Data from a new study published in the New England Journal of Medicine implies Canada is a much safer place for home births than the United States.
The study, called “Planned Out-of-Hospital Birth and Birth Outcomes” looked at all births that occurred in Oregon in 2012 and 2013. Researchers found that planned out-of-hospital births were associated with a rate of death more than twice that of planned in-hospital births (3.9 vs. 1.8 deaths per 1000 deliveries).
The U.S. study contrasts a recent Canadian study that compared approximately 11,000 planned home births with 11,000 hospital births in Ontario and found only slightly higher rates of death amongst home births (1.15 of every 1,000 home births resulted in death compared to 0.94 of every 1,000 hospital births).
The lead researcher on the U.S. study says there are systemic reasons for the discrepancy.
“According to the Canadian study, when out-of-hospital births are integrated into the healthcare system and there are regulations in place for how to select women for out-of-hospital births, I think it can be a safe option,” said Jonathan Snowden of the Oregon Health and Science University in Portland. “In our Oregon study we found that, absent a lot of these systems, there were small but slightly increased risks of neonatal mortality in the out-of-hospital setting.”
The lead author of the Canadian study, Dr. Eileen K. Hutton from McMaster University, says there is a major factor in Canada’s better record: the presence of midwives.
“When studies are well designed and carried out, the data consistently find that when women with midwives in a system of well integrated home and hospital birth care give birth at home, outcomes are similar.”
Ivy Lynn Bourgeault, a professor in the Telfer School of Management and the Institute of Population Health at the University of Ottawa says Canada is in desperate need of more midwives, particularly in low-risk scenarios. She notes that in The Netherlands 80 per cent of births are attended by a midwife and in the U.K all of them are, removing the strain on the healthcare system in those places.
“It is perplexing why we have so few midwifery births in Canada,” says Bourgeault. “Part of the cause is that Canada was one of a handful of countries (and the only Western industrialized nation) not to have any provisions for midwifery care prior to 1993. In the last 20 years, there has been growth in the profession, but only modest. At the same time there has been a rapid exodus of family physicians no longer delivering babies, for a number of reasons, including that attending births is disruptive to one’s practice and one’s lifestyle. Babies like to come at all hours of the day and night, and not neatly into 9 to 5 time slots, Monday to Friday.”
In the ongoing debate between home and hospital births, some are choosing a third option. Of the roughly four-millions births each year in the United States, 98 per cent take place in hospitals. But some parents are now opting for privately run “birthing centers”, such as the Greenville Midwifery Care & Birth Center in South Carolina, which is one of more than 300 similar facilities across the country.
“It’s nicer than our house,” said mother Dana Schrenk. “I believe birth is a natural experience … and wanted a quieter, calm peaceful environment.”