Home birth

What to know about home birth

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.

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.

What reasons do people give for wanting a 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 indicates that:
• 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 of 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. These results from Canadian research are consistent with international research in settings where midwifery is well-integrated into the health-care system, including results from the Birthplace in England study that compared planned home and birth centre births with planned hospital births and from a Dutch study, the largest of its kind to date, that compared 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.

Which babies 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

Which moms 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
Many women discover that at each stage of labour as contractions become more intense, their coping techniques help them manage.
At home, women have freedom to move from one room to another, to walk around outside, to have a bath in their own tub, to have privacy and to feel control over their surroundings.
You can prepare in advance to have a birth pool if you wish.
Your support team including your midwives may help you with touch and massage if you find that helpful.
Some people find that watching television or a movie is a helpful distraction.
If you do wish to have medication for pain relief, ie epidural, we can go to the hospital and arrange for you to receive it.
Taking prenatal classes or reading books to know what is happening in your body, what to expect, and ways to cope is very useful.

Siblings of the baby
We recommend that you talk to your other children about birth and what they might expect to see or hear if they are home when you have the baby.
We recommend having another adult present for childcare, even if the children are asleep when you go into labour, so that if a child needs something, your partner can continue to stay with you in labour support while your child is attended to.
It is your decision if you would like to include your children in the room with you when you labour or deliver your baby.

Safety of home birth
Several recent research studies have found that 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.

Some statistics in the past have implied that home birth is less safe than hospital birth. These statistics include all babies born at home, including preterm babies born before the mother was able to get to hospital, or mothers who did not receive prenatal care or any assistance from a trained birth attendant. The outcomes of these births are not relevant to the safety of planned home birth with a midwife in attendance for women with normal healthy pregnancies.

The equipment midwives bring to home births and that is available in birth centres is similar to the equipment in a level I community hospital, including oxygen, neonatal resuscitation equipment, medications to treat postpartum hemorrhage and sterile instruments.
Midwives are trained to manage emergencies in all settings and undergo regular recertification in neonatal resuscitation (NRP) and managing emergency skills (ESW, ALARM).
Midwives work well with paramedics, obstetricians, pediatricians, and nurses. If we need to transport to hospital urgently, we call an ambulance and call the hospital to prepare them for our arrival.

Transfer to hospital

If a situation arose at home during labour or postpartum that required more specialized management than possible at home, we will transfer you and/or your baby to Grand River Hospital.

Your midwife will monitor your labour for progress of labour, your health, and your baby’s heartbeat. If she has any concerns she will discuss with you her recommendations, which may include transport to hospital. The aim is to transfer well before a situation becomes an emergency. The method of transport, choosing between ambulance and car, depends on the stage of labour and the urgency of the situation.

The majority of births occur where women planned to give birth. Among clients who, at the onset of labour, had planned to give birth at home, nearly 87% of moms with previous deliveries and about half of first time moms gave birth at home.
Though it is much less frequent, it is possible for planned hospital births to occur at home or for an ambulance to be called to their home and transport them to hospital, especially in the event of a quick labour.

Most cases of transport to hospital are non-urgent and do not require emergency services or paramedics. At times, an ambulance may be used for transport to hospital because it is the fastest or most appropriate means of transportation even in the absence of a health emergency. At other times, an ambulance may be called and then the situation resolves without needing to transport to hospital.

The most frequently reported reasons for transport from home during labour, in Ontario include: prolonged labour, need for pain relief, and fetal well-being concerns such as meconium and fetal heart rate.
The most frequently reported postpartum reasons for transport from home to hospital in Ontario include: postpartum hemorrhage, repair of severe lacerations and neonatal health concerns such as respiratory distress.

Position Statements

College of Midwives of Ontario
Standard on Home and Out-of-Hospital Births 2014
http://www.cmo.on.ca/wp-content/uploads/2015/07/FINAL-Home-and-Out-of-Hospital-Births-May-2014.pdf
The literature on Ontario homebirths demonstrates that planned homebirths with a well-screened population of women, within a supportive health care system, and attended by professionally trained midwives carrying emergency equipment, are as safe as planned hospital births. Similar outcomes have been shown in other jurisdictions with comparable models of midwifery care.
The view of birth as a normal physiologic process is central to the midwifery philosophy of care. The promotion of normal birth and the reduction of unnecessary interventions in pregnancy and childbirth are recognized as essential factors to improving maternity care outcomes. The CMO supports the belief that promoting and supporting home and out-of-hospital birth contributes to the safeguarding of normal birth.

Canadian Association of Midwives
Position Statement on Home Birth 2013
https://canadianmidwives.org/position-statements/
• Women have the right to make an informed choice regarding their place of birth.
• Planned home birth should be recommended for healthy, low-risk women.
• Women who plan home births experience reduced obstetric and neonatal interventions and a course of care that facilitates normal, physiologic birth.
• Evidence-based birth site selection requires ongoing assessment and care throughout the antepartum, intrapartum and postpartum periods. Midwives have unique expertise in the use of low technology procedures and are skilled in intrapartum assessment and care in low resource settings. Therefore, midwives are ideal primary care providers for mothers and newborns in the home setting.

College of Midwives of Ontario
Statement on Home Birth, 1994
www.midwivesofheadwaterhills.ca/pdf/home_birth.pdf
The College of Midwives of Ontario (CMO) believes that midwives must continue to support this option [home birth] and that for families seeking this option, normal birth at home must be encouraged and supported.
The CMO believes that women have the right to choose to give birth in their own homes with their families. The World Health Organization describes health as multi-dimensional. Decisions about health are based on many factors including physical, emotional, social, spiritual and cultural considerations. Women must be free to make decisions regarding birth based on all of these factors. Birth is more than a physical or medical event.

Society of Obstetricians and Gyneocologists of Canada
Policy Statement on Midwifery, July 2009
http://www.jogc.com/article/S1701-2163(16)34248-7/abstract
The Society of Obstetricians and Gynecologists of Canada (SOGC) recognizes and stresses the importance of choice for women and their families in the birthing process. The SOGC recognizes that women want to choose the setting in which they will give birth. All women should receive information about the risks and benefits of their chosen place for giving birth, and should understand any identified limitation of care at their planned birth setting. The SOGC endorses evidence-based practice and encourages ongoing research into the safety of birth settings.

RCOG/RCM Joint Statement No.2, April 2007 Home Births
Royal College of Midwives & Royal College of Obstetricians & Gynecologists (joint statement)
https://www.rcm.org.uk/sites/default/files/home_births_rcog_rcm0607.pdf
The Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists (RCOG) support home birth for women with uncomplicated pregnancies. There is no reason why home birth should not be offered to women at low risk of complications and it may confer considerable benefits for them and their families. There is ample evidence showing that labouring at home increases a woman’s likelihood of a birth that is both satisfying and safe, with implications for her health and that of her baby.

Research

http://www.cmaj.ca/content/early/2015/12/22/cmaj.150564
Outcomes associated with planned place of birth among women with low-risk pregnancies
Eileen K. Hutton, Adriana Cappelletti, Angela H. Reitsma, Julia Simioni, Jordyn Horne, Caroline McGregor and Rashid J. Ahmed
CMAJ December 22, 2015 cmaj.150564; DOI: https://doi.org/10.1503/cmaj.150564

http://www.cmaj.ca/content/181/6-7/377
Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician
Patricia A. Janssen, Lee Saxell, Lesley A. Page, Michael C. Klein, Robert M. Liston and Shoo K. Lee
CMAJ September 15, 2009 181 (6-7) 377-383; DOI: https://doi.org/10.1503/cmaj.081869

http://www.bmj.com/content/330/7505/1416
Outcomes of planned home births with certified professional midwives: large prospective study in North America
BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7505.1416 (Published 16 June 2005) Cite this as: BMJ 2005;330:1416

http://www.cmaj.ca/content/166/3/315.full
Outcomes of planned home births versus planned hospital births after regulation of midwifery in British Columbia
Patricia A. Janssen, Shoo K. Lee, Elizabeth M. Ryan, Duncan J. Etches, Duncan F. Farquharson, Donlim Peacock and Michael C. Klein
CMAJ February 05, 2002 166 (3) 315-323;

https://www.ncbi.nlm.nih.gov/pubmed/2006954
Outcomes of 1001 midwife-attended home births in Toronto, 1983-1988.
Birth. 1991 Mar;18(1):14-9. Tyson H.