So you're considering a home birth....
If you live in Ontario, and have access to midwives, a home birth is one option you may want to consider for your birthplace.
There are three things to consider when deciding whether a home birth is right for you and your baby:
1. Maternal and pregnancy risk factors:
Are you considered low-risk? Things that care providers will be looking for include a healthy and uncomplicated pregnancy, a full term baby who is vertex (meaning head down), and no multiples. You may be interested to know that having one prior cesarean with a low transverse incision does not automatically preclude you from having a home birth. The College of Midwives of Ontario’s position on VBAC at home is that it should be up to the client to choose their birthplace after weighing all the pros and cons, and discussing the risks and benefits, with their midwife.
2. Midwife qualifications:
In Ontario, midwives are licensed and regulated. They must complete a 4-year bachelor’s program at an accredited university and a 1-year internship. Midwives are the only health care providers that are trained to provide care during a home birth. And, they bring all the same equipment to a home birth that they would use at a hospital, including medication, oxygen, and resuscitation equipment.
3. Integration with the healthcare system:
This is so important but sometimes overlooked! In the Greater Toronto Area we are lucky to have a hospital near most homes, making transfer when needed fast. Midwives are well established and integrated into our healthcare system, which makes hospital transfers seamless in most cases.
Let’s talk about some statistics, because looking at facts is important when making an informed decision about anything. For those of you who like to skim (I get it, I’m one of them), I’ve listed the statistics in an easy to read format below, but first a summary:
Studies have found that those who have a home birth (compared to a hospital birth):
Have fewer complications (1-7)
Higher rate of spontaneous vaginal birth
Lower rates of postpartum hemorrhage
Less perineal trauma
Have fewer medical interventions (1-7)
Lower c-section rates (30% less likely)
Less assisted vaginal birth
Fewer epidurals, spinals, and narcotics used for pain relief
Less likely to have labour augmented with oxytocin
Lower rates of blood transfusions
Have no higher rates of adverse outcomes (1-7)
No difference was found in the risk or mortality (stillbirth or neonatal death) between home and hospital births
No difference was found in neonatal interventions and adverse health outcomes (such as lower Apgar scores, need for resuscitation, chest compressions, NICU admissions)
One study (1) I love looked at Ontario births compared 11,493 planned home births and 11,493 planned hospital births. These births were low-risk and excluded those who were induced, had a breech baby or multiples, had more than one prior c-section, and were full-term. These were the results comparing those who planned a home birth vs. those who planned a hospital birth:
Another study (8) found that there was no difference in the risk of death or other serious newborn health outcomes between home and hospital birth. The absolute risk for both groups of adverse outcomes was 3.9/1,000, and the perinatal death rates were also the same at around 1 per 1,000.
Sometimes I find there is a stigma around out-of-hospital births, and I've heard some pretty ill-informed comments about home birth. If you're planning a home birth and feeling some resistance from those around you, feel free to share this post and open up a dialogue about your preferences. I've cited the studies below so you can read through them fully and know that no matter which birthplace you choose you are making an informed decision. xoxo
Just a note that the above are statistics that are most relevant to Canada. Too often, likely due to our proximity to the U.S., I see American statistics quoted, when the healthcare system is completely different to that of Canada’s, and unfortunately the statistics coming from down south are not comforting. For one, midwives are not as well integrated into the healthcare system, which can cause friction if transfers are needed, making transfers less likely to happen (or less likely to happen in time). As well, there is the financial consideration to the healthcare system in the U.S. which could cause emergency transfers to be delayed - families may have to pay out of pocket for a home birth with a midwife, but if a transfer is needed they may also have to pay for the hospital bill as well. How lucky that we don’t have the same concerns weighing on us when it comes to our birth choices in Canada!
Hutton EK, Reitsma AH, Kaufman K. Outcomes associated with planned home and planned hospital births in low-risk women attended by midwives in Ontario, Canada, 2003-2006: a retrospective cohort study. Birth. 2009 Sep;36(3):180–9.
Hutton EK, Cappelletti A, Reitsma AH, Simioni J, Horne J, McGregor C, et al. Outcomes associated with planned place of birth among women with low-risk pregnancies. CMAJ. 2016 Mar 15;188(5):E80–90.
Janssen PA, Lee SK, Ryan EM, Etches DJ, Farquharson DF, Peacock D, et al. Outcomes of planned home births versus planned hospital births after regulation of midwifery in British Columbia. CMAJ. 2002;166(3):315–23.
Janssen PA, Saxell L, Page LA, Klein MC, Liston RM, Lee SK. Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician. CMAJ. 2009 Sep 15;181(6-7):377–83.
Brocklehurst P, Hardy P, Hollowell J, Linsell L, Macfarlane A, Marlow N, et al. Perinatal and maternal out- comes by planned place of birth for healthy women with low risk pregnancies : the Birthplace in England national prospective cohort study. BMJ. 2011;7400(November):1–13.
Davis D, Baddock S, Pairman S, Hunter M, Benn C, Wilson D, et al. Planned place of birth in New Zealand: does it affect mode of birth and intervention rates among low-risk women? Birth. 2011 Jun;38(2):111–9.
Davis D, Baddock S, Pairman S, Hunter M, Benn C, Anderson J, et al. Risk of severe postpartum hemor- rhage in low-risk childbearing women in New Zealand: exploring the effect of place of birth and comparing third stage management of labor. Birth. 2012 Jun;39(2):98–105.
Cheney et al. (2014). J Midwifery Women's Health 59: 17-27.