By Lori Mork

Congratulations! So, you’re having a baby!!!! What the heck to do now?

First you choose your care provider. Do not take this task lightly. That is for a whole other blog on how to choose wisely. But to quickly recap your options for care providers in British Columbia are in the conventional medical system (used to be Family Docs…. Now it’s Obstetricians), and then Midwives. Both are covered under MSP and not out of pocket costs to you. For OB you usually just get a referral from your family physician, but for a Midwife you do not need a referral. I recommend choosing early since midwives are in high demand and you want to switch over and be with the care provider as soon in your pregnancy as possible to develop a relationship with them. 

STOP! DO NOT RUSH THIS PROCESS! Seriously!!!!! It is important to make thoughtful decisions about who will provide your maternity care. Then once you choose that person/people (since most work in collectives of 2-15 and share on call times.) But where you will give birth is another major decision you need to make. 

These major decisions can affect:

The care you receive and the effects of that care.

The quality of your relationship with your care provider(s).

How much information you will get.

The choices and options you will have, particularly during labor and birth.

Your involvement with decisions about your care.

If you are a healthy childbearing woman, like most pregnant women in Canada, you can consider giving birth in a hospital, or in your home. (Other provinces in Canada have a third location of a Birthing Centre… we don’t have this option in British Columbia so I will focus on the 2 locations we can choose from.)

Before you choose your care provider it’s important to decide which location you want to give birth in.  

The conventional medical system, aka Obstetrician’s only deliver babies at the hospital.

Midwives can deliver at the hospital or at the home location. BUT, and it’s a big but! Some midwives only deliver at hospitals (this is a whole other rant blog for me), or they only take a certain number. So, if a home birth is your choice of location, then you have to find a midwife who will come to your home for the birth, but also has rights at the hospital closest to your home, unless you are open to going to another hospital. 

If you want a hospital birth, then you can choose to go with the OB, or a Midwife, but it needs to be a midwife that has rights to the hospital you have chosen. (Not all midwives have rights at every hospital, they usually have 1 and maybe 2. 

If there is this amazing doctor that you want and you know you can’t live without at your birth, then you will have to give birth at the hospital. 

If you are dead set on a home birth, then you can take doctors off the table and start searching for the midwife that will support you at your home birth.

If you aren’t sure if you want a hospital birth or a home birth, I recommend going the midwife route since then you can decide as you gain more information, and your pregnancy progresses. You can change your mind at any time. But you would have to find a midwife who is open to either home or hospital birth. And buyer beware, some midwives will tell you they would be okay with a home birth, then when push comes to shove, they talk you out of that birth since they only really want to assist hospital births. Horrible right!? But I am being fully transparent. 

I recommend making both of these decisions together since they both affect who and where you will birth.

Here is a great article on the British Columbia Women’s Hospital (BC Women’s Hosptial) Website on selecting a care provider for more information when searching. Planning to Give Birth at BC Women’s (bcwomens.ca)

When thinking about location you really need to block out all of the external noise – aka your mother, sister, cousin, neighbors, and girlfriends, all who want to give their 2 cents and it usually stems from a biased opinion on their part depending on their birth story. It’s hard to block out the opinions, and then also the societal and media portrayal of birth. Which is completely inaccurate.

As a Doula I can sit with my clients and help them learn the pros and cons of decisions surrounding home versus hospital birth, as well as pros and cons of both types of care providers. When clients hire me early in their pregnancy, we can take time to listen to their needs, and allow them to make these decisions in advance to ensure they are supporting their birth with the right support team around them.

A great article is listed on the HealthlinkBC (government of British Columbia website_ to give more information, tips, research, and facts, when selecting your birthing location. Choosing Where to Give Birth – Hospital or Home? | HealthLink BC

I find when clients hire me later in their pregnancy, they realize their birth vision doesn’t align with their care providers or location, and although you can always make changes if you aren’t happy, it is more work to change care providers. It’s not as hard to change location if you have that supportive midwife open to either or in terms of home or hospital. 

Before I get into each, I want to dispel the biggest myth we are led to believe by society.

HOME BIRTH IS SAFE. HOSPITAL BIRTH IS SAFE. BIRTH IS NOT DANGEROUS. BIRTH IS NOT BROKEN. BIRTH DOES NOT NEED TO BE FIXED. BIRTH IS NOT MEDICAL.

Previous studies — including one from McMaster University in 2015, proved that the risk of adverse birth outcomes is low for both home and hospital births. 

The bottom line – HOSPITAL BIRTHS ARE NOT SAFER THAN HOME BIRTHS, as we are led to believe and are programmed into thinking. 

So, let’s break down benefits of hospital versus home birth:

Hospital

In Canada, the hospital is the most common site for birth. Maternity care in a hospital is usually led by physicians and often reflects the medical model of care. Although midwives also have rights to attend births at hospitals, they are held to those policies, procedures and timelines enforced at each hospital. This can mean that hospital maternity care may:

Emphasize standardized care rather than individualized care. 

Use some health interventions whether or not birthing women need them (e.g., electronic fetal monitoring, breaking membranes, cesarean birth – remember the stats of almost 50% of births ending in this option).

Rely more on the facility’s technology than your body’s physiology.

Not having proper staffing available. The British Columbia medical system has been struggling with staffing issues for some time now. Staff who are not available to provide continuous physical, emotional and informational support during your labour and birth. At BC Women’s hospital it is a 1:1 ratio for nurse to birthing person care, but some hospitals are severely short staffed. Because of the staffing issues that timeline for labour is fiercely enforced in order to have space for all of those labouring and needing care. But to note, the average time for a first-time woman labouring is 36 hours, this means a change of staffing multiple times. Not receiving the same familiar faces in care can add to the stress of birth. It’s not familiar when the nurse you have providing your care changes shifts to go home at the 12-hour mark, and another enters. Or when those staff members get their scheduled breaks as per union agreement means more strange faces coming into your birth space to cover them as they go for their lunch.

There are some advantages to hospital birth:

Although most childbearing women and newborns are well and healthy, a hospital is best equipped to diagnose and treat those with serious complications or high risk of developing such complications. Good for high-risk pregnancies. 

You can access some interventions you may want, such as epidural pain relief, which is not available in home births. 

Home 

With is being midwifery care only in the home that birth has advantages that may include:

Be highly tailored to your needs and preferences. This allows for religious and cultural factors to also be considered. Hospitals have more policies surrounding things like burning candles, etc.

Be more comfortable to labour in birth in familiar surroundings. 

Avoid the routine use of interventions and their side effects.

Rely more on your body’s own healthy processes than technology.

Enable you to receive continuous physical, emotional and informational support during your labor and birth, and offer important support to loved ones who are with you. You have the same person or people caring for you throughout your entire birth. Midwives are there and don’t get union breaks! They have a second midwife show up at the pushing stage of birth to have a backup in the event it’s needed, but otherwise you have the same person with you and not multiple bodies and personalities. 

Freedom to choose the delivery position, how long to labour, eating in labour, and whether to use other birthing elements: Some moms want water births, that some hospitals don’t allow or have the facilities to accommodate this. Their ‘rules’ ‘ or policies and ‘normal methods’ are often hard to escape at the hospital, at home it’s easier to DO WHAT YOU WANT!

Optional in-home follow up and lactation support available: Your team of your midwife comes to your home after birth, for multiple appointments (something you will appreciate when you are asleep deprived new parent and not having to get baby and yourself ready to head all the way to the clinic for checkup appointments.

The possible drawbacks of home birth:

Some women planning home birth switch to hospital care before, during or after labour (as a precaution if concerns arise, or due to complications); a flexible attitude can be helpful. This may or may not be warranted though, as our medical system is a flawed and broken one for the things that they now consider high risk, or for the bully tactics used to scare women into thinking birth is dangerous or unsafe, and the hospital is safer than a home, which is not an evidence-based fact.

True emergencies are rare but do, of course, happen. Two recent Canadian studies, the first conducted in British Columbia and the second in Ontario, examined the outcomes for planned home and hospital births and concluded there were fewer interventions with low-risk planned home births than with low-risk hospital births. Registered midwives are trained to respond to any delivery-related emergency. They undergo yearly recertification for neonatal resuscitation and biyearly recertification of emergency skills. Midwives attend home births with the same equipment that is found in hospital labour rooms, with the exception of epidurals. The Colleges of Midwives in regulated provinces issue a list of essential equipment, which includes fetal Dopplers, stethoscopes, blood pressure cuffs, oxygen tanks, bags and masks for resuscitation, drugs to stop hemorrhaging, IV bags to treat bleeding, and medication should stitches be required.  Remember birth is safe, regardless of its location.

Drive-thru Hospital Birth

Is there another option? I made this term up just recently when I was meeting with my client, and we were discussing their options for the location for their birth. I often have clients that have a tough time deciding between HOME versus HOSPITAL BIRTHS. It truly is a huge decision and one many people struggle with. 

I rarely share my personal birth stories with clients, but in this case, it served a purpose. I would describe it as “mostly home birth, with the grand finale at the hospital”. I would try to explain it, then also the “why” surrounding why I did a combo of home and hospital. 

I realized there are a whole bunch of people who truly want a physiological birth but are torn on HOW they can achieve this. They like the home birth concept but are brainwashed by the thing’s society (and Hollywood) has told them regarding birth. That it is unsafe, or dangerous. That it is medical and requires medical ‘help’. That there are ‘what if’s’ and a hospital is the best place to be. But research doesn’t back this up. The hospital isn’t any safer than home. But taking on the task of reprogramming the mindsets of multiple generations will take more than just little old me shouting it from the rooftops. 

It was at a prenatal visit that I blurted out when I was describing my 2nd birth “It was kind of like a drive thru birth.” I wasn’t going to the Fairmont Hotel downtown and hitting up the piano bar, to sit down, have glasses of wine, appies, entrée, dessert, a few more drinks, and then stay the night in one of their suites. I was pulling up to the drive through, ordering up a quick “baby delivery”, and then pulling away quickly to head home to enjoy my milkshake and large onion rings! Lol 

I realized it could be the answer for many clients who had other issues surrounding committing fully to a home birth. Fear or anxiety surrounding hospitals. My solution was “cut down the time you are at the hospital.” 

Some clients can’t find midwives to support their home births (either due to lack of midwives, waitlists, or no one willing to do a home birth). So, this drive-thru hospital birth option could also be a good one, since then they still cut down possible interventions, and have a more comfortable experience as long as possible at home, but then heading to the hospital since their care provider won’t attend a home birth. 

This is YOUR BIRTH!!!! You get to customize how you want it to look. So, while this isn’t a real thing, I have tried to find an in-between for those who really want the home birth, but still haven’t come around yet to release that feeling that the hospital is needed to be safe or helped. You are birthing this baby, you know how to, the location and those around you are just there to be spectators. 

Home Birth at a Hospital

I hear this phrase used a ton. This isn’t a real thing. It’s impossible to transport all of the benefits of a home birth to a hospital setting, regardless of the amount of tea lights or lavender essential oils you bring to it. You can try to make the hospital a bit more comfortable, but it is medical and will always have that feeling around it. There will always be outside noise from other things happening, as well as bodies in your space that cause it not to be a home birth anymore. So, I don’t use this term or try to convince clients it’s a thing. It’s not. If you want the benefits of a home birth, then choose that. If you are okay with all of the things surrounding that hospital birth location, then choose that one. 

The decision between home birth and hospital birth is a deeply personal one. It should be based on your individual preferences, risk factors, and medical history. It’s important to weigh the pros and cons carefully and consider your comfort, safety, and the level of medical support you desire during labour. 

Ultimately, the most important thing is the health and well-being of both the mother and the baby, but that doesn’t mean we should accept a traumatic/uncomfortable experience either. Remember this is a deeply vulnerable time that involves things happening more than just physically. Emotionally, mentally, psychologically, so it’s so much deeper than just being in a hospital room or your bedroom. 

Your birth story is one that you will bring with you and never forget for the rest of your life. The location of that birth plays a huge part in the narrative of that story. Choose wisely!

Happy Birthing!

Lori