What is a home birth (or out-of-hospital birth) and what are some of the benefits?

Registered midwives are the only healthcare providers trained and equipped to offer choice of birthplace. There is a robust body of evidence examining midwife-attended births and the safety of planned out-of-hospital birth in Canada. For midwifery clients at low risk of complications, overall, rates of obstetric and neonatal interventions and negative health outcomes are low in all birth settings. Compared with hospital, planning birth at home or in a birth centre with a registered midwife is associated with lower rates of obstetrical complications such as postpartum hemorrhage, perineal trauma (3rd and 4th degree tears) and episiotomy. Compared with hospital, planning an out-of-hospital birth is associated with higher rates of spontaneous vaginal birth. Birth planned for home, birth centre, and hospital are associated with similar rates of neonatal complications.

If you are thinking about having a home or birth centre birth, here are a few questions you might want to consider and discuss with your midwife.

1. Do you have a registered midwife as your primary care provider in pregnancy? You can confirm your midwife is registered by searching their name on the provincial or territorial regulatory body website (ex. College of Midwives of Ontario).

2. Have you spoken with your registered midwife about out-of-hospital birth in the context of your specific circumstances?

3. Do you have a person or team in place to support you through labour?

4. Do you understand the circumstances in which a homebirth may not be possible and the circumstances that necessitate transfer to hospital?

Benefits of an out-of-hospital birth and reasons that many families choose this option:

• Wanting to give birth in a comfortable, familiar setting

• A desire for more input into the birthing process

• Cultural or religious reasons

• Water immersion in labour when not available at hospital

• Valuing birth with low interventions when not needed

• Previous negative hospital birth experience or negative experiences in a hospital setting

• Lack of access to transportation

• Lack of a local hospital

Some additional tips to help with choosing your birth place:

1. Everyone benefits from attending a childbirth class to help you prepare so you know what to expect during labour and de.

2. Create a preference plan

   1. Consider these questions:

      • Who do you want to be with you when you give birth?

      • What do you want your surroundings to be like?

      • What comfort measures would you like to rely on during labour?

      • Will you use any specific methods to manage pain?

      • Do you want to nurse your baby immediately after delivery?

Most births occur where clients plan to give birth. Among clients who planned to have their first baby at home (at the onset of labour), just over half actually gave birth at home. Your healthcare provider might advise transport to hospital if:

• Labor is prolonged

• Fetal well-being concerns like abnormal fetal heart rate or the presence of meconium in amniotic fluid

• Postpartum hemorrhage (after birth)

• Medical pain management

• Repair of severe lacerations (after birth)

• Neonatal health concerns (ex. Respiratory distress) (after birth)

Once you have determined that an out-of-hospital birth is a preferred option for you, discuss your birth preferences plan with your midwife. They will give you more information about the (very minimal) supplies you will need. Share the plan with others who will be supporting you during labor and delivery. This will help everyone understand what you want, so you can feel safe, supported and confident in your birth experience.

Sources / Additional resources:

• Choice of Birthplace by Association of Ontario Midwives

• Understand Your Options by Association of Ontario Midwives

• Birthplace Options by Alberta Association of Midwives