Both of my sons were born outside the hospital, by choice. The first one arrived in a bedroom at the back of a Toronto midwifery clinic. The second one was born a couple of years later in the middle of my living room. Both times I was attended by two highly trained midwives – one for me, one for the baby – and a midwifery student. Despite the physical pain of natural childbirth, both of my birth experiences were wonderful, positive, and extremely empowering.
The midwives brought with them the equivalent of a Level 1 hospital – a resuscitation station with oxygen tanks, an IV, oxytocin, trays of sterilized tools and needles, warmed blankets. The only thing they can’t do is provide an epidural. As the hours passed, we talked and told stories; I moved in and out of the shower; I was massaged, encouraged, fed, and helped by my husband and mother. All the while, the midwives never left my side, keeping careful track of my progress. They checked the fetal heartbeat frequently and explained the various stages of delivery. When the baby arrived, they stayed the mandatory three hours post-delivery to ensure everything was okay.
“Isn’t it dangerous?” people often ask. No, it’s not. Midwives only allow a mother to deliver at home if she’s low-risk. They are skilled at detecting the slightest abnormalities throughout the three trimesters and labour – something that doctors, with their medicalized view of childbirth, lack of experience with ‘normal’ or natural births, high intervention rates, and distant relationships with patients, are not as tuned in to.
According to Mary Newburn, head of Policy Research at the National Childbirth Trust, in a 1999 article in The Independent, there are two basic models of childbirth:
The "midwifery model" is based on the belief that childbirth is a normal physiological process, for which women's bodies are well designed. Midwives and doctors educated within this framework believe it is important for women to feel confident about their body and their ability to give birth. They believe the environment and the things done to women can help labour go smoothly or interrupt the flow.
The "medical model" is based on the belief that evolution has done childbearing women no favours - the human brain is now big and our pelvises are narrow - and birth is only normal in retrospect. Doctors and midwives who have been educated in this frame of reference tend to relate to pregnant women as cases with the potential for complications which must be managed to avoid disaster.
Midwives are highly trained professionals in Ontario, Canada, where I live. They must complete a four-year Bachelor of Health Sciences degree at one of three universities that offer midwifery training, and they have to attend a minimum of 60 births before graduating. By contrast, a GP medical student only has to attend 3 births before he or she can deliver a baby.
Midwives in Ontario have hospital rights, which means they can deliver babies in hospital, if mothers choose to, and can transfer easily if there are complications. Midwifery care is covered under Ontario’s universal health care plan, and includes 6 weeks of postpartum care, breastfeeding assistance, and in-house visits.
Home birth is gaining popularity as people realize how safe and conducive to natural delivery it is. A recent study of 17,000 women and babies, the largest-ever analysis of women who planned home births in the U.S., found that 5.2 percent were delivered by cesarean section (after being transferred to the hospital), whereas 31.1 percent of planned hospital births involving comparably low-risk, full-term pregnancies ended in cesareans.
The same study found that 4.5 percent of women giving birth at home were given oxytocin to speed labour along, compared to 40 percent of low-risk, planned hospital births. Neonatal mortality rates remain mostly the same – 0.41 per 1,000 born at home and 0.46 per 1,000 born in hospital.
While giving birth at home wouldn’t work for everyone, and many women will continue to feel most comfortable in a hospital setting, it’s important for people to realize that the same medical advances that have improved obstetrics to the point they’re at now have also benefited midwifery. No longer should the mention of a midwife conjure up images of boiling pots of water and bundles of rags in a dark, dirty cottage. Thankfully midwifery has evolved to become a totally modern medical practice.
Giving birth at home was the most empowering thing I’ve ever done. It made me feel strong and in control of my body. There was no pressure to deviate from my wishes for a natural birth or deliver more quickly. Midwifery is a route I recommend to anyone considering having a child.