The Society of Obstetricians and Gynaecologists of Canada (SOGC) just released an updated statement on home birth – No. 372 Statement on Planned Homebirth in the February issue of the Journal of Obstetrics and Gynaecology Canada (JOGC).  The SOGC opinion and corresponding statement is a refreshing respectful and collaborative approach to the choices of birth location facing birthing families today. One only has to compare this document with the American College of Obstetricians and Gynecologists' position statement on home birth to immediately see the difference in both tone and attitude.

SOGC Key Messages

1. Registered Midwives and some physicians provide homebirth care in Canada.
2. The SOGC reaffirms and emphasizes the importance of choice for women and their families in the birthing process. The SOGC promotes well-integrated community and hospital birthing care to ensure safe maternal and newborn care.
3. In Canada, planning a homebirth with a registered midwife or an appropriately trained physician in the integrated system described is a reasonable choice for persons with low degree of risk where the birth is anticipated to be uncomplicated and neither mother nor neonate will require resources beyond the local capacity.
4. All pregnant women should receive information about the risks and benefits of their chosen place for giving birth and should understand any identified limitation at their planned birth setting. Risk assessments should be ongoing throughout pregnancy and birth and care providers must ensure the individual is advised of any change in their risk status to support their ability to make an informed choice for most suitable birth site.
5. Communication amongst and between the hospital and community obstetric teams using set standards supporting emergency transport are critical components of a seamless integrated system and should remain a priority in supporting best practice outcomes for planned homebirths.
6. The SOGC endorses evidence-based practice and encourages ongoing research into optimizing birthing outcomes in all birth settings. Prospective data collection should capture all births and include planned and actual place of birth.

Collaboration

No. 372- Statement on Planned Homebirth, though an SOGC opinion, was collaboratively written by both registered midwives and obstetricians.  Both sides were aligned in accurately presenting the research and having the statement be an appropriate guide in support of home birth in Canada.  It is clear from the language used in the document that there is mutual respect between physicians and midwives.  SOGC acknowledges that the rate of home births in Canada is steadily rising.  They also acknowledge that both registered midwives and physicians are qualified to attend out of hospital births.

Family choice is imperative

The SOGC statement takes a firm stance on recognizing that the wishes of the birthing family are imperative and of key importance.  Families have the right to decide where they want to give birth and who they want to attend them.

Home birth is a reasonable option

This document reaffirms that home birth is an appropriate and reasonable option for low-risk pregnant parents.  There is no shaming, or alluding to parents caring more about the experience than the health of the birthing parent or baby.  Home birth is a choice that is  respected.

Risks and benefits of all birth locations should be discussed

The Society for Obstetricians and Gynaecologists Canada states that it is important for the benefits and risks of all birth locations should be discussed with pregnant families so they can make an informed choice for themselves.  Shared decision making can only take place when families clearly understand all the choices that they have available to them.

Smooth transfers are key

In order to make home birth a safe and viable option for low-risk birthing families, there must be smooth transfer protocols in place.  Approximately 20 percent of out of hospital births will transfer to the hospital.  Most of those transfers occur intrapartum due to the need for labor augmentation or pain relief.  Collaboration should exist and systems should be in place to ensure a seamless transition from home to hospital when appropriate.

Providers should practice evidence-based medicine

Regardless of whether the birth location is at home, a free-standing birth center or a hospital, all health care providers should offer and provide evidence-based care to their patients and clients.

Registered midwives have hospital privileges

Canada offers registered midwives hospital privileges that permit the midwives to follow their clients to the hospital for continuity of care and collaboration with obstetricians when a transfer is needed. These midwives are well integrated into the health care system.  Additionally, and of great importance, “no punitive or financial disincentives exist for those transfers”.

Research demonstrates the safety of home birth

Metanalysis of four studies concluded that people who birthed at home had increased spontaneous vaginal births, a reduction in interventions, lower maternal morbidity, less use of intrapartum pain medications, less obstetric anal sphincter injuries, fewer operative vaginal delivery, fewer episiotomies, fewer cesareans, fewer infections, and less postpartum hemorrhages. 

There was no difference in neonatal death, newborn APGAR scores, NICU admissions, severe adverse neonatal outcomes or intrapartum stillbirth between midwives attending births in the hospital and midwives attending births at home. 

SOGC concludes that for low-risk populations “data indicate that individuals at low risk for poor perinatal outcomes who plan homebirth with a regulated provider in an integrated health care system may have improved obstetric outcomes without increased neonatal morbidity or mortality.”

Conclusion

Out of hospital birth in Canada is accepted as a reasonable choice.  Midwives and physicians model collaborative and respectful behaviors when working together, keeping the common goal of good outcomes in mind.  They also acknowledge that birthing families have rights that need to be respected. All of this creates a very positive climate for out of hospital birth in Canada.  The United States has a long way to go to even begin to approach this level of collaboration and respect.  Unfortunately, with continued infighting in the United States on whether home birth is even an appropriate and safe option for families, consumers are unlikely to be able to enjoy the improved birth outcomes and respectful collaboration that our Canadian neighbors enjoy. And even more unfortunately, the maternal and neonatal outcomes that America experiences are unlkely to significantly change without this shift.

References

Association of Ontario Midwives. Choice of Birthplace: Guideline for Discussing Choice of Birthplace With Clients: Methodology and Review of Evidence. Toronto: Association of Ontario Midwives; 2017.

Campbell, K., Carson, G., Azzam, H., & Hutton, E. (2019). SOGC CLINICAL PRACTICE GUIDELINE: No. 372-Statement on Planned Homebirth. Journal of Obstetrics and Gynaecology Canada, 41, 223–227. https://doi.org/10.1016/j.jogc.2018.08.008

Planned home birth. Committee Opinion No. 697. American College of Obstetricians and Gynecologists. Obstet Gynecol 2017;129:e117–22.