What to Know About Home Birth

Overview

Midwives are qualified and experienced in delivering babies at home.

Canadian research examining outcomes of midwife-attended births in different settings is consistent with findings from studies looking at comparable health-care systems, such as England, New Zealand, the Netherlands and Norway. In jurisdictions where midwifery services are well-integrated into the health-care system, evidence shows that planning to give birth at home or in a birth centre is as safe as planning to give birth in a hospital for midwifery clients at low risk of complications. It is also associated with a decreased need for obstetric and neonatal interventions.

For moms who are at low risk of complications, giving birth is generally very safe for both them and their baby. These moms can choose either birth setting available in our community: i.e. home, hospital. Overall, rates of obstetric interventions and negative health outcomes are low for all midwifery clients at low risk of complications in all birth settings.

Equipment and Preparation

Midwives bring all the equipment, medications, and supplies that we may need.

The family having the baby will gather things that will be useful, such as:

• Towels
• Face cloths
• Garbage bags
• Paper towels

(See list of things to prepare)

There are no special requirements for your home. Some planning with your midwife may occur around potential emergency access for paramedics; for example, if there is a narrow staircase to your bedroom, perhaps we will recommend delivery on the main floor.

Many people imagine a birth leaves quite a mess, but we pride ourselves on leaving your room and your house as clean as when we arrived.

We recommend you get a large plastic sheet large enough to cover your bed completely. Midwives bring disposable plastic absorbent pads.

When the midwives leave, there will be a bag of garbage and a bag of laundry.

Reasons People Choose Home Birth

• Feel more comfortable in home environment
• No restrictions on number of people who can attend, or their ages. Other children can be present if they wish or can be in another room with an adult caregiver
• No need to travel to the hospital in labour, and home with a brand new baby
• Previous fast labour, and wish to give birth safely

Research Evidence

• Planning birth at home compared with hospital is associated with a higher rate of spontaneous vaginal birth and lower rates of postpartum hemorrhage, perineal trauma (3rd and 4th degree perineal tears), and obstetric interventions such as caesarean section, assisted vaginal birth, episiotomy, augmentation of labour with oxytocin, epidural or spinal analgesia/anesthesia.
• Planning birth at home compared with hospital is associated with lower rates of use of narcotics for pain relief.
• Planning birth at a birth centre compared with hospital is associated with a lower rate of blood transfusion and a higher rate of immersion in water for pain relief.
• Overall, rates of neonatal interventions and negative health outcomes are low for all midwifery clients at low risk of complications in all birth settings.
• No difference was found in the risk of mortality (intrapartum stillbirth, early neonatal death or neonatal death 0–28 days) when comparing planned home births with planned hospital births.
• No difference was found in other neonatal interventions and adverse health outcomes, including neonatal resuscitation with positive pressure ventilation (PPV) and chest compressions, neonatal intensive care unit (NICU) admissions and Apgar scores when comparing births planned at home and in birth centres compared with hospital.

Eligibility

Babies Who Can Be Born at Home

• Single baby
• Head down
• Full term (37 to 42 weeks)
• Can be first baby
• No concerns with growth or size
• No anticipated need to have a pediatrician present for the delivery

Moms Who Can Deliver at Home

• Healthy pregnancy free of complex medical concerns
• Spontaneous labour not needing induction
• Can be GBS negative or positive
• Pregnancy completely managed by midwife without obstetrician consultation
• If water breaks, the fluid is clear of meconium

Labour and Pain Relief

• Women have freedom to move from one room to another, walk outside, bathe in their own tub, have privacy, and feel control over surroundings
• Can prepare in advance to have a birth pool
• Support team and midwives can help with touch and massage
• Distractions such as TV or movies can be used
• If medication for pain relief is desired (e.g., epidural), transfer to hospital is possible
• Prenatal classes and reading are recommended

Siblings of the Baby

• Talk to your other children about what to expect
• Have another adult present for childcare
• Your decision whether children are in the room or elsewhere during labour and birth

Safety of Home Birth

• Home birth is at least as safe as hospital birth for outcomes for baby and mother, if the pregnancy is normal and the birth is attended by trained midwives
• Older statistics implying home birth is less safe include unplanned or unattended births, and are not relevant to planned midwife-attended home birth

Equipment and Emergency Readiness

• Equipment similar to that in a level I community hospital: oxygen, neonatal resuscitation equipment, medications, sterile instruments
• Midwives undergo regular recertification in neonatal resuscitation (NRP) and emergency skills (ESW, ALARM)
• Midwives work well with paramedics, obstetricians, pediatricians, and nurses
• If urgent transport needed, ambulance and hospital are prepared

Transfer to Hospital

• If a situation arises requiring more specialized management, transfer will be made to WRHN @ Midtown (formerly Grand River Hospital)
• Midwife monitors labour, health, baby’s heartbeat, and recommends transport if needed
• Aim is to transfer before a situation becomes an emergency
• Method of transport (ambulance vs car) depends on labour stage and urgency

Most Common Reasons for Transport (Ontario)

During Labour:

• Prolonged labour
• Need for pain relief
• Fetal well-being concerns (meconium, fetal heart rate)

Postpartum:

• Postpartum hemorrhage
• Severe laceration repair
• Neonatal health concerns (e.g., respiratory distress)