Should I Give Birth at Home or in a Hospital?
Years ago, giving birth at home was the only option available to women. In the 20th century, we shifted to hospital births, an option that quickly gained popularity for women looking for pain-free experiences. But in the 1970s, pregnant women were introduced to the idea of having more control over their births. In the ensuing years there’s been another shift – one reverting back to home births and the use of doulas and midwifes in the birthing process.
Rise in Home Births
An increasing number of women are choosing to have home births for various reasons, including:
- An aversion to medical intervention, such as pain medication, labor induction or fetal heart rate monitoring
- A preference to give birth in a comfortable, familiar place, surrounded by one’s spouse or family
- A desire for more freedom and control in the birthing process
- Cultural or religious concerns
- Living in a remote location, making it harder to travel to a hospital
Doulas vs Midwives
The current shift to home births has led to a rise in the hiring of doulas and midwives. Many mistakenly believe that they’re one and the same. They’re not. Doulas are trained to provide emotional, practical and informational support and care for an expectant mother before, during and after labour and delivery. But doulas – who can be certified by local, national and international organisations – are not trained to offer medical care – and they do not deliver the baby.
On the other hand, midwifery – a practice regulated in Ontario pursuant to the Midwifery Act, 1991, S.O. 1991, c. 31-– provides neonatal care, deliveries and helps the mother and baby post-birth. Midwives have medical training and can, therefore, provide gynecological exams and prescriptions. Of note, midwives attend about 10 percent of all births in Ontario, and about 20 percent of those births occur at home.
It is also important to understand what a “regulated” health professional is in Ontario. The Regulated Health Professions Act, 1991 S.O, 1991 c.18 is a provincial statute that clarifies which health professionals are “regulated” in the province. A professional that is regulated means their training, education, scope of practice and other rules of practice are governed under stricter oversight than a non-regulated health professional.
Understanding the difference between a regulated and non-regulated health professional is an extremely important consideration every patient must be aware of. If a Doula explains that they also deliver babies (which they can’t) or a midwife offers to do caesarean sections (which they can’t), then the patient should look for someone else who understands their appropriate scope of practice. This is why many expectant families use multidisciplinary teams to assist in the delivery of their child: doula to offer emotional support and midwife or obstetrician to do the actual delivery. The better educated a patient is, the better suited they will be to make their own health care decisions. Are Home Births Safe?
According to a 2015 study by McMaster University that was published in the Canadian Medical Association Journal, women with low-risk pregnancies who choose to have home deliveries face no greater risk of harm to their babies than those who give birth in hospital.
But the American College of Obstetricians and Gynecologist, among other experts and practitioners, caution against home births. The College base their concerns on a 2010 study published in the American Journal of Obstetrics & Gynecology which found that babies born at home die at two to three times the rate of those born in hospitals.
Similarly, many are worried that doulas and others are providing pregnant women with incorrect information, encouraging them to turn down medical interventions that may prove essential. The biggest concern for those wary of home births is the access to nurses, OBGYNs and other hospital staff who could help out in case of emergency. They fear that women giving birth at home are sometimes too far from a hospital to get the proper and quick care they need in those risky situations.
Keep in mind, without quick thinking and actions, a baby experiencing a lack of oxygen to the brain can end up with a permanent brain injury, often leading to cerebral palsy and other conditions.
That’s why it’s generally recommended that women who fall under high-risk categories – e.g. they’re expecting multiples, are obese, have high blood pressure etc. – take extra precautions or simply deliver in the care of a hospital.
The decision where to have your baby, and by whom to deliver, is a medical decision, not a legal one. However, when patients understand what their health professional can, and cannot do, they take greater control over their own healthcare decision making.
If you experienced complications during your pregnancy or birth – whether at home or in hospital – that led to a birth injury, a medical malpractice lawyer could help.
My past experience as a Personal Support Worker (PSW) helps me better understand the needs and concerns of my clients and navigate their complex situations. I also draw upon my experience on medical malpractice actions, many of which were a result of paediatric or obstetrical negligence.