Screening key to home births
By Jenn Watt
Published Dec. 12, 2017
A recent study has found for low-risk pregnancies, choosing home birth with a midwife is just as safe in a rural area as an urban one in the U.S.
The research examined the outcomes for more than 18,000 women in the United States whose pregnancies had low-risk of complications. It found it was just as safe to choose home birth in the city as the country.
Researcher Elizabeth Nethery, working in the school of population and public health at the University of British Columbia, explained the motivation for the study on a question and answer section of the university’s website.
“People tend to assume that there is an additional risk to having a baby at home in rural areas, because of potentially longer travel times to a hospital with maternity services, difficulty getting ambulances, and weather that can make it hard to travel,” she said.
“We found that midwifery care and home birth is as safe for rural women and their babies as it is for women from the rest of the country. The risks for rural women who had low-risk pregnancies and planned to deliver at home or in a birth centre with a midwife were no different than for the moms or babies in the rest of the country.”
This study was conducted in the United States, so it cannot be perfectly applied to Ontario, said local registered midwife Annalee Winter, however, the findings are still useful.
“One of the reasons [the safety levels are similar between urban and rural] potentially is because we do screening for which women are considered low risk and who isn’t. Then making a better plan for delivering at the hospital if you do have any risk factors,” she said.
“We always talk about how we keep home birth safe because we want people who are planning [for] home to feel safe there.”
Winter is one of a team of midwives based at the Midwifery Services of Haliburton-Bancroft.
She explained that midwives are regulated by the College of Midwives of Ontario.
They are trained for four years in university-based low-risk obstetrics. Part of that training includes emergency skills and the midwives bring with them the equipment commonly found in a Level 1 hospital.
In 2016, 61 babies were born through the local midwifery services with 20 per cent of those being home births.
Nearly a decade ago, Haliburton Highlands Health Services ceased operations of its obstetrical bed, which means all women who want to deliver in a hospital leave the county to do so.
A low-risk pregnancy is assessed by health professionals based on a wide range of factors which includes whether the mother has serious underlying health conditions and if the pregnancy is progressing in a normal fashion.
Home births statistically come with lower rates of intervention. Some women just find being at home a comforting environment for delivery.
For those who have had quick births in the past, being at home might provide peace of mind, said Winter.
“They feel way more comfortable knowing they’ll be at home and there’ll be midwives who come and bring equipment with them rather than having their baby at the side of the road in their car,” she said.
Midwives provide a range of care stretching from the months leading up to birth to several weeks postpartum.
“Our schedule of visits prenatally is very similar to what you’d have with a family doctor and OB. We do [visits] once a month until the beginning of the third trimester, and then once every two weeks until 36 weeks, and then once a week until they have their baby. There are two midwives at the birth. Then we care for Mom and baby until six weeks postpartum. We do home visits within the first two weeks, which is helpful in rural areas if people have issues with transportation or just having to drive all the way to Peterborough for follow-up care,” Winter said.
Home births are an option for local women, but are not the most frequently chosen.
Ultimately, the midwives are there to support the choice the client makes, providing insight and expertise.
“One of the biggest things for us as midwives is to offer people informed choice and for them to be able to make the decision about what they feel is safest and what they feel is the most risk. So, having the option of delivering at home or hospital. We feel it is so important for people to be able to work with that choice.”
The Midwifery Services of Haliburton-Bancroft offers information sessions about home births, which includes current research on the practice and offers an opportunity to look at the equipment used.
The midwives are also happy to discuss options one on one.
You can get in touch with them at 705-457-9992 or go to haliburtonbancroftmidwives.ca.