Out-Of-Hospital Birth: Toronto

As I am 28 weeks now, and entering the third trimester of this pregnancy, I am faced with the decision to make a birth plan. Now I am not entirely set on the term “birth plan,” as it is somewhat misleading. The best healthcare staff in all of the land can never guarantee that your idea of the perfect birth will be followed right down to the very last point. I take an approach of birth preferences or wishes or even visions. I believe that birth happens. It happens at its own pace, each time at a different rhythm and outcome. That being said, I am planning to give birth at the Toronto Birth Centre. 
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The first step of my birth plan: LOCATION. ​

The Toronto Birth Centre is one of only two midwife-run Birth Centres in all of Ontario. It is a free-standing operation where birth is welcomed in a safe, and calm atmosphere. Located in Toronto’s downtown East end, the TBC is a brand new facility created through the visions of the Seventh Generation Midwives, SGMT. The location features many aboriginal artworks, and a well thought out design. Three birthing rooms and one consultation room are all equipped with amazing features. The rooms include low lighting, fireplaces, double beds, grab bars, walk in shower with benches, and deep soaking tub. 

Our midwife directed us to the SGMT information session about out-of-hospital births. We are really glad we went. Although we were fairly certain about wanting to give birth in the Birth Centre, it was very informative and offered us a lot of reassurance that we made the right decision for us.

We were informed about home births first. The midwife giving the information session unpacked her midwife kit and explained to us all of the items that a midwife would have on hand for a birth. The reality was that apart from perform a cesarean, epidural, vacuum, or forceps delivery, she has every other tool for the job. Then she talked about TBC births. The only real difference is that at the TBC, the amenities are designed for birth and the midwifes have the ability to welcome us into their “home.”
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But what if there is an emergency? 

​In the downtown core of Toronto the average time for transfer, by ambulance, to a hospital is roughly 4 minutes. If a planned hospital birth required an emergency procedure, it is often the case that an operating room will need to be prepared, staff called to serve the patient, and everything organized in order to maintain the health of mom and baby. The waiting time in which all of these events must occur is very similar to the time a planned out-of-hospital birth transfer would take to arrive at the hospital.

The verdict? Emergency transfer times are very similar for both out-of-hospital and hospital births. 
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How many out-of-hospital births are transferred to a hospital for extra care? 

The rate of transfer for out-of-hospital Ontario births to a hospital are roughly 5.8% (according to her study, published in Birth Journal). The midwife explained that this value is not always emergency transfer. She went on to break down the reasons why a mother and baby might be transferred to a hospital. ​

• The mother is exhausted or is having a hard time with the pain - reason: epidural.
• A mother’s desire to have longer postpartum care after birth. She may self-admit to a hospital in the hours after birth or the midwife may suggest it for her client. 
• When a fetal heart rate is not looking great or is requires further monitoring.
• If the baby is presenting in an odd position and attempts to change said position have been exhausted.
• When a baby requires cesarean for a multitude of reasons, although it is not common.

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These emergencies were well described by the midwife as not always as sudden as people would think. She talked about “pink flags” that would come up throughout the earlier stages of labour. Something that might indicate that labour is taking a funny turn and that additional care may be required.
All in all, the rate of birth transfers may seem like a high number, but as that figure is broken down we are able to clarify how most of the reasons for transfer are not emergencies.
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More information 

Seventh Generation Midwives of Toronto - here
525 Dundas Street East, 2nd Floor
(416) 530 - 7468

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​Toronto Birth Centre - here or here
525 Dundas Street East, 1st Floor
(416) 366-8080

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