What is a midwife and how can they help me?
A Midwife is a qualified health professional, trained and specialised in providing care, education, advice and support to women and their families during pregnancy, labour and birth, and the early postnatal period. (Australian College of Midwives)
Midwives can be based at a hospital, birth centre or may be based in the community.
There are also independent midwives who work outside the public health system in a self-employed capacity.
A midwife is an individual who has successfully completed a midwifery education program and demonstrates competency in the practice of midwifery.
In Australia, Midwives must also be registered with the Nursing and Midwifery Board of Australia (NMBA), and meet the NMBA’s registration standards, in order to practise.
An eligible midwife is a registered midwife who has been endorsed by the NMBA, identifying midwives with additional qualifications and specific expertise.
The endorsement for midwives is to prescribe scheduled medicines.
An eligible midwife must meet the following requirements of the registration standard:
- 3 years full-time postgraduate experience,
- Currency across all areas of midwifery care
- Completion of a professional review program
- Completion of a postgraduate prescribing course at university (Screening, Diagnostics, Pharmacology and Prescribing for Midwives)
Once endorsed, an eligible midwife will get a Medicare provider number enabling women to claim Medicare rebates for midwifery services.
An eligible midwife can also order tests and investigations such as blood and ultrasound tests, refer clients to an obstetrician or paediatrician as required and prescribe medication (dependent on State and Territory legislation).
What qualifications do midwives have?
Becoming a midwife means undertaking professional education at degree level.
Some midwives are qualified nurses who have chosen to undertake the extra study necessary to be registered as a midwife (Graduate Diploma in Midwifery, Masters of Midwifery).
Others begin their career by working their way up via a range of roles (for example from support roles, which require no set qualifications) before going on to study for a registered midwifery degree (Bachelor of Midwifery).
Some begin their midwifery career after a first career in an unrelated field.
Are there laws regulating homebirth midwives?
Section 284 of the National Law states the midwife complies with any requirements set out in a code or guideline approved by the National Board under section 39 about the practice of private midwifery, including any requirement in a code or guideline relating to the safety and quality of the practice of private midwifery.
In Australia, the NMBA regulates the practice of midwifery by developing registration standards, professional codes, guidelines and standards for practice which establish the requirements for the professional and safe practice of midwives in Australia.
The Safety and quality guidelines for privately practising midwives were published for privately practising midwives (PPM) attending homebirths, and established the requirements which PPMs providing homebirth services must meet.
What is a doula?
A doula is a non-medical support trained companion for women and their families during pregnancy, labour and the weeks following birth.
Can I also have a doula at my homebirth?
Midwives and Doulas work as a team to give you the support you may need and both have similar approaches to labour and birth.
Their roles are very different- Midwives are responsible for the clinical well-being of you and your baby, for example checking baby’s heart rate and Doulas provide physical, emotional and informational support during labour and so do midwives.
Who can have a homebirth?
Home is a suitable and safe place to give birth to a healthy women, that are experiencing an uncomplicated pregnancy and are expecting a healthy baby.
Homebirths are not recommended for women with a higher risk of complications. This includes women who have certain medical conditions such as heart or kidney disease, diabetes, high blood pressure. Or who have had complications in previous labours or more than 1 previous caesarean.
Twin and breech births (although possible overseas in the UK or USA) are homebirth exclusion criteria in Australia.
If I have had a caesarean before, can I still have a homebirth?
There are additional factors to be carefully considered when planning a homebirth after a previous caesarean. Understanding the safety, birthing advantages and risks will help you to make your decision.
The risk of a uterine rupture is very small for most women – inform yourself on these risks.
Some health professionals support a home VBAC as a reasonable choice providing all factors have been carefully considered and the woman has made an informed choice, and there are others who will not attend a home VBAC.
What if I have a low lying placenta?
Your placenta needs to be at least 2cm away from your cervix in order to have a vaginal birth.
Who will be present at my homebirth?
2 registered midwives with up to date obstetric and neonatal emergency training will be present at each homebirth.
You will meet with your primary midwife at your first appointment with us.
Your primary midwife will be your own midwife that you will have for all of your pregnancy and postnatal appointments and most importantly will be that known person there for you during the birth!
You will meet a second midwife, your support midwife around the 36 week mark during a Birth Plan Meeting, which is located at your home address, where both your primary and support midwife come along together.
What do you bring to births?
- Equipment to monitor you and your baby—stethoscope, blood pressure cuff, thermometer, hand-held Doppler and/or fetoscope, CTG
- 1 Oxygen cylinder and resuscitation bag/masks for the woman and newborn, including Neopuff
- Medications that can be used in case of excessive bleeding (Syntocinon, Syntometrine, Misoprostil)
- Sterile instruments and topical anaesthetics in case suturing is required
- Suction device for removing mucus and other material from the baby’s nose and mouth
- Intravenous catheters, administration sets and Intravenous fluids
- Hanging scale and sling for weighing the baby
- Vitamin K (only given with parents’ consent)
- Various and sundry other medical equipment and supplies such as gauze, syringes, needles, flashlights, etc.
- Episiotomy scissors (have never been used)
All our equipment is checked annually by biomedical engineering and certified as functioning.
Am I too far away from you to have a homebirth?
Our catchment radius is within 45 minutes of Chadstone.
It is also a requirement that you live within 30 minutes of a public hospital in case of transfer.
If you have decided not to have any scans during your pregnancy, you are required to live within 20 minutes of a hospital.
If you do live outside those catchment areas we invite you to organise accommodation closer to those catchment zones, for example hiring an Air BNB.
If you click on the link that is provided below, it will open a map of Victoria. All the purple pinpoints on the map are suburbs in which Ten Moons have attended homebirths. This map will give you an indication of where we can travel to for future homebirths.
What service do you provide?
Ten Moons provides home birthing services only.
When should I book in?
We would like to hear from you as soon as you have found out that you are pregnant.
What is the process once I’ve booked in my homebirth?
We start your care straight away! We do not have any time constrainents or waiting times, we book you in for first antenatal appointment as soon as possible.
From there on you will have around 10 appointments throughout your pregnancy. If you enter our service later on in your pregnancy, the amount of your appointments may differ.
At the start of your pregnancy, we will see you every four weeks for your appointments. As you are nearing the end of your pregnancy the appointments increase and we see you every two weeks.
The appointments are held at our office located in Chadstone.
We are open Monday to Friday 10am to 5pm, with every Thursday Night open until 9pm. We are able to book you in for anytime during those times.
Your appointments (this does include both your antenatal and postnatal appointments) will run for 1 hour to an 1:30 for each appointment.
Do I need to see a GP/ doctor during my pregnancy?
Usually, women will see their GP as the first point of contact once they found out that they are pregnant.
However, we are also able to discuss your care and order blood tests or ultrasounds that you may want throughout your pregnancy.
If you are fit and well you do not need to see a GP for routine pregnancy visits. If your midwife has any concerns about you or your baby’s well-being she will advise you to make an appointment with your GP or next closest public maternity hospital.
Do I need a referral to have a homebirth?
Yes- collaboration is required from a GP obstetrician or obstetrician in order for mums to obtain Medicare rebates.
We will provide you with the contact details of GP obstetricians so you can organise an appointment. During the appointment, the doctor will give you a written referral letter to pass on to your midwife.
How many clients do you accept per month?
On average we accept no more than 3 to 4 clients per months. However, there maybe some more busy months (usually March/ April and August/ September) where we temporarily accept a higher about of bookings and hire additional resources to meet the needs of our clients.
Can I book in late in my pregnancy?
Yes- we do accept later bookings providing you had regular pregnancy care and you are otherwise a suitable candidate for homebirth. We have supported mums that have changed over into our service as late as 41 weeks.
What pain relief can I have during homebirth?
Labour and birth are a physiological event in a woman’s reproductive life and we do believe in the woman’s capacity to give birth naturally and within her own power.
We encourage the use of natural methods that can provide comfort- shower or bath, acupressure/ acupuncture, heat and massage, Aromatherapy or TENS machine.
We do not carry any pharmacological pain relief- no gas in air or Morphine and epidurals are not available at home.
How do you monitor the baby and its heartbeat during labour and birth?
During labour, we listen to your baby’s heartbeat with a handheld Doppler initially every 30 minutes and more frequently towards the end of labour as you are about to give birth.
At times we may suggest to put on a CTG (cardiotocograph) monitor to ensure your baby is well.
If your baby’s heart rate is abnormal, a transfer to a hospital will be required.
What if I’m overdue and my labour needs to be induced?
We do not use routine induction of labour based on an arbitrary due date of 41 or 42 weeks. Providing that the baby’s well-being has been confirmed by extra monitoring we are supportive to continue with plans for homebirth.
We strongly recommend having extra monitoring for your baby in regular intervals to ensure your baby remains well and also strongly recommend a CTG if you are over 41+6 weeks pregnant when we arrive at your home for labour and birth.
If at any stage your baby’s monitoring returns abnormal, we recommend induction of labour and transfer care to the hospital.
What happens if my ‘waters break’ before my labour starts?
Once we have been notified that your waters have broken, there are 2 options available to you.
You can choose to go into labour on your own, which is generally what most our mums choose. As the other option, labour induction, requires a transfer of care to hospital as we do not use synthetic hormones to start or enhance labour in the home environment.
We will keep any eye on your baby’s wellbeing through daily CTG monitoring whilst we are waiting for your labour to start.
We also recommend for mums to monitor their own wellbeing by checking their temperature a couple of times per day, as having a fever could indicate signs of infection.
As long as mum and baby are well and healthy, we support the wait and see approach and we do not have an arbitrary time limit or cut off for homebirth as such. One of our mums patiently waited for 8 days before her baby decided to make an entry into the world and had a wonderful homebirth.
We will make contact with your back up hospital though to keep them up to date with your decision.
What if my cervix takes a long time to dilate? Would you speed up my labour?
For some women labour just takes its sweet time, in particular first time mums and mums that had a prior caesarian section and never had a vaginal birth before.
We belief in physiological birth and trust that you and your body know exactly what they are doing. We do not work with arbitrary time limits and will just patiently wait for it to happen when your body and baby is ready. The longest labour we have supported at home went over 5 days!
Of course, if labour takes a little longer we carefully monitor you and your baby to ensure all is well.
We do not speed your labour along with medical interventions. In the home environment we do not break your waters or use synthetic hormones to enhance labour.
What happens if my placenta does not want to come out naturally after the birth of my baby? Would you give an injection to help my placenta? What usually happens in this situation?
As long as your blood loss is fine, there is no rush to assist the birth of your placenta and we can just wait for it to happen naturally.
If there are any concerns about blood loss, we then proceed to give you an injection and remove the placenta by pulling it out on the umbilical cord, unless you are able to push it out yourself.
If the placenta does not come after the injection has been given and by pulling on the cord, we then recommend transfer to the hospital in an Ambulance to have it manually removed in the operating theatre.
What happens if I need stitches after birth? Are there any painkillers available for this process?
We stitch small tears at home under local anaesthetic. Bigger tears that involve deeper pelvic floor structures (3rd and 4th degree tears) need to be repaired by a doctor in hospital.
What happens if I have a haemorrhage after birth, do I need to be transferred to the hospital? Do you have the medication needed at the birth in the case of a haemorrhage?
The good news are that so far we never had to transfer a mum to the hospital because of a haemorrhage after birth. We had them occur but managed them all in the home environment.
We bring 3 different anti-haemorrhage medications to every homebirth we attended. As well as equipment to insert a drip and give some fluids for hydration.
In an emergency, if my baby needs resuscitation after birth would you be able to resuscitate my baby?
We are able to resuscitate your baby. We bring along a breathing devise for babies, oxygen and equipment to suction to every birth. We will call a MICA Ambulance for extra support as they carry advanced equipment that might be required.
If I am transferred to hospital, will Ten Moons still care for me? What is my midwife’s role in the hospital?
Once we arrive at the back-up hospital, Ten Moons will formally handover care to the midwifery and medical team at the receiving hospital. After the handover of care has taken place, we can stay present for emotional support only and will have no further involvement in your clinical care.
What happens if I have a very fast labour and my baby arrives before the midwife gets to my home?
If your baby makes a fast entry into the world we recommend to call an Ambulance to make sure you have medical assistance nearby if needed.
How long will my midwife stay for after birth?
Generally, we stay until 4 hours after the birth. We will check you over, assist you with breastfeeding, do first checks on the baby and take the baby’s measurements.
We make sure that both you and your baby are doing well before we leave your house.
Who examines my baby after birth?
We will do a thorough check up on your baby within the first 4 hours of birth and then again at 24 hours of age. The check up includes listening to heart sounds and breathing, checking the baby’s hips and reflexes are just a few examples of the check up.
If any abnormalities are identified during these check ups, we then recommend a GP check up of your baby or refer to a paediatrician.
Are there tests for my baby after birth?
A full newborn exam will be carried out by the midwife within 24 hours of birth.
Between 48 to 72 hours after birth we offer to take the Newborn Screening test, which involves getting a small blood test from the baby’s heel. This will be done during a home visit and we will bring everything required for the test with us to your home.
For the Infant hearing screening you will have to call up your back-up hospital to organise an appointment in the first couple of days or weeks. You will have to take your baby to the hospital for this test.
Who organises a birth certificate for my baby?
We will give you all the paperwork required to register the birth. Once you have completed the paperwork you then hand it into Birth, Death and Marriages and Centrelink.
The birth certificate will be posted by Birth, Deaths and Marriages to your nominated address within a few weeks of birth.
How can we stay in contact once my care has ended?
After your care with us has ended, that does not mean a goodbye from us! It’s not all over. We would love to keep in touch with you. You will be invited and notified of all upcoming events via Facebook, SMS or Email, as well as being welcome to all of our Ten Moons Mums and Mums to Be Mothers Group every month.
However if you do have any questions/concerns regarding you and your baby, you still will have access to your Private Midwife’s contact details after the care has concluded with us in which you are able to contact us on.