Professionals weigh in on associated risks

 Midwifery care in Alberta has become more popular since funding for the service became covered under Alberta Health Care in 2009. Waitlist to get care from a midwifery clinic have increased with some expectant mothers never getting in.

However, the questions remains is the practice safe? The long and the short of it is yes.

Dr. Stephanie Cooper, an obstetrician at the Foothills Medical Centre, said there have been a number of studies conducted on midwifery care in Canada.

“There is not anything to suggest in the appropriately chosen patient and when (the patient is) managed appropriately there it is any higher risk to have a delivery at home under the care of a qualified midwife,” she said.

However, Dr. Cooper added that she herself would not chose a homebirth because of what she has experienced as an obstetrician with even the lowest risk patient and suggested some patients should not deliver at home due to risk factors.

“We’re always biased thinking that (even if) it’s very unlikely for a bad thing to happen, if it does I’d rather be there where we can get help right away,” she said.

The results of the national “Canadian Maternity Experience” survey conducted in 2009 suggested, “evidence that midwifery outcomes meet or exceed Canadian maternity care standards is mounting.”

The survey was conducted by female Statistics Canada interviewers on behalf of the Public Health Agency of Canada and received responses from 6,421 of the 8,244 women contacted.

In the survey 71 per cent of respondents whose birth was attended by a midwife said the overall experience of their labour and birth was “very positive.” Of the women who delivered with an obstetrician only 52 per cent reported the overall experience as “very positive.”

The 2009 Canadian Maternity Experience Survey said that
there is mounting evidence that midwifery care may meet or exceed in-hospital maternity care.

Photo courtesy of Pumpkingood/Wikimedia CommonsVeteran midwife and Mount Royal University assistant professor Debbie Duran-Snell said the regulations around midwifery in Canada makes these practice even safer. She said Canadian midwives are required to have certain continuing education recertification each year including neonatal resuscitation, CPR for health care providers, and emergency skills. Along with the education midwifes are regulated in the equipment they are required to bring to each birth.

“That’s why when you have (midwifery) regulated and the midwives follow that regulation the safety is there,” Duran-Snell said.

Mount Royal University associate professor, Margaret Quance, has been conducting a four-year midwifery research questionnaire for midwives in Calgary and area. She said for the first time the 2012 questionnaire will include questions about the number of midwifery clients requiring hospital intervention.

“There’s no reason to be afraid of (homebirth with a midwife) as long as you pick the cliental right,” Quance said.

The right cliental for midwifery-supervised homebirth according to Dr. Cooper is somebody who is very healthy with no underlying medical conditions.

Low risk patient means:

• Appropriate body mass index

• Not considered late maternal age – over 35

• No problems developed during pregnancy – hypertension, diabetes

• No history of significant bleeding concerns – surgical or otherwise

• Baby is normal size – not known to be small

• No fetal concerns – including even minor defects

• Full-term pregnancy

• No previous cesarean section or myomectomy (benign tumour removed from uterus)

• Not having multiples – twins

• Baby in the normal position for birth

Dr. Cooper said homebirths should always include an emergency back-up plan and she added in her experience midwives have this in place and will call for help when required.

Midwifery care in Alberta has become more popular since funding for the service became covered under Alberta Health Care in 2009. Waitlist to get care from a midwifery clinic have increased with some expectant mothers never getting in.

 

However, the questions remains is the practice safe? The long and the short of it is yes.

 

Dr. Stephanie Cooper, an obstetrician at the Foothills Medical Centre, said there have been a number of studies conducted on midwifery care in Canada.

 

“There is not anything to suggest in the appropriately chosen patient and when (the patient is) managed appropriately there it is any higher risk to have a delivery at home under the care of a qualified midwife,” she said.

 

However, Dr. Cooper added that she herself would not chose a homebirth because of what she has experienced as an obstetrician with even the lowest risk patient and suggested some patients should not deliver at home due to risk factors.

 

“We’re always biased thinking that (even if) it’s very unlikely for a bad thing to happen, if it does I’d rather be there where we can get help right away,” she said.

 

The results of the national “Canadian Maternity Experience” survey conducted in 2009 suggested, “evidence that midwifery outcomes meet or exceed Canadian maternity care standards is mounting.”

 

The survey was conducted by female Statistics Canada interviewers on behalf of the Public Health Agency of Canada and received responses from 6,421 of the 8,244 women contacted.

 

In the survey 71 per cent of respondents whose birth was attended by a midwife said the overall experience of their labour and birth was “very positive.” Of the women who delivered with an obstetrician only 52 per cent reported the overall experience as “very positive.”

 

Veteran midwife and Mount Royal University assistant professor Debbie Duran-Snell said the regulations around midwifery in Canada makes these practice even safer. She said Canadian midwives are required to have certain continuing education recertification each year including neonatal resuscitation, CPR for health care providers, and emergency skills. Along with the education midwifes are regulated in the equipment they are required to bring to each birth.

 

“That’s why when you have (midwifery) regulated and the midwives follow that regulation the safety is there,” Duran-Snell said.

 

Mount Royal University associate professor, Margaret Quance, has been conducting a four-year midwifery research questionnaire for midwives in Calgary and area. She said for the first time the 2012 questionnaire will include questions about the number of midwifery clients requiring hospital intervention.

 

“There’s no reason to be afraid of (homebirth with a midwife) as long as you pick the cliental right,” Quance said.

 

The right cliental for midwifery-supervised homebirth according to Dr. Cooper is somebody who is very healthy with no underlying medical conditions.

 

Low risk patient means:

  • Appropriate body mass index
  • Not considered late maternal age – over 35
  • No problems developed during pregnancy – hypertension, diabetes
  • No history of significant bleeding concerns – surgical or otherwise
  • Baby is normal size – not known to be small
  • No fetal concerns – including even minor defects
  • Full-term pregnancy
  • No previous cesarean section or myomectomy (benign tumour removed from uterus)
  • Not having multiples – twins
  • Baby in the normal position for birth

 

Dr. Cooper said homebirths should always include an emergency back-up plan and she added in her experience midwives have this in place and will call for help when required.