Marriages Data 2004). This compares with the planned homebirths recorded in the Mothers & Babies report of only 19 in the NCAHS and a total of 93 in 2004 across all of NSW (Mothers and Babies Report pp. 22, 2004). This data exemplifies the marked underreporting of homebirths in the Mothers and Babies Report. This data also indicates that the NCAHS is the site for the highest percentage of homebirths in NSW.

Hence there continues to be a contradiction within data sources of the actual numbers of out of hospital births that occur within the NCAHS. What is abundantly clear is that the Mothers and Babies Report greatly understates the actual number of homebirths that are occurring. This is verified by the comparison between it as a data collection tool and the Register of Births Deaths and Marriages for the NCAHS postcode areas. The rationale for this marked discrepancy in data sets is beyond the means of this report. There could also be debate as to the reasons that the home birth  rate is rising in the NCAHS. These reasons could include: higher remuneration for birth from the government thereby reducing the barrier of cost for a homebirth practitioner; a continuation of a lack of midwife led models of continuity of care within the AHS Hospitals; greater public awareness of the benefits of midwife led continuity of care.

Within the subculture of homebirth there is a group of couples who continue to choose to birth without the assistance and care of a trained midwife. To many couples the cost of a trained midwife is prohibitive or they choose to prioritise their family payment elsewhere. This report supports the argument that it is the Area Health Services mandate, responsibility to support the availability of trained midwives for all women giving birth irrespective of their chosen venue.

Anecdotal data indicates that the Register of Births Deaths and Marriage data on out of hospital birthing is underestimating the numbers considerably. Individual homebirth practitioners and empirical information about unattended homebirths would confirm with the earlier Issues Paper that the NCAHS has a considerable population of couples choosing out of hospital birth. The Issues Paper estimated a total of approximately 3% of all births occurred out of hospital. This is the highest percentage in all of NSW.

Essentially it is recognised that the NCAHS homebirth rate in one recorded data collection (albeit it a significant underestimate) has increased from 58 births in 2004 to 65 in 2005 (Ref: Register of Birth Deaths & Marriages Data 2004). This is a predicated increase from when the Home Birthing in the NRAHS Issues Paper was written. At the time that paper was written there was an average of 3% of births in the NCAHS occur out of hospital. This compares with a NSW State average of only .1% of births occurring out of hospital in 2004 (Mothers and Babies Report pp. 22, 2004).