Your Choice of Birth Place: Hospital, Home, Birth Centre
Did you know that the majority of people who give birth in Ontario do so within a hospital setting, but that there are other options? If your primary care provider is a midwife, you may also have the option to birth at home, or at one of the three birth centres in the province. Each birth place has it’s own benefits and setbacks depending on what your wants and needs are.
By far hospitals are the most common place to give birth. Toronto itself has 10 hospitals with labour and delivery units within the city proper, and another 10+ options in the immediate surrounding area. All high-risk births will be directed to a hospital under the care of an Obstetrician. You will have the option of an epidural or narcotics for pain relief, but other comfort measures (such as jacuzzi tubs, nitrous oxide, and birth balls) can be hit or miss depending on the hospital and availability - for example, some hospitals have one birthing tub that is used on a first come, first serve basis so it’s not always a guarantee that it will be available for you. The great thing about hospitals though? You are exactly where you want to be in the event of an emergency, with all the tools and resources on hand that can keep an outcome from going south. The downside is that you are often more restricted when it comes to things like how many visitors you can have at one time, or how much you can eat or drink.
Ontario currently has 3 birth centres total in the province, with one of those being in Toronto (a 2nd birth centre is located in Ottawa and another on the Six Nations of the Grand River Territory). The Toronto Birth Centre is located in the east downtown core and is currently affiliated with 9 midwifery clinics. Birth centres serve low-risk pregnancies that are attended by midwives, and really offer a comfortable out-of-home birthing space - in fact, the rooms at the Toronto Birth Centre look more like a swanky hotel room than they do a birth room (but really, isn’t that what birth spaces should look like?). There are no epidurals or narcotics available, but you do have access to all the non-medicinal birth equipment that you could want: a tub, birth balls, nitrous oxide, TENS machine, birth stools, slings, and the list goes on! The level of care is the same as you would find at a home birth or a community hospital, and true emergencies would require a transfer to the nearest hospital (for the Toronto Birth Centre that would be the 5-minute trip down the road to St. Mike’s).
And guess what!? In 2018 Markham-Stouffville Hospital opened the province’s first Alongside Midwifery Unit (AMU), which is a great alternative for those who may want the experience of a birth centre but with a hospital right across the hall. The new AMU offers the same comfortable birthing space as a birth centre, but because the unit is located within Markham-Stouffville Hospital there is almost no delay in getting access to Obstetricians or Neonatalogists if needed during labour - it is quite literally as easy as walking across the hall! There are currently 3 midwifery clinics that have privileges to AMU, and you can find out more about the unit here.
If you have midwives you also have the option of having a home birth. There is something to be said for being able to labour and birth in the comfort of your own home, but this option is ideal only for low-risk pregnancies. You won’t have the option for an epidural or narcotics, and in an emergency your midwife would call an ambulance for transfer to the nearest hospital, much like they would at a birth centre. For many, the idea of a home birth is appealing because home is usually a safe, comforting space, and that’s exactly the type of environment we want to replicate for all births. The benefit to being in your own space is that you really call the shots - if you want your whole family present for the birth, or to eat and drink as you wish, by all means go for it! Midwives in Ontario are trained to provide the same care that you would find in a Level I hospital, and because midwives are so well integrated into our healthcare system, home birth is statistically as safe for low-risk births as a hospital setting is. To find out more about home birth safety, see my previous blog post “So you’re considering a home birth…”
So how do you choose?
Start by asking yourself some of the below questions:
• Am I low-risk or high-risk? Being high-risk will likely predetermine that the safest place for you to give birth is in a hospital setting.
• What kind of comfort measures do I want? Remember, epidurals and narcotics are not available at home or birth centres!
• How technologically inclined are you? If you want to be surrounded by more technology, the hospital is the way to go. If you feel that you would rather have a birth with fewer outside interventions, your best bet is probably a home or birth centre where interventions are fewer.
• How much planning do you feel you can do? What’s nice about an out-of-home setting is that you can show up when you’re in labour and everything else is already taken care of - including the clean-up!
• Where do I feel safest? For some, that could be the hospital - for others, that could be in their home.
Ultimately, the decision that you feel best about is the decision that’s right for you! Do your homework, go on a tour of your hospital’s maternity ward and see how it feels to you. Talk to your midwife about home birth if it’s an option and attend a home birth night that most midwifery clinics have monthly. Weigh all the pros and cons of your options and then make the decision that feels right for you, your baby, and your birth. And remember, nothing is ever set in stone. You can always plan for one option and change your mind - yes, even during labour!
Regardless of where you plan to give birth, if you’re interested in having one-on-one support shoot me an email or give me a call - I’d be happy to talk you through how I can integrate into your birth team.