Friday Fact! Home Birth in Ontario

Did you know?

  • —About 25-30% of midwifery clients in Ontario plan a home birth. All women have the right to a choice of birthplace.
  • —Since 1994, medically trained midwives have attended approximately 25,000 home births in Ontario.
  • About 21% of all midwifery births in Ontario are at home. The remaining 79% of midwifery births are in hospital.
  • Two midwives attend every home birth, one to manage the labour and care for mom, while the other prioritizes baby. Then they both help clean your house!
  • Research shows that perinatal and neonatal mortality rates are equal between home and hospital births for normal, low risk pregnancies.
  • Women who plan a hospital birth have a cesarean delivery rate of 8.1%, whereas only 5.2% of women who choose a home birth move to hospital for a cesarean delivery.
  • The most common reasons for transfer to hospital are for pain relief (epidurals are not offered at home) and slow labour progress, not some sort of impending doom emergency.

Now you know too! Share with your friends!

 

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Stillbirth

A couple of weeks ago I experienced my first stillbirth.

It was undoubtedly one of most tragic things that has ever happened to me. From delivering the news that there was no heartbeat to the moment the client lovingly took her newborn from me after delivery, I was enveloped in a fog of disbelief and heartbreak. I left that day feeling incredibly humbled, saddened, and rocked with raw feeling.

Clinically, I had to grow up. We needed the medical induction of labour and vaginal delivery of the infant to be smooth and, without question, professional. I didn’t have time to ask for the step-by-step instructions of things I should already know how to do. I found clinical confidence I didn’t know that I had. It challenged everything I had ever learned about labour management, because the focus shifts entirely from both mother and baby … to the mother alone.

I cried.

Once alongside the longing labour cries she expelled to mourn the motherhood she would never have, and once when she asked for 60 more seconds with her baby before we took him. Putting the little bassinet into the morgue wasn’t easy for me either.

I had some flashbacks to my Dad’s death, but I was able to focus them into giving her everything I had in labour support. I can only hope that it made even a fraction of the pain less sharp.

The staff at the hospital were incredibly supportive, helping my preceptor and I negotiate all the additional paperwork required in this situation. One of the nurses gave us each a solid, lasting hug. Midwives cannot declare death, so several consultations were had with the obstetrician on-call, ranging from the most appropriate method of induction, to special certificates that needed signing. The hospital provides the family with memory boxes and the option of getting footprints, while also empowering clients to spend as much (or as little) time as they want with their child.

This situation was hard. Certainly not as hard for me as it was for that unbelievable family that endured literal heartbreak, but tough nonetheless. As health care providers we have to balance caring for our clients and caring for ourselves, and in this situation my tank was drained on both accounts. I drove home at 4:50am and it was only then that I was consumed with a full, empty sadness that made me cry myself to sleep. I woke up around noon, feeling heavy, and called my school to file an incident report. I spoke with one of my favourite midwife professors, who talked me through things. We then paid a visit to the client’s home to check on her, later in the afternoon.

Almost two weeks later, after talking it out with my peers and my preceptor, I feel more acceptance. The clients thanked us by name in their obituary, which to me is the greatest honour of all. We will continue to support the client until 2 weeks postpartum, and then we will part ways until she is ready to try again.

My preceptor handled things so eloquently and I feel honoured to have learned from her care approach. I am also somewhat grateful to have had this experience as a student, because I know that this is a part of our job that we cannot run from, and that I will unfortunately have to manage again someday. This was the 3rd stillbirth in my preceptors career, and she noted to me that there are usually never any concrete answers we can find to tell us why this happens.

It’s not fair.

I guess Life is always there to remind you that it’s precious, isn’t it? Hug your loved ones and spend a moment being grateful today; trust me, those moments are what you’ll remember when it matters the most.