![\"photo](\"http:\/\/www.jewishindependent.ca\/wp-content\/uploads\/2016\/02\/feb-26-health.26.Home1-Birth-Dr-Michael-Klein-200x300.jpg\")
In 2009, Klein worked on a study that looked at the safety of home births, evaluating three groups of births: home births by a midwife, hospital births by the same midwives, and a matched sample of physician births. The researchers looked at women who were identical in their risk profile and found that, regarding fetus development and the newborn baby, there was no difference in these three groups.<\/p>\n
\u201cHome birth seemed to be as safe as hospital birth, whether by the doctor or by the same midwife,\u201d said Klein. \u201cThere are now two other studies from Ontario that show the same thing.<\/p>\n
\u201cHome birth is integrated within the health-care system in B.C.,\u201d he continued. \u201cMidwives are supported and part of the system, so when the midwife needs help from a hospital backup system, she gets it.<\/p>\n
\u201cOf course, what you also see is dramatically more interventions on the physician-hospital side than at home. And you find, interestingly, that the midwives \u2013 the same midwives delivering in hospitals \u2013 have results in terms of interventions of various sorts that are closer to the doctor\u2019s side than they are to themselves at home.\u201d<\/p>\n
Klein attributes this observation to the influence of the hospital itself, a setting that is anxiety-driven. There may also be differences in the population, with women wanting a midwife in a hospital differently motivated from those wanting a midwife in a home setting.<\/p>\n
In terms of the methodology of the study, it was very important that, once a woman was beginning her labor at home, no matter if the birth ended up being in a hospital or not, that she was counted in the home birth column or category.<\/p>\n
\u201cRoughly, a third of midwifery births will be home births,\u201d said Klein. \u201cThat\u2019s because this is what women are requesting. The model is what is called a \u2018woman-centred model.\u2019 If a woman wants a home birth and she meets the criteria in terms of her risk profile, then the midwife is obligated to deliver that service in the way she wants.<\/p>\n
\u201cI think there\u2019s no question that we should have more home births. You may be unaware, but the minister of health in B.C. has supported that notion \u2013 that home births should be … I wouldn\u2019t say promoted, but certainly made available.<\/p>\n
\u201cWomen need to know what the options are and they need to know if they need help during labor that they will get it. A home birth, to be safe, needs to be within 30 minutes of an operating room. Contrary to what most people believe, things don\u2019t suddenly go wrong. They evolve.\u201d<\/p>\n
Something else that can be a limiting factor in increasing home birth numbers is the lack of midwives across Canada.<\/p>\n
\u201cThe joke is that you have to register with a midwife before conception,\u201d said Klein.<\/p>\n
In British Columbia, the midwifery class recently doubled in size. Why not quadruple the class size to keep up with demand? The simple answer is that the system is not currently able to support that, although it is estimated that a home birth costs the system between a third and half as much as a hospital birth.<\/p>\n
\u201cI think it\u2019s too complex,\u201d said Klein. \u201cWhat we are talking about now is a serious planning exercise. That\u2019s not happening. I think it will take time for the system to collapse a little bit more before it happens.<\/p>\n
\u201cThe other player in all of this, which we haven\u2019t talked about yet, is the doula. That movement is, of course, gaining more and more popularity. In some settings, it\u2019s been so successful that some hospitals are supporting the doulas\u2019 salaries.\u201d<\/p>\n
According to Klein, doulas are successful in lowering the caesarean-section rate and other interventions. \u201cWhen you lower the c-section rate, it has a big impact on the hospital budget, because a person who has a caesarean stays twice as long in the hospital than one who has a vaginal birth,\u201d he said.<\/p>\n
Avoiding a c-section means less likelihood of a uterine scar in subsequent pregnancies. \u201cOnce a pregnant woman has a uterine scar, the whole reproductive trajectory is changed,\u201d said Klein. \u201cOne is more likely to have a whole series of problems, complicated next pregnancies, placental attachment problems, ectopic pregnancies, stillborn births and infertility. With the c-section rate at four percent in home births and up to 30% in hospital births, that many more women will end up with a uterine scar and be at higher risk of complications.\u201d<\/p>\n Dr. Brian Goldman, an emergency physician at Mount Sinai Hospital in Toronto, and the host of White Coat, Black Art<\/em> on CBC Radio One, has, for years, had an eye on the growing demand among women in Canada for licensed midwives.<\/p>\n \u201cMidwives are experts in low-risk, uncomplicated births, as are family doctors,\u201d said Goldman. \u201cHowever, even though low-risk birth is a core part of the training of family physicians, very few of them want to attend low-risk births once out in practice.<\/p>\n \u201cIn Canada, we have a situation in which the vast majority of births \u2013 high-risk and low-risk alike \u2013 are attended by obstetricians. These specialists have tremendous knowledge, skill and experience which, in my opinion, is best put to use managing women who are likely to have a complicated pregnancy and birth. We need more professionals like midwives and family doctors to attend low-risk births.<\/p>\n \u201cMost family doctors run busy practices and find it difficult for practice, family and social reasons to devote a significant amount of time to attending women in labor through the night. To me, midwives represent the likeliest prospect for increasing the pool of professionals qualified and interested in attending low-risk births.\u201d<\/p>\n Rebeca Kuropatwa<\/strong> is a Winnipeg freelance writer<\/em>.<\/p>\n","protected":false},"excerpt":{"rendered":" With only about five percent of Canadians giving birth at home, one might think the practice is dangerous and that is why the number is so low. On the contrary. Studies show that, as long as the mother is at low risk, it is as safe to give birth at home as it is to […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5],"tags":[5419,5417,5413,5415,5418,5414,5416],"class_list":["post-17498","post","type-post","status-publish","format-standard","hentry","category-national","tag-brian-goldman","tag-child-and-family-research-institute","tag-doula","tag-home-birth","tag-michael-klein","tag-midwife","tag-pregnancy"],"blocksy_meta":{"styles_descriptor":{"styles":{"desktop":"","tablet":"","mobile":""},"google_fonts":[],"version":8}},"_links":{"self":[{"href":"https:\/\/www.jewishindependent.ca\/index.php\/wp-json\/wp\/v2\/posts\/17498","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.jewishindependent.ca\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.jewishindependent.ca\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.jewishindependent.ca\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.jewishindependent.ca\/index.php\/wp-json\/wp\/v2\/comments?post=17498"}],"version-history":[{"count":0,"href":"https:\/\/www.jewishindependent.ca\/index.php\/wp-json\/wp\/v2\/posts\/17498\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.jewishindependent.ca\/index.php\/wp-json\/wp\/v2\/media?parent=17498"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.jewishindependent.ca\/index.php\/wp-json\/wp\/v2\/categories?post=17498"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.jewishindependent.ca\/index.php\/wp-json\/wp\/v2\/tags?post=17498"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}![\"photo](\"http:\/\/www.jewishindependent.ca\/wp-content\/uploads\/2016\/02\/feb-26-health.26.Home2-Birth-Dr-Brian-Goldman.jpg\")