Planning to have your baby in the hospital? You might have to contend with some of the symptoms of an over-burdened healthcare system. Maternity wards can be over-crowded and under-staffed. Hospital stays are getting shorter. And if you happen to go into labour at the wrong time, you could be sent to another city’s hospital because all of the hospitals nearby are at capacity. What if our maternity care system could be over-hauled to relieve the burden?
What are the realities?
Fewer doctors and nurses
Besides the well-publicized shortage of nurses, Canada also faces a shortage of physicians who attend births. Between 1992 and 2004, the percentage of general practitioners who attended births fell from 28% to only 13%.
Having a baby in these technological times is not cheap. The average cost for a vaginal delivery is $2,800. For a caesarean, it is closer to $5,000. This does not include the added costs associated with length of hospital stay or neonatal care. With every epidural, there is an added expense for the anesthesiologist and with a BC cesarean rate approaching 30%, costs are rising for maternity care.
An obvious cost-cutting measure is to shorten hospital stays. The average length of stay for a vaginal birth in BC has fallen to only two days. For a cesarean birth, it is less than four days. Women are being sent home to care for newborns within a couple of days of major abdominal surgery. What happened to resting and recovering from birth?
How would a new system look?
Midwives are trained specialists in birth. They have usually completed four years of practical training. Their appointments run about fifty minutes (as opposed to the standard ten minutes with your family doctor). They often do home visits in the first week after baby is born to help initiate breastfeeding and to monitor mom and baby. Mothers report excellent continuity of care and higher levels of satisfaction with their births and their care.
The midwifery model of care tends to be cheaper than the current medical model. Midwives believe that birth is a natural physiological process. Though trained to spot and mitigate problems, midwives adopt a fairly hands-off approach as caregivers. Births attended by midwives show a lower incidence of epidural use, episiotomy, and cesarean section. The benefits are not just higher maternal satisfaction, but also much lower costs.
Homebirth & Birth Centres
In the last two hundred years, medicine has managed to pull birth firmly into its clutches. Contrary to all logic, with birth, we take women who are healthy and place them in the hospital as a preventative measure (in case something goes wrong) and then we treat them the same way we treat the sick and injured. Since when is pregnancy a disease?
Modern medicine can be thanked for the low incidence of infant and mother mortality associated with birth today. We know more about the human body, more about birth, more about infection. We know to keep wounds clean. We have antibiotics and other modern drugs. We can save moms and babies from situations that would have claimed their lives only 100 years ago. But that does not necessarily mean that birth belongs in hospital.
We can transfer our medical knowledge to other places, like the home. Recent studies show that with healthy pregnancies free of complications, planned homebirths attended by trained midwives are as safe as hospital births. For low risk women, we can achieve safe birth at home and reap a dual benefit because there are advantages to birthing where a mother feels safest and most comfortable.
We can also find a middle ground instead of polarizing between hospital and home. Imagine the power of a birth centre: birthing in a homelike setting with a midwife, a birth pool, medical equipment tucked out of sight and the potential of a quick transfer to hospital if need be. On the flip side, imagine the benefits for our rural and northern communities that don’t have hospitals have their own. Mothers would no longer have to travel to cities far from their families and support systems to have their babies. Birth centres could begin powerful partnerships between doctors/obstetricians and midwives.
Imagine if everyone birthed in a birth centre or at home with a midwife unless it was medically necessary to birth in the hospital. Imagine the resources (hospital space, staff and money) that could be diverted to caring for sick people. Imagine how different our medical system might look.
Canadian Institute for Health Information, Giving Birth in Canada: The Costs, 2006
BC Vital Statistics, Annual Report on Births, Deaths and Marriages, 2005
Canadian Health Services Research Foundation, Evidence Boost for Quality: Allow Midwives to Participate as Full Members of the Healthcare Team.
Outcomes of Planned Hospital Birth Attended by Midwives Compared with Physicians in British Columbia, Birth 34 (2), 140–147