How Safe Is Home Birth?

When I mentioned my desire to have a home birth with my first baby, there were mixed reactions, to see the least. Some friends and family were supportive and encouraging, while a few others were very vocal about their feeling that it was crazy. But I armed myself with an arsenal of resources and educational materials, and a rock-star birth team (an experienced and skilled midwife, a doula and my husband).  Thanks to that, and to a relatively straightforward labour and delivery, I had a healthy, complication-free home birth.

In most places in Canada, a woman has options when it comes to birth location, and safety is a key consideration for pregnant women and health-care professionals. Research shows giving birth at home for a healthy woman with no complications is a safe alternative to a hospital birth.

While physician-attended home births were the norm in Canada up until the early- to mid-20th century, midwives are now the only health-care professionals trained to attend home births.

One of the three founding principles of midwifery in Canada is based on the choice of birthplace—home or hospital; although pilot birth centres in Toronto and Ottawa may soon provide women in Ontario with a third option.

Home birth in uncomplicated pregnancies is supported by the Royal College of Midwives in the United Kingdom and by the colleges of midwives in Australia, New Zealand and Canada. The Society of Obstetricians and Gynecologists of Canada recognizes the need for further research. (1)

Stringent criteria for home birth
For women who choose a home birth, the criteria are stringent. Marie Hatherall, a recently retired registered midwife in London, Ont., explains it needs to start with a desire to have a home birth, and with a woman’s trust in her body and the birth process.

“A woman who is fearful of the birth process may not be very comfortable being at home in labour,” Hatherall notes.

As well, she must be healthy and have had a low-risk, straightforward pregnancy. “A woman who has high blood pressure, whose baby is in a breech presentation, or (who) is carrying twins would not be a good candidate for a home birth,” Hatherall says.

Many people aren’t aware of the strict protocols in place for monitoring labour at home, as well as for addressing any issues that might arise.
“With close monitoring in active labour, if an abnormality were to arise with the woman, the fetus or the progression of labour, transfer into the hospital can be arranged,” Hatherall says.

Midwives also bring a slew of equipment when attending a home birth, such as a monitoring tools, birth supplies, and oxygen tanks, as well as emergency equipment, including neonatal resuscitation items and postpartum hemorrhage supplies.

Midwives also maintain CPR and resuscitation certification, Hatherall says.

‘On my own terms’
Joni Surette-Nelson, an Ontario mom, birthed her second baby at home, knowing her midwife was trained to deal with any spontaneous complications: “I felt more safe being at home: on my own terms, in my own way and surrounded by those I had chosen to be present. It was truly ‘my’ birth.”

Like many others who choose home birth, she liked the idea of being in a familiar and comforting place, and felt it made labour easier because she had more control over the environment.

Asked about safety concerns of her planned home birth, Surette-Nelson explains: “Because this was my second uncomplicated pregnancy, my familiarity with the labouring and birthing process left me with few major concerns about the safety of a home birth.”
 
For some, hospital = security
Still, home birth is not for everyone, Hatherall says, and safety is a definite factor for women who choose to give birth in the hospital.

“Many women are not really interested in exploring the other option; even a small risk was perceived to be too great for them.”

Stephanie Campbell says she felt safer in the hospital with an obstetrician. “It was never a question for me to not go to the hospital. I felt and still feel it is the safest place for women to deliver babies.”

Although she did not have any complications during labour or birth, she wanted the obstetrician present and readily available in case of an emergency.  “I also like the idea of a sterile environment at the hospital,” she says.

Campbell had a wonderful experience with her obstetrician and didn’t feel she required the level of post-natal care midwives offer.

A 2011 article in Macleans echoes Campbell’s views on hospital safety and concerns about home birth.

In it, André Lalonde, executive vice-president of the Society of Obstetricians and Gynaecologists of Canada (SOGC), explains that he would never consider home birth an option for his family because of the unexpected risks and, from his career experience, knowing that although everything can look fine, disaster can suddenly strike. (3)

The ‘redeeming’ home birth
Yet Hatherall finds there is “another group of women who have previously had an experience in the hospital (usually related to birth) which has been traumatic for them, and they want to be in control of their experience” for their subsequent labour and delivery.

Alyssa Jarvis, a doula and mother of three, agrees. “After my second baby was born, I knew there had to be a better way to bring a baby into the world. I read everything I could about midwifery, natural birth and home birth, and hoped to have the redeeming home birth I knew I needed in order to give myself what I missed in the other two births.”

Jarvis felt safer being at the hospital for her first two births, but says she didn’t realize at the time she had other options.

“After the negative experiences at the hospital, I became a doula and attended numerous home births and hospital births, so I felt 100-per-cent safe for my own home birth because labour and delivery were no longer scary for me.

Jarvis also had minor issues at her home birth that required extra care (that would have been the same in the hospital), but says she always felt safe and would not hesitate to have another home birth.

Home births on the uptick
Although the majority of women in Canada still have their babies in hospitals, the number of women choosing to give birth at home is steadily increasing.

In a 2009 in-depth Canadian study published in the Canadian Medical Association Journal (CMAJ), the authors concluded that “planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric interventions and adverse maternal outcomes compared with planned hospital birth attended by a midwife or physician."(2)

Other medical professionals have a different take on the home environment.  Jon Barrett, the chief of maternal-fetal medicine at Toronto’s Sunnybrook Health Sciences Centre, says, “We should be working to make the environment of the hospital conducive to the home birth experience, rather than having more deliveries at home” (3).

For women who do decide to birth at home, Hatherall agrees with the findings of the CMAJ study: “I believe that a midwife attended home birth with a healthy, low-risk woman is just as safe as being at the hospital. In fact there may be additional benefits for the healthy, low-risk woman to give birth in her own home. “

Megan Powell writes about pregnancy and maternal health for momstown, and about natural family living at henfamily.com. She loves spending time with her very spirited son and is looking forward to the arrival of her second child in the spring.

References:
1. “The Safety of Home Birth: Is the Evidence Good Enough?” CMAJ. Sep 2009; 181(6-7): 359–360.

2. “Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician.” CMAJ. Sep 2009; 181(6-7): 377–383.

3. “Is Home Birth Safe?” – Danielle Bochove Macleans Magazine