Laura Suriawan was left so shaken by her first birth experience that she swore never to deliver in hospital again.
Perth-based Laura had "wanted to stay as natural as possible" with her labour but ended up with an induction at 42 weeks.
She had an episiotomy and vacuum extraction after the baby's heart rate began to dip, a postpartum haemorrhage and recurring infections of her episiotomy scar.
The 31-year-old educational interpreter experienced postnatal depression after the 2019 birth, which she says made her feel like she "wasn't able to fully trust the natural process of birth and my body, and wasn't able to be in tune with that process".
When she was planning her second birth, Laura took a different route: a home birth through the Community Midwifery Program in Perth.
"I felt I was in control of decision-making throughout the whole entire pregnancy," she says.
This is general information only. For detailed personal advice you should see a qualified medical professional.
What's driving the shift to home birth?
Laura is one of a growing number of birthing parents opting to deliver at home.
Alison Weatherstone, chief midwife at the Australian College of Midwives, says there's been a "sudden upward trend" in home births in recent years.
According to the most recent data from Australian Institute of Health and Welfare, 1,643 women birthed at home in 2021, up from 927 in 2020.
"[And] it is reasonable to expect a further increase over 2021–2023", says Ms Weatherstone, who's based in Cairns.
Some, like Laura, see home births as a way to reclaim their power after a previous hospital birth that felt out of their control. Others have sought home birth since COVID hit, amid concerns about visitor restrictions and birthing in a hospital with a known COVID infection, says Ms Weatherstone.
Homebirths with a privately practising midwife or publicly funded homebirths "are becoming more widely known and sought after every year", she says.
Home births are out of reach for some
Home births aren't accessible to everyone who wants one.
Public homebirth programs have criteria that restrict which patients can access the services, and the Royal Australian and New Zealand College of Obstetrician and Gynaecologists (RANZCOG) says home births are particularly dangerous when a pregnancy has any factor that increases maternal or perinatal risk.
Pregnant women in Australia have more complex needs than this population did 20 years ago, RANZCOG president Benjamin Bopp told ABC Health: "[It's] an older population, a population more likely to be overweight, with more comorbidities."
So while there's a large call for reduced intervention in the world of obstetrics, "by the same token, there's also a call for increased intervention", says Dr Bopp.
Even low-risk pregnancies can have births that don't go to plan, so RANZCOG recommends all home birth practitioners have a plan for a quick transfer to hospital if required, and many public homebirth programs require the patient to live within a 30-minute drive of the hospital.
"What's important is individualising treatment plans, and discussing with women and their families which way they want to progress, because it's the patient's choice as much as it is our advice," Dr Bopp says.
Location pressures and rising demand for private midwives
Dental nurse Caris Jansen, 27, is one of many whose location made a home birth hard to access.
Caris lives in Albany in Western Australia, a regional city about five hours' drive from Perth. She wanted to birth at home for her February 2022 delivery, but learned publicly-funded home births weren't available in her area.
Caris birthed instead in the local public hospital. She'd hoped not to have a C-section, but ended up with one — and experienced the birth as traumatic.
"My belief is that I've gotten to the hospital and I closed up and I didn't feel safe enough to let go," she says.
Queensland and Tasmania don't currently have publicly-funded homebirth models at all. Nor do some major regional cities, including Geelong and Ballarat in Victoria.
Keep in mind, though, that sometimes location means home birth just isn't a safe option: those who live more than half-an-hours' drive from hospital are cautioned against birthing at home because it's important they can safely transfer to hospital if problems arise.
Pregnant people seeking home births in regional, rural and remote settings can still hire a private midwife, Ms Weatherstone says. But a private home birth can cost thousands of dollars, in many cases $6,000 or more, making them unaffordable to many.
The rising demand for home births during COVID has also meant private midwives are in high demand, so not everyone can find one.
At the time she was planning her birth, Caris says "there were only one or two private midwives servicing the Albany area".
If she had the chance again, Caris says she "would think about moving back to Perth" to be closer to her family and a greater range of healthcare services.
She also says she'd look at hiring a private midwife and doula to birth at home.
"Birth is not always a medical emergency, and you're kind of made to feel like you need saving when you go through the hospital system."
Laura — whose successful home birth at 41 weeks and 5 days felt like a "beautiful" experience — wants public home births to be more readily accessible to more Australians, regardless of their income.
"This is the way birth should be: woman-centered, and empowering women to do what they were designed to do," she says.
Laura and Caris shared their stories as part of The ABC's Birth Project.
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