CHOICE OF BIRTHPLACE

OPTIONS AT TMC

POSTPARTUM DISCHARGE PLANNING

Regardless of place of birth, your midwives will stay with you and baby for the first 2-4 hours postpartum. This means that if you deliver at Michael Garron Hospital (MGH) or the Toronto Birth Centre (TBC), you will be discharged home after 2-4 hours as long as there are no concerns for you or baby. Before your midwives depart, they will explain what to expect in the next 24 hours and when to page with concerns.

If postpartum monitoring beyond 2-4 hours is clinically indicated, you will be moved to a postpartum room at MGH and introduced to a nurse who will care for you under the direction of your midwife or obstetrician. Your midwife will visit you in hospital and continue postpartum care once you are discharged home.

CHOICE OF BIRTHPLACE: WEIGHING YOUR OPTIONS

The following information is derived from the Association of Ontario Midwives “Choice of Birthplace” available at www.ontariomidwives.ca/cob

HOME VS HOSPITAL BIRTH OUTCOMES

Giving birth out of hospital is very safe for clients who are healthy and low risk.

Planning birth out-of-hospital reduces interventions and negative outcomes for the birthing person.

If the pregnancy & birth are uncomplicated, there is no difference in newborn health outcomes for those planning an out-of-hospital birth.

PLANNED BIRTHPLACE & TRANSPORT

Most births will occur where the client plans to give birth. Most cases of transport to hospital are non-urgent and do not require an ambulance.

The likelihood of transport to hospital by ambulance (including those that transferred by ambulance for non-emergency reasons) is 8.2% first birth and 3.9% second or later birth.

The most common reasons for transport from a planned home birth/birth centre to a hospital in Ontario include:

  • Pain relief (epidural)
  • Prolonged labour
  • Non-urgent fetal wellbeing concerns

EQUIPMENT & MIDWIFERY EXPERTISE IN EMERGENCIES

Canadian research shows very little difference in newborn outcomes between births planned at home and births planned in a hospital.

The equipment midwives bring to home births and that is available in birth centres, is similar to the equipment in a level 1 community hospital. This includes:

  • Sterile instruments
  • Oxygen for birthing person and baby
  • Newborn resuscitation equipment
  • Medications to treat postpartum hemorrhage (heavy bleeding after birth)

Midwives are trained to manage emergencies in all settings and participate in regular certification in neonatal resuscitation, CPR and managing obstetrical emergencies.

PAIN RELIEF

Compared with planned hospital birth, planning birth at home/birth centre is associated with lower rates of epidural, narcotics and nitrous oxide for pain relief.

Not all pain relief options are available in all settings. People who plan to give birth in hospital may choose this option knowing that they would like to have access to an epidural.

Desire for pain relief is one of the most common reasons for clients to transfer from home/birth centre to hospital.

CLIENT INTERVENTIONS AND OUTCOMES

Planning birth at home/birth centre compared with hospital is associated with lower rates of postpartum hemorrhage (too much bleeding after birth), significant tearing from birth and episiotomy.

 

TYPE OF BIRTH

Compared to planned hospital birth, planning a birth at home/birth centre is associated with:

  • Higher rates of vaginal birth
  • Lower rates of caesarean section
  • Lower rates of assisted vaginal birth (vacuum and/or forceps)

One criticism of studies that compare outcomes based on place of birth is that the studies have not compared appropriate groups. Clients who plan to give birth in hospital may have made that choice because they have conditions that put them at higher risk of negative outcomes, and that make c-section or assisted vaginal birth more likely to occur. The data below is based on studies that have carefully selected comparison groups of midwifery clients as equally low-risk as the clients who planned home birth.

BIRTHPLACE RESOURCES

Recent research from British Colombia https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2742137/
The Association of Ontario Midwives “Choice of Birthplace” www.ontariomidwives.ca/cob
The Association of Ontario Midwives “Birth Place Options” www.ontariomidwives.ca/understand-your-options
The Toronto Birth Centre www.torontobirthcentre.ca