Choice of Birthplace. Home birth. Nothing else about midwifery care stirs more emotion than home birth. For some people, the response is very positive. But for many pregnant people, their partners, family, friends, co-workers, other health care providers, cashiers, hair dressers and the dog walker, the knee jerk reaction to the idea of home birth is shock.
It is sad but not surprising, given that the vast majority of people in North America give birth in a hospital. People (for good reason) trust that we have an excellent medical system and that hospital birth provides experts and resources to keep people safe during the birth process. It is unfortunate, however, that people do not dig just a little deeper and consider that there may be other – equally safe – options.
I won’t try to cover every aspect of choice of birth place in this blog post. If you have a midwife, you will have lots of time and opportunity to delve deep and make a decision that is right for you. I only hope to provide a very brief overview of why one might consider a home or birth centre birth and encourage you to keep an open mind.
What does the research say about the safety of home birth?
We are lucky that there is good research from Canada and other places in the world where midwives are well integrated into the health care system. The research consistently shows that midwifery clients who plan a home birth are well screened for potential risks and complications and have outcomes that are just as safe as those who plan to give birth in the hospital – but, they have lower rates of interventions and complications.
What does this really mean? It means that there are no more deaths or disabilities resulting from planned home birth compared to planned hospital birth in a setting like Ontario. It means that low risk people who plan a home birth are less likely to experience a cesarean section, episiotomy, significant tearing and abnormal bleeding.
It is important to note that if you are at low risk when you go into labour then serious complications are rare regardless of where you choose to give birth and regardless of whether you have a midwife, family doctor or obstetrician. Giving birth in an Ontario hospital, birth centre or at home are all safe options. If you are interested in looking specifically at the research outcomes, check out the Association of Ontario Midwives Choice of Birthplace: Guideline for Discussing Choice of Birthplace with Clients. The document is written for midwives. It is heavy on statistics. But the recommendations are a clear and helpful summary of the research. It also includes a list of 39 references.
The safest place to plan a birth depends on you and your circumstances. Are you low risk? Do you have access to a skilled midwife? Can you travel safely to a hospital in labour? Does your local hospital provide maternity care? Do you have a history of really fast births? What are the road conditions? Where do you feel safe? Speak to your midwife to discuss all of the many variables that impact your safety.
What kind of care is provided at a home birth? How is it different from hospital care?
You can see from the video that planning a home birth is safe in part because if you need a hospital, your midwife will take you there. The great thing about hospitals is that they won’t turn you away if you need them. In fact, childbirth is one of the very few times that a hospital will let you stay when there is nothing wrong! We usually only go to the hospital when there is a problem. If you plan a home birth, we will take you to the hospital if you need care that can’t be safely provided at home. We promise.
Why do people choose home birth? What does it look like?
People choose home birth for all kinds of reasons. Here is a short list: Confidence that birth is a normal physiologic process. Feel more comfortable at home than in a hospital. Prefer not to have pain medications around. Feel that birth is intimate. Like that at home they control their environment. Want family, friends, pets or children around. Want access to the food in their fridge. Don’t want to drive to the hospital in active labour. Don’t want to drive home from the hospital with a sore bottom and a newborn unless necessary. Don’t have reliable transportation and want health care to come to them. Don’t want hospital protocols to influence their care. Want to rest in their own bed right away. Dislike how hospitals smell. Hospitals make them nervous. Don’t have to worry about ensuring childcare before leaving for the hospital. Don’t want to hear other people in labour. Home is a safe place that is reassuring. Last baby came quick and this one might come at the side of the road (and being on the news is not how they want their 15 minutes of fame). Think that their home has fewer foreign germs than the hospital. Want a water birth. Want to be able to move freely outside of a single room. Like the idea that nobody will walk in unless invited. Know that home is a safe option and can’t see a good reason to birth elsewhere.
Home birth looks like a lot of different things. It depends on the person, the choices and the birth. You can never know exactly how things will go at any birth and being prepared to roll with it is important. But here is a video showing one home water birth.
What should I do?
If you are pregnant and have a midwife you should talk to your midwife about what option is best for you. Look at the research. Read birth stories. Reflect on what is important to you. Talk to your partner. If you have family or friends that are nervous about the idea of home birth, share information, invite them to one of your midwifery appointments so that they can have their concerns addressed. Perhaps share this blog post. Birth matters. Get information. Be honest about how you feel. Own your choices. You deserve to make an informed choice.
If you know someone who is pregnant and might be considering a home birth then inform yourself. Read the research. Ask a midwife for information. Until you do, don’t assume that your opinion or worries are based in fact. Don’t tell people birth “horror stories.” It isn’t helpful no matter where someone plans to give birth. Be supportive. If you have a question or concern, raise it in a way that respects that this is not your body, your birth or your choice. Your feelings matter, of course. But use this issue to strengthen your relationship – not strain it.
Where you choose to give birth is a very personal decision. You should have all the information you want and need to make the decisions that are right for you. Your decision can include information about your personal health history, any risks or complications that could affect you or your baby, your midwife’s recommendations, your values and preferences, your family life and the health care resources available to you. Ultimately, what feels right and comfortable for you is likely the right decision. While you cannot predict exactly what your birth will be like, it is reasonable to trust that things will work out. Birth in Canada is generally safe no matter where you give birth!
Genia is a registered midwife and international board certified lactation consultant with Generations Midwifery Care. Learn more about Genia here.