Study on the safety of giving birth hits home

It seems strange now, but in Britain during the 1950s and '60s such births were the norm, not the exception. There are probably millions of afterbirths buried in flowerbeds and borders across the country. But in North America, despite a wealth of evidence supporting planned home births as a safe option for women with low-risk pregnancies, the setting remains controversial. And medical interventions such as epidurals, episiotomies, use of forceps, vacuum extraction, and cesarean sections are on the rise along with hospital costs.

Studies on home births have been criticized for being too small to accurately assess perinatal mortality or unable to distinguish planned from unplanned home births. But a major new paper published in the June 2005 issue of the British Medical Journal looked at 5,418 planned home births in Canada and the U.S. The results demonstrate lower rates of medical intervention in home births compared to hospital births, yet no discrepancies in mortality rates of both mothers and babies.

The findings are not a big surprise, according to Linda Knox, a registered midwife and assistant department head in the Department of Midwifery at BC Children's and Women's Health Centre and St. Paul's Hospital, which share one department. "The research has always shown home birth as a safe option for low-risk deliveries. In fact, it's well established that it's not the place of birth that affects outcomes but the skill of the birth attendant," she told the Georgia Straight during a phone interview.

Knox insists the safety of home births has never really been an issue in B.C.; rather, concerns have revolved around unregulated practitioners attending home births. The B.C. government began to regulate midwifery in 1995, when it established the College of Midwives of British Columbia. In 1998, the B.C. Ministry of Health initiated the Home Births Demonstration project, in which every home birth for the following two years had to be registered. "The project wasn't about demonstrating the safety of home births," Knox said, "but about how best to integrate them into the existing health system." One result, she cites, is that the ministry changed the regulations governing ambulance transport so that midwives attending a birth continued to be in charge in the ambulance, if they had to move the birth to the hospital, as opposed to the paramedics.

Still, the job of a midwife is to attend the birth wherever it occurs, observed Knox. "We are the guardians of normal birth, and certainly in a hospital, the medical interventions are right there so they tend to be used more often. But we don't encourage home deliveries. We follow the woman to the setting of her choice."

The reasons women choose one setting over the other are as varied as the length of a labour. Some women choose a home birth because they see hospitals as places for sick people. It's no surprise that during the SARS crisis in Toronto, home-birth rates skyrocketed. Some people consider moving a woman out of the home to give birth a medical intervention. Other women want the privacy and intimacy afforded by a home birth. On the other hand, some people feel safer at a hospital. And Knox has known women to choose a hospital birth simply because they don't want to deal with the mess at home.

After hearing about the positive home-birth experience of a friend, 37-year-old Nadine Rogers and husband Shayne chose to have their fourth baby at home with a registered midwife in attendance. Now five months old, their baby boy is healthy and more content, the parents say, than his three sisters were at the same age. They are convinced his cheerful disposition is partly the result of a serene delivery into the world.

"Our first experience was a nightmare," said Shayne from his home in North Vancouver. "My wife was in labour for 12 hours, hard labour for six. When it came time to push, she ripped from here to her toenails. There was this stream of blood, but nobody else noticed because the attention was on the baby. I was in horror when the nurses started raking a comb through the baby's hair. There were students coming in and standing around. And Nadine was in hospital recovering for five days. It was just horrible."

The Rogerses contrast that first delivery with their home-birth experience and say if they were to have another baby, they wouldn't set foot in a hospital unless it was a high-risk birth.

"With this last baby I wasn't nervous at all. It just felt very natural," Nadine told the Straight. She said it was so much nicer to be in her own bed, with familiar smells and sounds, her favourite music playing in the background, and candles lit instead of fluorescent lights glaring. "I went into labour at 2:30 a.m. and delivered at 7:30 a.m. The girls woke up at 8 a.m. and came in to see their little brother. And baby and I stayed in bed all day together. He just flowed into the world."

Clearly, as controversial as home births still are for many North Americans, the experience for those who choose to deliver at home can be a treasured one. For the Rogerses, the birth of a happy, healthy baby wasn't the only thing to celebrate. The experience gave back what they felt they'd lost during three hospital births: a valuable sense of control, empowerment, and pride. "We realized," said Shayne, "that pregnancy isn't a medical problem at all. In fact, it's a natural condition that we were perfectly equipped to deal with."