Your Options for Place of Birth
What does a hospital birth with a midwife look like?
Once you think you are in labour your midwife will assess you over the phone, and determine if you need to be assessed in person. If it seems you are in active labour your midwife will probably come to your home to do the initial labour assessment. She will listen to your baby’s heart rate, check your blood pressure, temperature and pulse, monitor your contractions and check your cervix for dilation.
Once you are in active labour your midwife will stay with you to monitor you, your baby and the progress of labour. Midwives always carry their equipment with them and they have all of the tools to monitor you safely at home. Many women choose to spend time labouring in the comforts of their home before moving to the hospital. This way you have access to your own bed, food, and bathroom. Like all mammals, changing environment and having unfamiliar people around can interfere with the progress of your labour. Ideally you will be in good strong labour once you are heading to the hospital.
Upon arrival at the hospital you will be assigned a room to go to with your midwife and your support people. You will continue to labour in that room and have your baby there. When the birth is imminent, your midwife will call a second midwife to come to the hospital to assist.
A few hours after your baby is born, if you and your baby are well you will go home. Your midwife will come to see you at home within 24 hours. If your midwife has any concerns about you or your baby you will be admitted to the postpartum ward. If you are staying in the hospital you will spend about 24 hours before you are discharged home.
What does a home birth with a midwife look like?
Once active labour is established your midwife will be with you in your home, and she will begin to set up her equipment for the birth. This includes all of the birth instruments, suture instruments, a resuscitation area for the baby including oxygen, emergency equipment and medications. Midwives do not carry pain medication. Your midwife will encourage you to change positions, use heat and cold, showers/baths, and sterile water injections to help with pain management. When birth is imminent, a second midwife will be called to come to your home as well. After your birth your midwives will stay with you for a few hours to make sure you and your baby are stable and well. Once your midwives are satisfied that everything is normal, they will leave and come back within 24 hours of the birth for the first postpartum home visit.
Transporting from home to hospital:
Your midwife will be monitoring you throughout labour (whether you plan a hospital or home birth), throughout the birth and in the postpartum period. Most of the time transporting from a home birth to hospital is due to a non-urgent concern, and you would go in your own car, or in a taxi. The most common reason to transport to the hospital is because of a non-progressive labour, or the desire for pain medication. Other reasons to transport include a fever or high blood pressure. In an emergency an ambulance would be called to take you to the nearest hospital, your midwife would go with you in the ambulance.
Your midwife is specially trained to provide home birth, and part of this training includes emergency skills in the home setting. If you require an emergency transport your midwife will call an ambulance and you will be transported to the closest hospital. Examples of these situations include too much bleeding after the birth (postpartum hemorrhage) or if the baby required resuscitation.
What about the Toronto Birth Centre?
Women in Toronto have the option of giving birth at the Toronto Birth Centre. A Birth Centre is a regulated, community-based health care facility that offers women a safe, comfortable, family-centred place to give birth. To learn more about the Toronto Birth Centre, please visit their website.
Myths and Misconceptions
Home birth is not as safe as hospital birth
Evidence suggests that for a low-risk woman who is at term, a home birth with trained personnel is a safe option for birth. Studies that compare safety of home and hospital birth show no differences in mortality and morbidity.
Many people have the misconception that being in the hospital and having immediate access to
interventions will provide the safest birth outcome. The reality is that being in the hospital increases the chances of intervention use and each of these interventions carry their own risks.
Home birth is messy, and involves lots of clean up
When planning a home birth you will be given a list of supplies to have on hand including some useful items to help keep your floors and mattress from having permanent stains. Your midwives are experienced at keeping things tidy throughout the labour and birth, and will help clean up afterwards. After the birth you will be left with one bag of linens to wash ( which when washed right away in cold water stains usually come right out) and one bag of garbage. You will also be required to store and dispose of your placenta (burial in the backyard).
My neighbors will be disturbed by the birth
Although many women do choose to vocalize during their labours, most women are not as loud as they think they will be. And even for those who are vocalizing loudly, when your neighbors discover the cause of the “noise” most are very excited to hear that a baby will soon arrive in the community.
My apartment or home is too small to have a home birth
At the end of pregnancy your midwife will come to your home for a prenatal home visit and you will discuss the setup for the birth and where you think you would like to have your baby. The reality is that you do not need a large space to have a baby at home. In fact most rooms at home are much larger that the room you would be giving birth in at the hospital.
Benefits of home birth
-more comfortable environment with more space to move around
-access to familiar food, sounds, smells, and shower/bath
-cleaner environment resulting in fewer infection rates in mom and baby
-fewer interventions used
-no need to move to the hospital while you are in labour, or to drive home once you have had the baby
-access to have a water birth (if desired)
Benefits of hospital birth
-some women feel more comfortable or safer in the hospital
-quicker access to pharmacological pain medication
-quicker access to a respiratory therapist/pediatrician if the baby required intubation, or extensive resuscitation
-faster access to specialized care in extreme emergencies