Hospital Births or Home Births Safer?

The knowledge and practice of midwifery constituted an integral part of the traditional health care system of Canada’s first peoples. As an indispensable feature of traditional life, its practice accorded Aboriginal woman a source of recognition and esteem in the community. The role of a woman as counselor and midwife was understood to be the Creator's calling to a very special profession. Traditional Aboriginal midwives were considered as fundamental in the childbirth process and in transmitting ethical values from one generation to the next. Elders can recall that pregnancy and childbirth took place on a closely knit basis linking the midwife to the birthing woman, the infant, the husband and father, the extended family, and the entire community. However in the post-contact era there came over time the loss of the right for midwives to assist with birth within their traditional territories. Colonialism, the impositions of western medicine, the residential school system, and government legislationall served to alter the socioeconomic and traditional ways of Aboriginal people and undermined many of their long-standing healing traditions. The combined impact of these forces, in addition to major deterioration in health status, played havoc on Aboriginal cultures and undermined the previous balance and harmony within their communities. In recent years Canada has faced a shortage of maternity care providers that grows more acute every year. This shortage is felt most acutely in rural and remote communities and has fostered an increased acceptance of midwives as appropriate care providers for low risk pregnancies. For Aboriginal communities, this situation has provided greater opportunity for the restoration of midwifery and community-based births. Indeed, current efforts are underway in a limited number of regions in Canada to revive traditional midwifery in Aboriginal communities. Despite the obvious need it has proven to be a difficult task. Many of the older practices have been lost and few Aboriginal midwives are left to pass along what survives of their indigenous knowledge. As an encouraging note, emerging forms of Aboriginal midwifery demonstrate an attempt to blend both traditional and modern forms of midwifery in order to create innovative models that focus on culturally relevant, community-based care. Safety Issues Perhaps the chief impediment to this movement taking full wing in all regions of Canada has been the misconception on the part of both medical professionals and lawmakers that high-tech hospital births are superior safety-wise to midwife-assisted births in more family based settings, such as the home. Although there can be some risks involved in childbearing, in the vast majority of cases pregnancy and childbirth are normal functions of a healthy body, and not a life or death crisis that requires the supervision of high technology and surgical intervention. With fewer high-tech hospitals and obstetricians than are found in North America, many countries such as Holland, Sweden and Denmark employ midwives as the primary care-givers for healthy women during their pregnancies and births. Statistically, such countries have the highest birth survival rates in the world. In recognition of this fact, and understanding the potential dangers of the overuse of childbirth technology, the World Health Organization has urged countries with highly medicalized birthing—as is the case in Canada and the United States—to return to a midwife-based system of maternity care. Midwives, in fact, still attend most of the births around the globe. Physicians, in spite of their advanced training and surgical specialties, have never proven themselves to be better childbirth attendants than midwives. And no research has ever demonstrated that hospitals are the safest places in which to give birth. In reality, study after study has demonstrated that for the majority of child-bearing women, the homebirth/midwifery model should be the standard for maternity care.Midwives, in fact, still attend most of the births around the globe. Physicians, in spite of their advanced training and surgical specialties, have never proven themselves to be better childbirth attendants than midwives. And no research has ever demonstrated that hospitals are the safest places in which to give birth. In reality, study after study has demonstrated that for the majority of child-bearing women, the homebirth/midwifery model should be the standard for maternity care.i Safety in childbirth is measured by how many mothers and babies die, and for how many the process of childbirth precipitates a compromise in their health and well being. Multiple studies that have compared hospital and out-of-hospital births point with clearness and consistency to fewer deaths, injuries, and infections for homebirths supervised by a trained attendant, than for births that occur in hospitals. While maternal death rates have vastly improved in the 20th and 21st centuries, factors such as improved maternal nutrition during pregnancy and greater attention paid to cleanliness have played a major role in this positive change. One of the earliest studies done on the issue of childbirth mortality and safety took place in 1939 in the American Southwest. It revealed a perinatal mortality rate of 26.6 per 1,000 live births in homes, compared to a hospital birth mortality rate of 50.4 per 1,000.ii A late 20th-century European study examining the perinatal mortality rate (PMR) for 185,573 births in Holland found the highest death rate among physician assisted deliveries in hospitals at 18.9 perinatal deaths per 1000 births; with physician-assisted home births at 4.5 per 1000; followed by midwives assisting in hospitals at 2.1 per 1000; with the lowest rate being for midwives assisting at home, 1 per 1000.iii So far, the largest and most comprehensive study on the comparison of hospital birth outcomes to that of homebirth outcomes was a study in which 1046 homebirths were compared with 1046 hospital births of equivalent populations in the United States. For each home-birth patient, a hospital-birth patient was matched for age, length of gestation, number of prior pregnancies, risk factor score, education and socioeconomic status, race, presentation of the baby, and individual major risk factors. Like their hospital counterparts, infants born at home had trained attendants and prenatal care. The infant death rate of the study was low in both cases and essentially the same, and there were no maternal deaths for either home or hospital. The primary differences were found in the significant improvement for both the mother’s and the baby’s health if homebirth took place. The results of this study showed these likelihoods if a woman gave birth in a hospital: