Reflecting on home birth in Ontario following Netflix release of _Pieces of a Woman_

CONTENT WARNING: perinatal loss

The subject of out-of-hospital birth has garnered a fair share of attention in the past several months, with midwives in Ontario and across Canada reporting a marked increase in client interest in home birth amidst concerns over COVID-19. Today’s launch of the dramatic new Netflix drama Pieces of a Woman has home birth in the spotlight again, in a devastating and heart-wrenching plot centred on a portrayal of childbirth that ends in tragedy.

While this Netflix film is not set in Canada (the story takes place in Boston, Massachusetts), Ontario viewers may be left with questions about the safety of planning an out-of-hospital birth. Pregnant people viewing the film, particularly those considering an out-of-hospital birth themselves, may find themselves faced with their own fears, confounded by questions and fears of well-intentioned family and friends. Viewers who have themselves experienced a perinatal loss may be painfully triggered by the raw, emotional scenes and subject matter of the film.

Unlike in the film, Ontario midwives follow their clients to give birth in hospital, at home or at a birth centre (where available), and clients can expect the same level of care from their midwife regardless of where the birth occurs. Ontario midwives are credentialled as part of the medical team in Ontario hospitals, and are the only regulated primary care providers in the province who receive extensive education and training and who are funded by the province to manage labour and birth outside of hospital, including  at home. There is excellent quality research (PDF, 449 KB) showing that home birth with a midwife in Ontario is a safe and responsible option for clients experiencing low-risk pregnancies. In fact, a Canadian-based analysis of more than 45,000 low-risk births attended by midwives reveals no difference in the number of babies born healthy and well whether the birth was planned to be at home or in hospital. The same research shows that merely planning to give birth at home lowers the chance of interventions like C-section and assisted vaginal delivery, regardless of the actual location the birth took place. Additionally, clients choosing homebirth perceive many benefits, including control over their birth environment and increased comfort and freedom.

There is excellent quality research showing that home birth with a midwife in Ontario is a safe and responsible option for clients experiencing low-risk pregnancies.

The fact is, most healthy people have healthy pregnancies and uncomplicated births, regardless of location. However, sometimes birth does not go as planned. Midwives in Ontario are prepared for this. They receive extensive emergency skills training to identify when a complication is developing early on; to manage and correct many such complications; and to know when to involve specialists and other care providers, or to transfer to a hospital, to achieve the best possible health outcomes for labouring clients and their babies. Midwives bring equipment and medications to home births that are comparable to the equipment and medications available in a hospital that provides Level I care.

Unfortunately, traumatic events in childbirth can sometimes occur, both in and out of hospital. Experiencing the loss of a pregnancy or the death of a baby is often devastating, and individuals may respond differently to the experience of loss and to portrayals and discussions of perinatal loss in the media. The Pregnancy and Infant Loss Network (PAIL Network) is a provincial program dedicated to providing support to grieving families who have suffered the loss of a pregnancy or infant(s), available at no cost to Ontario families. If you or someone you know could benefit from such support, we encourage you to connect with their program, or speak to your care provider for additional resources.

Regardless of what the research says about the safety of out-of-hospital birth, the most important thing is that a person giving birth feels safe and supported in their chosen birth environment – that may be in hospital or in the community. Anyone interested in the option of out-of-hospital birth should speak to their midwife about this choice in the context of their own pregnancy. Our Birthplace Options web portal provides access to research-based information, interviews with midwives and clients and additional tools and resources to help support these discussions.

Media interested in speaking with a midwife spokesperson, including about perinatal loss or home birth, please contact Christine Allen, Manager, Policy & Communications.