Birth Centre Safety

If you are experiencing a healthy, low risk pregnancy, birth is generally very safe for both you and your baby regardless of care provider (midwife or doctor) and setting (home, birth centre or hospital).

That said, the specialized education and traning that midwives undergo significantly contributes to the safety of birth centre births in Ontario.

Midwives:

  • are regulated health professionals
  • receive an education specific to attending births and responding to birth emergencies both in and outside of the hospital
  • engage in regular, continuing competency training to attend births and respond to birth emergencies both in and outside the hospital
  • can quickly access specialist care (e.g. obstetrician, pediatrician) in the hospital when needed to support the best health outcomes for you and your baby

Over 2000 babies have been born safely at the Toronto and Ottawa birth centres since they opened their doors in 2014.

What does Canadian research say about the safety of planned free-standing birth centre births?

Midwife-led birth centres are somewhat new in Canada; however, they have long existed in the United Kingdom, Australia and the United States. Health outcomes at Ontario’s birth centres are being carefully tracked, but the birth numbers are still too low to make research-based conclusions.  

A preliminary 2016 evaluation of the Ottawa and Toronto birth centres completed by Ontario’s Better Outcomes Registry and Network (BORN Ontario) concluded that:

  • birth centres appear to safely support uncomplicated, low intervention births
  • the vast majority of families who use birth centres were very satisfied with their experience and would choose to give birth there again

These conclusions are consistent with Canadian research that shows excellent health outcomes associated with midwife-attended home births. Home births and birth centre births have many important aspects in common including:

  1. midwives as the primary health care providers
  2. availability of similar medical equipment and medications
  3. availability of similar pain relief options

Because of these similarities, we can assume birth centre health outcomes are comparable to home birth health outcomes. 

What does international research say about the safety of planned, free-standing birth centre births?

While there are no Canadian studies on the safety of midwife-attended birth centre births, international research provides insight into the issue.

In the United Kingdom (UK), over 15, 000 babies are born annually in free-standing midwifery units (FMUs). UK midwives practice in much the same way as Ontario midwives, and FMUs can be considered the UK equivalent of Ontario’s birth centres. Strong research from the UK shows excellent health outcomes for low risk birthing parents and their babies following planned FMU births.

Infant outcomes by planned place of birth: obstetric unit (hospital) vs. free-standing midwifery unit (birth centre)

The diagrams* below show outcomes for babies when birth is planned in a hospital obstetric unit or an FMU (birth centre). In each case, the green circles represent a baby born healthy, and the blue circles represent a baby with a poor outcome (e.g., the baby was injured, seriously ill or died during or just after birth). These outcomes are very rare amongst healthy people who are at low risk of complications, but they can happen in any birth setting.

UK research indicates that the same number of babies are born healthy and well regardless of planned birth setting (FMU or obstetric unit).  

 

  

Birthing parent outcomes by planned place of birth: obstetric unit (hospital) and free-standing midwifery unit (birth centre)

UK research also indicates that low risk parents planning to have their babies in an FMU (birth centre) rather than an obstetric unit (hospital)  experience the following less frequently:

  • use of medical forms of pain relief such as epidural, spinal or general anaesthetic
  • induction of labour
  • C-section
  • assisted delivery (forceps and vacuum)

This was even true for birthing parents who planned to have their baby at an FMU (birth centre) and ended up transferring to obstetric unit (hospital) during labour to have their baby there. 


* These pictograms have been adapted with permission from Coxon, K. Birth Place Decisions: Information for women and partners on planning where to give birth. This work was funded by the National Institute for Health Research as part of a Knowledge Mobilisation Fellowship (Personal Award no NIHR-KMF-2012-01-29).  These draw on findings from the "Birthplace in England" programme of research. More information, including published papers and summaries of findings can be found at https://www.npeu.ox.ac.uk/birthplace