Choosing where to birth: answers to common questions about home birth

Untitled design (5)If you have a midwife in Ontario then you can choose a home birth or hospital birth. You need answers to common questions about home birth so that you can make an informed decision about your options. Many people assume that they will have a hospital birth because that is what has been most common in the last few decades – and it is still a valid choice. But don’t make the choice based on assumptions. Be open to having your assumptions challenged! If you are someone who has never considered a home birth then this blog post is for you.

Times are changing. Health care is changing. Research is growing. Ask questions. Read the research. Check out this blog post. Consider your options. Talk to your midwife. Birth matters! Make an informed decision about what is best for you. Start with this video from the Association of Ontario Midwives and then read on below!

Here are some quick responses to some common questions, comments and statements we hear about home birth to get you started. 

What if there is an emergency during a home birth?

Most emergencies don’t happen at home because midwives are experts at detecting signs that an emergency might happen later in the process. When we see signs of a possible future emergency we will tell you about it and discuss changing the plan and moving into the hospital. 

If an emergency happens at home your midwife will deal with it in the same way as they would at a hospital. They bring all the equipment, supplies and medications to your home that they would use in hospital. If the emergency requires hospital care then they will stabilize you or your baby and transport you in. Think of the treatment for birth emergencies like treatment for heart attacks. When someone has a heart attack they need all kinds of treatment before they are ready to go to the operating room for bypass surgery. Midwives provide the care you need while you are transferring into hospital. 

The research about low risk birth is clear. Your midwife can keep you and your baby just as safe at home as you would be in hospital. Talk to your midwife about specific emergencies that worry you and your individual circumstances to get an answer that is specific to you. 

Yes, but if an emergency happens in the hospital then the doctors are right there to manage it, right?

Sometimes. Our community hospital, like many others, does not have obstetricians, paediatricians and anaesthetists in the building at all times. Our excellent nurses are available 24/7 to care for your. The doctors might be at the hospital while you are in labour but they might not. Even if your hospital is a Level 2 or 3 where these physicians are on site all of the time, they are not necessarily available all of the time. Level 2 or 3 hospitals have people on site because they are busy enough to warrant that. The general guideline for any hospital that offers maternity care is that they should be able to offer a cesarean section within 30 minutes of the decision to do the surgery to the first incision. The hospital doesn’t promise that surgery can happen immediately. All care providers keep this in mind when they are offering care and making decisions about the safest course of action.

Your midwife will be on site with you the whole time whether you choose home or hospital birth. Home or hospital, your midwife is looking out for your safety and taking timing into consideration. 

Home birth is for granola crunchy hippies and celebrities. Not for people like me. 

Home birth is not just for granola crunchy hippies and celebrities. Midwives in Ontario have attended home births for doctors, lawyers, neonatal and adult intensive care nurses, singers, dancers, artists, teachers, stay at home parents, politicians, youtubers, construction workers, pastors, plumbers, chefs, line cooks, servers, factory workers, managers, government officials, farmers, florists, postal workers, dentists and dental hygienists, media consultants, single parents, professors, rich, middle and low income people in big cities and remote locations. Chances are very good that “people like you” absolutely have home births. 

What if I want an epidural?

We have your back! If you are absolutely sure that you want an epidural then you should plan for a hospital birth and we will get you an epidural.

However, if you want to have access to an epidural if you decide you need one during labour then planning for a home birth is a reasonable option depending on your community hospital and how far you live from the hospital. Labouring at home is experienced as less painful by many people. Having the one-to-one support of your midwife is often helpful in dealing with pain. Getting into a bathtub or birth pool can be so effective at decreasing pain that it has been termed the “midwives’ epidural.” (It doesn’t eliminate pain entirely but for most people it helps a lot!) If you are at home and choose to get an epidural we can take you to the hospital and get you an epidural. 

Yes, but if I am in the hospital won’t I be able to get an epidural right away?

Not usually. Timing depends on your hospital. Some hospitals (level 3 hospitals like Mount Sinai in Toronto) have an anaesthetist dedicated to obstetrics who is in the hospital all the time. Some hospitals only offer epidurals during business hours. Some hospitals make no guarantees at all. At my my hospital there is an anaesthetist on call 24/7 for the whole hospital. Regardless of the services at your hospital, an epidural can’t happen immediately in most situations. You need blood work results, a bolus of IV fluid (this means you have recently received a bunch of IV solution) and even if the anaesthetist is in the hospital they could be occupied with another patient. It can take time. I find at our hospital that people who transfer in from home experience a delay of about 30 minutes in receiving their epidural compared to someone who is already at the hospital. 

Isn’t home birth messy?

Do you imagine a scene from a horror movie? Blood on your bed or your carpet? If you’ve never seen a birth before maybe you even imagine walls and ceilings involved in the drama. Sorry to disappoint you. Birth is (thankfully) nothing like that. If you give birth at home or at hospital your midwife will have to clean up the mess. If she left a hospital room looking like what you are imagining in your home she would likely be in trouble! I honestly think that hospital births are messier than home births because they tend to take place on narrow hospital beds that are made up of pieces. At home we use a plastic sheet to cover a large, comfortable area and add disposable absorbent pads. When all is said and done we roll up the mess and your home is the same as when you started. No fuss, no muss, no worries. 

My home is too small and cramped to have a home birth.

If your home is large enough to fit a baby then it is large enough for a home birth. Our equipment fits nicely into the trunk of our car. It will likely fit easily into your home. If you have stuff blocking the halls and it is difficult to safely get in or out of your house then we might need you to do some decluttering. Other than that you are likely good to go. Your midwife will likely offer a prenatal home visit and you can brainstorm together if necessary. 

I don’t feel safe in my home (for any reason).

If you are not safe in your home then please, please speak to your midwife. Sometimes people don’t feel safe in their home just while they give birth because they live with people they don’t know or like very much but are not in any direct danger. Sometimes people face danger from other people at home or their living conditions are dangerous. It is a good idea to tell your midwife about any of this. Your midwife will help you think through your choice of birth place options and might be able to help you find safer housing. 

I’m worried that people will hear me during labour if I have a home birth.

People might hear you. It is true. However, most of the time we don’t get any complaints or comments from neighbours even when the walls are thin. People giving birth also tend to think they are louder than they actually are. Also consider that if you have a home birth you are unlikely to hear other people making noise in labour. This is a very common and sometimes distressing reality when you are in hospital. Your midwife will likely offer you a prenatal home visit and can help you figure out if sound is an issue in your home. 

I really love my hospital and the staff and I feel safe there. I really appreciated being able to call the nurses when I needed help and want to stay for a day or so after I have the baby. 

That is great! I really love our hospital and the staff, too. I enjoy working there.  When my family members have been patients I have been confident that they are getting exceptional care. I know that you will get great care from the nurses if you stay after the birth. Your midwife will visit you at home 12-36 hours after your birth. However, if you feel best knowing that someone is down the hall then this may be the best option for you. Weigh all the pros and cons and then feel good about your decision. An informed decision is a great way to make a good decision!

I love the idea of having a home birth but I think I would be nervous or afraid if I stayed home during birth. I think I will feel safer, more comfortable and more confident in a hospital. 

One can always prepare for a home birth and then see how they feel at the time. If home doesn’t feel good, then you can go to the hospital. If just the thought of preparing for a home birth upsets you then plan for a hospital birth. The decision that you feel best about is the right decision for you. Be proud that you considered your options and made an informed decision that is right for you! Your midwife looks forward to helping you have a safe and excellent experience!

My pregnancy is high risk so I have to have a hospital birth.

You might be right that a hospital birth is the safest choice for you. Sometimes people are told by care providers or family and friends that their pregnancy is too high risk for home birth when this may not be the case. Check with your midwife. Midwives are experts in home birth safety and can make recommendations and help you make decisions about what is the safest option for you. If you are in early pregnancy or are considering getting pregnant and think you are too high risk for midwifery care then call us. We are happy to let you know if you are right for midwifery care and/or home birth. 

Keep in mind that the decision is always yours. Nobody can tell you that you have to have a hospital birth. It is your body and your choice. I am not suggesting that you should ignore risks or ignore the recommendation of your midwife. But it is important that you know that you can accept and refuse recommendations from any health care provider. It is your legal right. 

I really don’t want a home birth. I know midwives want people to have home births but I don’t want to. 

Woah. FULL STOP! Midwives want people to make informed decisions. They want people to consider out of hospital birth as a safe and lovely option. Midwives want people to question assumptions based on fear and misinformation. Midwives do not want to coerce someone into an unwanted home birth. If you want a hospital birth then choose a hospital birth. Your midwife will be happy that you made an informed decision and will support that choice. 

Midwives are in a difficult position. Whether it is home birth or unmedicated birth or breastfeeding, midwives are often accused of having a particular agenda and being judgemental about it. Maybe some midwives are. I don’t know all 800 (or so) Ontario midwives so I can’t say for sure anymore than I can make a single statement about the 800 (or so) obstetricians in the province. 

Midwives do, generally, want to fight the cultural fear that childbirth is just a disaster waiting to happen and a terrible experience. Midwives do want people to trust that birth is a physiologic process that usually proceeds well without technology and interventions. Midwives do want childbearing people to feel good about their body’s ability to get this job done. Midwives do want people to understand that birth can be a positive experience although of course, it isn’t always.  

We live in a culture that currently undervalues physiologic birth and breast/chest feeding despite strong evidence that this improves health outcomes. Midwives work to counter that fear and misinformation without in any way implying that there are not good reasons to choose hospital birth, epidurals or bottle feeding formula (etcetera). One good reason is individual choice.

Health education and promotion are tricky. The goal of informed choice is to make sure that one understands all the background and pros and cons of their options without pressuring or making people feel bad. Sometimes you get it just right and other times…not so much. It is further complicated by the fact that sometimes what works well for most people offends someone else. Yowzers!  Tough gig! Midwives, like all the other health care providers, do their best to get it right for you

If you feel like your midwife is pressuring you then tell them. It is very likely not their intention.  You can expect your midwife to listen to your concerns and work with you to fine tune your communication. If you are assuming that midwives will pressure you to have a home birth then make an appointment to talk with a midwife in your community. You will likely be pleasantly surprised.

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Genia is a midwife and lactation consultant with Generations Midwifery Care. You can find out more about Genia here and here