Women who choose homebirth are often portrayed as moving away from safety. The research tells a different story. Many are moving towards the kind of safety they value: a known and trusted midwife, bodily autonomy, privacy, protection of birth physiology, freedom from unwanted intervention, and emotional, psychological, cultural and spiritual security.
Women choosing to birth at home in Australia more than doubled from 923 in 2019 to 2,081 in
2023. This number is still only 0.7% of births, but the trend matters. Women are
seeking relational, midwife-led care that the mainstream system does not
reliably provide. Australian research has found that women choose homebirth to
avoid unnecessary intervention, remain in the comfort of home, make their own
decisions and receive continuity of care. A 2025 systematic review similarly
found that women understand safety more broadly than institutions commonly do:
physical safety matters deeply, but so do dignity, trust, autonomy and
protection from psychological harm. Midwives' expertise was central to their
sense of physical safety.
A long-awaited solution: with a fatal gap
Since national registration began on 1 July 2010, privately practising
midwives attending homebirths have operated under a specific exemption from
holding professional indemnity insurance for intrapartum care. The exemption
was necessary because no insurer offered a suitable product. Midwives still
required insurance for antenatal and postnatal care and had to comply with the
Nursing and Midwifery Board of Australia’s safety and quality requirements.
From 1 July 2025, the Commonwealth-funded Midwife Professional Indemnity
Scheme was expanded to cover eligible claims against endorsed midwives
providing out-of-hospital labour and birth care. MIGA is the sole insurer
participating in the scheme. This reform was important and overdue. The
exemption was extended one final time but will end on 31 December 2026.
The difficulty is that a planned homebirth requires a second registered
health practitioner who is educated and current in maternal and newborn
emergency care. The second midwife has not historically needed endorsement for
scheduled medicines and does not need prescribing or diagnostic-ordering
authority to perform the second-midwife role. Yet from 1 January 2027, a second
midwife practising privately at a homebirth must also hold appropriate
intrapartum insurance, while the only government-supported product is available
to endorsed midwives. This requirement creates a practical, even if indirect,
endorsement requirement. A registered midwife may be legally and clinically
capable of acting as the second practitioner, but unable to obtain the
insurance required to do so.
The NMBA’s 2026 draft revised Safety and Quality Guidelines compounded
the concern by proposing that the second practitioner hold appropriate
insurance and be prepared to assume the primary-midwife role if required. The
consultation has closed, and the NMBA is considering feedback. Homebirth
Australia and the Australian College of Midwives have warned that no
fit-for-purpose product exists for the non-endorsed or occasional second
midwife. MIGA is not the sole cause of this conundrum. It is a systems-design
failure produced by the interaction of Commonwealth funding rules, National Law
and NMBA requirements, and the terms of the sole available insurance product.
Each part may be presented as a safety measure. Together, they may make
compliant practice impossible.
Rural women will pay first
The consequences are already visible. ABC News reported in May 2026 that Geraldton’s last privately practising homebirth midwife planned to pause her practice. The small number of endorsed midwives in the region were largely public employees and could not justify paying approximately $2,400 for insurance to attend only a handful of births as a second midwife. Without a second, the primary midwife cannot offer homebirth. These changes to insurance rules and the shortage of qualified midwives may force families to make difficult decisions about their care. See the Channel 7 News New England Regional video on the story:
Award-winning midwife is sounding the alarm about access to safe homebirth services in the bush.
The economics are stark. Public homebirth midwives are indemnified
through their employer. A self-employed midwife must assemble, coordinate and
finance the same two-practitioner safety structure birth by birth. The
Australian College of Midwives has also identified the absence of a Medicare
item for intrapartum homebirth care, run-off cover costs that may total up to
$15,000 over three years when a midwife leaves private practice, and
unaffordable entity insurance for many midwife-led practices.
This convoluted bureaucracy is how reproductive inequality is produced:
not usually through an explicit prohibition, but through accumulated costs,
qualifications, exclusions and administrative conditions that make a service
unviable. Metropolitan women may retain some options as there are more midwives in metropolitan areas. Rural,
regional and remote women will lose their options first as the Geraldton and Tamworth stories indicate.
When regulation intended to create safety
increases risk
Homebirth care must be well governed. Registered midwives must practise competently, communicate risk honestly, consult and refer appropriately, recognise deterioration, and transfer care when indicated. Serious adverse events warrant rigorous, fair examination. Women and babies deserve nothing less. But an insurance eligibility rule is not a clinical safety intervention. Requiring a second midwife to obtain an endorsement designed primarily for prescribing and diagnostic authority does not necessarily make her more capable of neonatal resuscitation, managing an obstetric emergency or assisting a timely transfer. It may simply remove her from the available workforce. That eligibility rule can produce the opposite of the intended result. In an Australian survey of 1,681 women who had planned a homebirth, most preferred care from a registered midwife. If there was no midwife available, half said they would freebirth or engage an unregistered birth worker. Almost 60% reported a factor that would have excluded them from a publicly funded homebirth program. As a privately practising homebirth midwife, I often ended up the default choice for women denied publicly funded midwifery care because they were 'too old and too fat' and 'outside' guidelines. More recent media coverage continues to document women turning away from the formal system following trauma, coercion, lack of consent or inability to access midwifery care.
Homebirth with a registered midwife and freebirth are not the same.
Removing access to the former is not a credible strategy for preventing the
latter. For healthy women with uncomplicated pregnancies, Australia-wide linked
data found planned homebirth was associated with substantially more normal
labour and birth and fewer interventions than planned hospital birth, without a
statistically significant difference in perinatal mortality. More broadly, the 2024 Cochrane review found that midwifery
continuity models improve women’s experiences and reduce caesarean and
instrumental birth. Safety policy should build on these benefits through
integration, reliable consultation and respectful transfer pathways, not
dismantle the workforce that provides them.
Regulation, notifications and the chilling of
woman-centred care
A wider regulatory climate also matters. Notifications to Ahpra are essential when there is a genuine concern about unsafe or unprofessional practice. A notification, however, is an allegation requiring assessment, not a finding of wrongdoing. Notifications about midwifery practice in 2024–25 involved about 0.5% of the profession. Publicly available data doesn't adequately separate private homebirth practice from other midwifery settings. Although notification numbers are small, regulatory processes clearly cause harm. A 2021 feminist qualitative study of eight privately practising midwives found that other health professionals mostly made the reports after the midwives supported women choosing care outside recommended guidelines. None of the reports in that study was made by the women receiving care. Participants described being “caught between women and the system”, experiencing profound distress and changing or leaving practice. A 2025 study across midwifery settings similarly found serious personal and professional effects, poor communication, protracted investigations, loss of confidence and inadequate support.
Accountability and procedural justice must coexist. A process that takes
months or years can become a punishment before any adverse finding is made. It
can also encourage defensive practice: declining women with complexity,
transferring responsibility prematurely, or abandoning private practice
altogether. In maternity care, that chilling effect falls not only on midwives
but on women’s access to relational care and informed choice.
Choice without infrastructure is not choice
Australia’s national maternity strategy says women should have access to
continuity of care with the provider of their choice. The Australian Charter of
Healthcare Rights protects access, respect, partnership, information and
informed decision-making. These principles do not create an unlimited
entitlement to every requested service regardless of clinical circumstances.
They do require governments and regulators to avoid making safe,
evidence-informed options structurally unattainable. The gendered pattern is
hard to miss. A predominantly female profession providing intimate, relational
care to women is required to absorb growing layers of personal financial risk,
regulatory surveillance and unpaid coordination. Meanwhile, the
hospital-centred system remains institutionally funded and treated as the
default, even when women describe that environment itself as a source of risk
and trauma.
Midwifery is repeatedly asked to prove itself within structures designed
around medical institutions, rather than being resourced according to its own
evidence, philosophy and scope. The result is not neutral regulation. It reproduces professional hierarchy through policy.
What must happen before 1 January 2027
The Commonwealth, NMBA and MIGA need an urgent, jointly designed
solution. At minimum, this should include:
- a
fully underwritten, low- or no-cost, scope-limited insurance product for
non-endorsed second midwives;
- extension
of the primary midwife’s policy to cover a second midwife working within a
documented peer or mentoring arrangement;
- no
endorsement requirement for a second practitioner unless she actually
assumes the primary role;
- a
Medicare item for intrapartum homebirth care, together with equitable
run-off and entity-cover arrangements;
- funded
rural loadings, mentoring pathways and workforce development;
- integrated,
respectful hospital consultation and transfer pathways;
- early
triage, transparent timeframes and meaningful support for midwives subject
to regulatory notifications; and
- national
reporting of notifications by practice setting, source, duration and
outcome, so claims about risk and regulation can be tested rather than
assumed.
Insurance should protect women and midwives when something goes wrong.
It should not be designed in a way that prevents a safe workforce from
existing.
If reform drives registered midwives out of homebirth and women out of
regulated care, it cannot honestly be called a safety success. Women do not
have meaningful choice simply because no law expressly forbids homebirth.
Choice exists only when a safe, skilled and sustainable service is genuinely
available.
Selected sources
Australian Health Practitioner Regulation Agency. (2025). Annual report 2024–25: Notifications.
Australian College of Midwives. (2026). 2026–27 Federal Pre-Budget Submission.
Australian Government Department of Health, Disability and Ageing. Midwife Professional Indemnity Scheme.
Australian Government Department of Health. (2019). Woman-centred care: Strategic directions for Australian maternity services.
Australian Institute of Health and Welfare. (2026). Australia’s mothers and babies: Place of birth.
Chauncy, C., Dawson, K., & Bayes, S. (2025). What do safety and risk mean to women who choose to birth at home? A systematic review. Midwifery, 144, 104340. https://doi.org/10.1016/j.midw.2025.104340
Gordon, F., Whitburn, L. Y., & Newton, M. (2025). Understanding the impact of AHPRA notifications on midwives’ wellbeing, practice and career. Midwifery, 148, 104471. https://doi.org/10.1016/j.midw.2025.104471
Homer, C. S. E., et al. (2019). Maternal and perinatal outcomes by planned place of birth in Australia 2000–2012. BMJ Open, 9, e029192. https://doi.org/10.1136/bmjopen-2019-029192
Homebirth Australia. (2026). Response to the NMBA consultation on Safety and Quality Guidelines for privately practising midwives.
Hunter, J., Dixon, K., & Dahlen, H. G. (2021). The experiences of privately practising midwives in Australia who have been reported to AHPRA. Women and Birth, 34(1), e23–e31. https://doi.org/10.1016/j.wombi.2020.07.008
Melville, B. (2026, May 21). Birth choices dwindle as new laws push Geraldton’s last private midwife to press pause in WA.
ABC News.Nursing and Midwifery Board of Australia. Professional indemnity insurance arrangements.
Sandall, J., et al. (2024). Midwife continuity of care models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews, CD004667. https://doi.org/10.1002/14651858.CD004667.pub6
Sassine, H., Burns, E., Ormsby, S., & Dahlen, H. G. (2021). Why do women choose homebirth in Australia? A national survey. Women and Birth, 34(4), 396–404. https://doi.org/10.1016/j.wombi.2020.06.005
