PREGNANCY

So, is it safe to have a baby at home?

That depends who you ask. Because birth has long been seen as a medical event in our society, the knee-jerk reaction of many lay people is to assume it isn’t safe. And these feelings don’t come out of nowhere. Although the Society of Obstetricians and Gynaecologists of Canada supports midwifery for uncomplicated pregnancies, their policy statement says that “the SOGC is opposed to home birth because of potential risks to mother and fetus.” What are the risks? I contacted the SOGC to find out, but the media relations department there could not find a doctor willing to be interviewed on home birth.

However, a landmark study published in the February 2002 issue of the Canadian Medical Association Journal found that planned home birth, when attended by a licensed and regulated midwife, is no more dangerous than hospital birth for mothers or babies. The research, based on more than 2,100 births in British Columbia, was prepared by a team of experts (including Patricia Janssen of the department of family practice at the University of British Columbia and Michael Klein, a BC family physician) and financed by Health Canada.

Registered midwife Patricia McNiven, who teaches in the four-year bachelor of health sciences midwifery program at McMaster University in Hamilton, agrees. McNiven, who has been in midwifery for almost 20 years, says, “The most common complications at birth are maternal bleeding and fetal distress — the baby having difficulty breathing — and we carry equipment to manage both of those.”

The other main safety consideration involves knowing when a move to the hospital is necessary, or even a good idea. “We try to transfer to the hospital prior to the situation becoming an emergency — that’s what keeps it safe. If you find any abnormality in the baby’s heart rate or meconium [fetal feces — a sign of distress] in the water, you go.”

Although emergencies do happen, it’s important to put them in perspective: “Ontario research shows that the most common reason for transfer is pain relief; the next most common reason is slow progress,” says McNiven.

Both of these are valid reasons to transfer, but they are not emergencies.

There is even research to suggest that home birth can be good for mom and baby. A project conducted out of the University of Copenhagen in 1997 looked at six controlled studies covering around 24,000 low-risk women planning home or hospital births. When researchers compared the outcomes, they found that mortality rates were not significantly different between the planned home and planned hospital groups, but the planned home birth group had fewer low Apgar scores and fewer severe maternal lacerations (cuts or tears). There was less medical intervention in the planned home birth group as well: fewer inductions, episiotomies, assisted deliveries and Caesareans.

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What’s so great about home birth?

For some parents, the benefits of home birth are obvious: You get to be in your own environment, which is often more empowering, comfortable and convenient than the hospital. When you’re home, nobody insists that you wear a certain gown, take off your rings or stay in your room. And your birth can be as public or as private as you like — you can surround yourself with friends, family, even your older children if that’s your preference, or invite no one except your caregivers.

A home birth also means no rushing to or back from the hospital (midwifery clients are usually released a few hours after the birth, unless there are complications, since a midwife will do the postpartum care at home) and no anxiety about whether you’re going to arrive too early or too late. The care you get during a home birth is also unique: It’s an extremely personal one-on-one or two-on-one situation sans staff changes and hospital rotations. Add that to the many hours you’ve spent with your midwife during prenatal appointments (which are usually 45 minutes to one hour long) and you end up with an appealing care package.

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What’s not so great about home birth?

Clearly home birth isn’t for everyone. Women who are carrying twins (or triplets), who go into labour before 37 weeks and whose babies are in a breech position are among those best off in hospital. Midwives are trained to look for other medical concerns throughout pregnancy, and to rule out home birth when appropriate.

Home birth won’t suit every low-risk pregnant woman, either. Simply feeling safer and more comfortable in the hospital is a perfectly good reason to deliver there. “These days you can have a fabulous natural childbirth experience in the hospital,” says McNiven (see “How to Bring a Little Bit of Home to the Hospital,” p. 76).

When you give birth in the hospital, you don’t have to worry about gathering supplies or cleaning up mess. If you would prefer that your young children are safely out of sight, mind and earshot, you can leave them at home with a family member or a babysitter. And if you think you’re going to want an epidural or other pain relief, the hospital is the place to be.

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Is it allowed everywhere in Canada, and how much will it cost?

You may hear of the occasional family doctor who will attend a home birth, but generally, planning to give birth at home means finding a midwife. In BC, Manitoba and Ontario, midwives are registered and are allowed to assist women giving birth at home or in hospital. In either case their services are fully funded by the province. In BC, Manitoba and Ontario, a home birth costs nothing more than a bag of green garbage bags, a package of sterile, waterproof pads and whatever other minor items your midwife asks you to have on hand.

In Alberta, midwives attend home births and some hospital births (depen-ding on the city), and are registered with the province but paid by consumers. Patty Lenstra, registrar of the Alberta Association of Midwives, says, “Each midwife can set her own fee, but most of the practising midwives charge $2,500 for the complete course of care — prenatal, labour and birth, and postpartum care up to six weeks.”

Québec’s legislation does not currently allow midwives to attend home births. In New Brunswick, Nova Scotia, Prince Edward Island and Newfoundland, midwives attend home births, but are not regulated by their provincial governments. They are paid by individual families. In the North there are only a handful of midwives, who are also paid by consumers.

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What the heck’s a Doula?

If you’re being cared for by a family doctor or an OB/GYN, a doula can add a whole other dimension to your birth experience. As Maryanne Zuzak, a certified doula in Saskatoon explains, “Basically, a doula is there to mother the mother: She helps the woman in childbirth by providing emotional, physical and informational support.” Zuzak charges $350 for services that begin during pregnancy and end six weeks postpartum, but rates vary.

Like a midwife, a doula comes to your home early in labour to offer support. And although she doesn’t perform vaginal exams, Zuzak says an experienced doula will know when it’s time to go to the hospital: “We can tell by outward signs — the sounds she’s making, the things she’s doing or not doing. If she’s hitting the floor on her hands and knees during contractions, it’s probably time to go!”

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July 2002