What is a birth centre?

Krystal Ferguson’s first baby was born at home, but last May, when she was 39 weeks pregnant with her second, she was still unsure of where she wanted to deliver. A home birth wouldn’t be the same—she was in a smaller house and now had a toddler running around—so she was considering a hospital delivery. But when her midwife raved about the Toronto Birth Centre (TBC), with its new and spacious rooms, large birthing tubs and soothing atmosphere, she began to second-guess her decision. She booked a spot, but before she could even take a tour, her baby girl was born in one of the TBC’s birthing tubs. Ferguson doesn’t regret her last-minute choice one bit. “It had all the comforts of home, with a hospital close by. It was like giving birth in a beautiful hotel room.”

The provincially funded, not-for-profit Toronto Birth Centre opened in January 2014 and was developed by indigenous midwife co-leads Cheryllee Bourgeois and Sara Wolfe from Seventh Generation Midwives of Toronto, a practice focused on guiding indigenous families through pregnancy, birth and postpartum. Though it’s a health-care facility that specializes in midwife-led childbirth, its four birth rooms have all the comforts—and maybe more!—of home: a double bed made up with cozy linens; a sleek, deep tub set off to the side; a fireplace and a full ensuite bathroom. The furniture is comfortable, the fixtures are modern, and there’s a kitchen where expectant families can gather. Metis artist Christi Belcourt’s colourful murals cover the walls.

While the TBC wasn’t the first to open in Ontario—that one, the first in Canada, is located on the Six Nations of the Grand River Territory reserve, near Brantford, and opened in 1996—it’s one of two birth centres (the other in Ottawa) to open under a pilot project by the Ontario government. The new centres mark a strong shift back to the philosophy of birth as a life event, not a medical one, that can safely take place outside a hospital. The concept is not new; midwife-run birth centres are well established in the US, the UK and Australia.

That the Toronto Birth Centre is located on a busy street with a big sign is intentional, says Bourgeois. “Toronto midwives didn’t want it to be hidden away. We wanted people to be able to see: This is a birth centre. This is where babies are born.”

Today there are 18 birth centres across Canada, including one community birth centre in Winnipeg, two private facilities in Alberta (where midwifery care is covered, but there’s a fee to actually use the space) and a whopping 12 in Quebec—and there’s a demand for more. “We need to open up new birthing centres and build up midwifery teams,” says Claudia Faille, past president of the Association of Midwives of Quebec, who adds that some of their current birth centres don’t have enough midwives to fill them, due to government funding shortages. But, increasingly, women want the option of midwife-assisted deliveries in birth centres or at home. Among midwife-assisted births in Quebec, 80 percent happen in birthing centres, 15 to 20 percent happen at home and less than two percent occur in hospital.

Midwives in Vancouver have formed a working group to advocate for the creation of community-based publicly funded birth centres, such as one proposed for St. Paul’s Hospital. When the project gets the green light, they’ll be ready. Lisa Sutherland, a registered midwife and the chair of that working group, says pregnant women in BC have increasingly been pressing their midwives for this kind of alternative birthing environment.

Birth centres appeal to midwives and expectant women because they’re designed specifically for the natural flow of birth, with all the tools for supporting labouring mothers but with as little medical intervention as is necessary. All the equipment a midwife would bring to a home or hospital birth is there, discreetly tucked away behind cabinets. The intimate, unintimidating design and size of these centres—they typically have just a handful of birthing rooms and accommodate a maximum of around 400 births a year—is also a big draw. “Our birth centres in Quebec are designed to be somewhat limited in how many women they can serve,” says Faille. “The idea is to protect its smallness, so it doesn’t become a miniature hospital.”

Although birth centres are medical facilities, there aren’t any doctors on site, so interventions like epidurals, medical inductions and C-sections are unavailable. But there are other tools used to manage pain. The Toronto Birth Centre has birthing balls, TENS machines (which provide an electrical current to the bottom of the back, which relieves pain in some women), birth stools and rebozos—large scarves that a support partner can use in a variety of ways to alleviate the pressure of labour. The Toronto Birth Centre also offers nitrous oxide as an option for pain management. Birth centres work closely with local paramedics and the nearest hospitals to make sure transfers—when needed—are quick and smooth.

But it’s the very lack of medical interventions that makes birth centres so appealing to many women. “Because you’re birthing outside the hospital, you’re automatically diminishing your intervention rate,” Faille says. It’s hoped that a birth centre in BC would help decrease the province’s high C-section numbers. “When we look at the data around the world, there is a very statistically significant decrease in C-sections for women who attend birth centres,” says Sutherland. “The role of a birth centre is to provide family-centred care that promotes healthy birth and prevents unnecessary medical intervention.” Midwifery care is an ideal choice for low-risk pregnancies and the delivery of healthy infants, and moving those births into community birth centres frees up hospital resources for high-risk pregnancies, says Bourgeois.

When complications crop up during pregnancy or delivery with a midwife, the long-held mantra of childbirth and parenting—expect the unexpected—rings true. You may be set on birthing at home or at a birth centre, but the location can change depending on the path your labour takes. Sabrina Vieira and her husband, James Cox, registered at the Toronto Birth Centre for their first baby, but during a long, slow-to-progress labour, the couple, in consultation with their midwife, opted for the hospital to have access to options such as Pitocin to speed up labour and an epidural, if Sabrina wanted one. “The birth centre was our preferred place to welcome our baby into the world,” says Vieira. “But we had toured the hospital as well, knowing that we needed to be flexible and open to different options during labour, especially since this was my first delivery.”

Vieira was lucky to have had choices as she planned ahead, but there’s still a long way to go before delivering in a community birth centre, or even delivering out of the hospital with a midwife, is an option for most Canadian women, says Faille. “There’s a lot of work to do in the whole of Canada, considering certain provinces and territories are not publicly regulated and funded for midwifery,” she says.

Ferguson loved her experience at the Toronto Birth Centre. “I would deliver there again in a heartbeat,” she says. “Every woman should have the option to deliver in a place like it—it’s a shame there aren’t more of them.”

Did you know? In a study published in the Canadian Medical Association Journal last December, researchers from McMaster University looked at 11,493 each of planned home births and hospital births, and found that women with low-risk pregnancies who planned midwife-assisted home births saw no increased risk of harm to the baby and fewer interventions compared with those who had planned hospital visits.

A version of this article appeared in our Summer 2016 issue, titled "What is a birth centre?", pg. 44-45.

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