Midwives and doctors push for Medicare rebate for home births

Tina Barbossa’s daughter Oriaan, now aged two, was born in a birthing pool in the middle of her children's playroom, after a six-hour labour.

“It was the most surreal experience,” the Craigeburn mother of three said. “There was a midwife there, but I actually pulled her out myself. I sat in the water just holding her in my arms. There was no rush to cut the umbilical cord.”

Tina Barbossa with daughter Oriaan, who was born at home.Credit:Simon Schluter

The birth set Ms Barbossa back about $5000, a few hundred dollars of which she received back from Medicare for clinical appointments before and afterwards. She had previously had two births in public hospitals but found them traumatic.

A group of midwives and doctors are pushing for Medicare to foot the bill for home births, arguing a $1500 rebate for women with low-risk pregnancies would save the government money and give women more choice.

The Participating Midwives Reference Group, including midwives and individual doctors from around Australia, has made the call in a report submitted to the federal government's Medicare Schedule review.

Medicare rebates are available for care before and after birth, but not for the cost of the two licensed midwives required by law to attend all home births.

Oriaan’s home birth cost about $5000.

Private midwives can set their own rates and very few health insurers provide rebates. Women who choose this option are typically left more than $5000 out of pocket.

Australia's peak medical bodies remain staunchly opposed to home births, regarding them as too risky.

Advocates argue universal access to safe home births is necessary to regulate the industry and weed out unregistered birth workers. They also claim it could save the health system money.

But is it worth taxpayers' money? Dr Emily Callander, a health economist at Griffith University, believes it is.

A shift away from women choosing to give birth in the private health system has put mounting pressure on public hospitals.

Dr Callander said including low-risk home births in the Medicare scheme would allow more women the financial choice to give birth at home and free up resources such as public hospital beds, doctors and midwives for women with more complex needs.

The average uncomplicated vaginal birth costs the health system about $4500, Dr Callander said.

Under the proposed $1500 rebate for women with low-risk pregnancies who choose to give birth at home, the  health system could potentially be saved more than $2000 a birth, consumer groups say.

"From a public health point of view it really does tick all the boxes," Dr Callander said. "This is from a women's choice point of view, to a resource-saving perspective, to the actual dollar savings demonstrated."

The most recent figures from the Australian Institute of Health and Welfare showed 97 per cent (301,095) of mothers gave birth in hospitals in 2017. There were 806 babies born at home, the equivalent of 0.3 per cent of births.

Rates of home births have remained stagnant in recent years, but Homebirth Australia co-ordinator Grace Sweeney said demand surpassed national figures.

"A growing number of women are choosing it as an option after being left traumatised by hospital care," Ms Sweeney said. "What we know is that consumer demand for homebirth is much greater, but the main barrier is the high cost of home births and a lack of funding."

Experts also feared the cost of a regulated home birth, complicated by a national shortage of private midwives, had seen a surge in free-birthing — a risky practice in which babies are born without medical assistance at home.

Tina Barbossa holds her daughter Oriaan as her partner looks on after the her home birth.

Only 14 Australian hospitals offer publicly funded home births, but these are limited to low-risk pregnancies and are only in capital cities. A birth in a private hospital can cost between $2000 and $10,000.

In countries where home birth is funded by the healthcare system, such as New Zealand, the rate hovers at almost 4 per cent, while in the Netherlands it's about 13 per cent.

The Australian Medical Association cautioned against the proposed changes to Medicare, saying a medical practitioner should always be involved in births.

"This is essential, not only to ensure effective risk assessment and management, but so that if complications do occur, the medical practitioner who is required to step in has prior personal knowledge of the mother and her needs," the AMA said in its submission in response to the midwifery report.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists was also opposed, arguing the safest place for births was in a hospital.

A spokesman for federal Health Minister Greg Hunt said the Medical Benefits Schedule review taskforce was considering the midwifery report and would submit its findings before the end of the year.

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