Health region should reconsider home birth decision, group says

A local group is lobbying the Saskatoon Health Region to allow midwives to attend home births with women who’ve previously had a caesarean section.

In June, the health region ended its practice of offering midwifery for home births by mothers wanting to deliver vaginally after having a caesarean section during a previous birth. Maternal Health Consumer Group says the new position restricts a woman’s right to make her own health care decisions, while the health region says it’s necessary to protect mother and child.

“We absolutely support these mothers and their decision to have a midwife, but we can’t support the decision to have a home birth,” said Jackie Mann, the health region’s vice-president of integrated health services. “You can choose, but choose based on the best evidence you have and do the thing that is safest.”

Vaginal births after a caesarean come with increased health risks and women need to be close to an operating room, blood supplies, increased monitoring and other medical help should complications arise, Mann said.

Dionne Miazdyck-Shield, a representative of Maternal Health Consumer Group, said the group hopes the health region reverses its position and considers allowing home births after caesarean on a case-by-case basis, a policy used in other provinces.

“Largely, the decision was made without regards to maternal rights – a woman making decisions about her body and decisions about her baby,” Miazdyck-Shield said.

Home birth is an important option for women who’ve had a negative experience in the hospital during their first birth, said Nicole Eramian, a Saskatoon mother and president of International Caesarean Awareness Network Canada.

“There are some women so opposed to hospital births that they would rather have an unassisted birth at home,” she said, adding that unassisted birth is not recommended.

“These women deserve to have a trained professional there to take care of them.”

Not many women seek home births after caesarean and there is a small risk of uterine rupture, but women should still have the option if they’re fully informed of the risks, Eramian said.

“With monitoring, uterine rupture can be caught and midwives are able to catch it in home births,” she said.

“If there are problems, the midwives do make sure women are taken to the hospital.”

A uterine rupture during vaginal birth after a caesarean can be devastating, said Dr. Thomas Mainprize, head of the department of Obstetrics, Gynecology & Reproductive Sciences for the University of Saskatchewan and the health region.

“Have you ever seen someone bleed to death?” Mainprize said.

“I’ve been in situations were I’ve seen patients take as many as 75 units of blood in the hospital, and you never want to see that. When you’re pregnant, your blood flow increases significantly to the pelvis as a consequence of trying to maintain the fetus and uterus. Women can bleed to death quickly.”

The health region considered research from Canada and other countries in its decision earlier this year, Mainprize added.

The change in practice was largely pushed by midwives uncomfortable with attending home births after caesarean – the profession is not unanimous on the issue – and it was done without consultation with mothers and other interested parties, Miazdyck-Shield said.

Midwives, who are health region employees, weren’t forced to take this work before the change in practice, but there are a limited number of midwives who are willing to do them, she added.

Health care providers shouldn’t be put in needlessly risky situations, Mainprize said.

“To tell a staff person they must do something where the patient is at risk and you are also at risk is an unfair situation.”

The home offers benefits such as privacy and can accommodate alternative birthing options that make birth more comfortable for a mother, Miazdyck-Shield said.

“If a risk factor came up for me – and I think for most women – that changed the calculations, I would go to a hospital,” she said.

“I’m not interested in creating more risk. I’m interested in the best outcomes for my child.”

jjwarren@thestarphoenix.com Twitter.com/WaywardReporter

© Copyright (c) The StarPhoenix