The Saskatoon Health Region is no longer allowing its midwives to offer home birth to women who've previously had a Caesarean section.
The health region said it's a preventative measure, which took effect two weeks ago, to keep women and their babies safe.
"When we look at some of the recommendations from the Society of Obstetricians and Gynecologists of Canada, the guidelines from those all really point to women after Caesarean sections, their birth should be in a place where an OR is readily available, a blood bank is readily available, and the baby can be electronically monitored," said Leanne Smith, director of maternal services Saskatoon Health Region. "So we can't provide those services at home, so we decided that the best place and the safest place for mom and baby are in hospital for those births"
Last year, midwives in Saskatoon assisted with 139 births. Of those, 87 were home births and only one woman had previously had a C-section. Three other women who had C-sections requested it, but never ended up giving birth at home.
There is no policy on home births after Caesareans in the Regina Qu'Appelle Health Region. The decision is at the discretion of the midwife.
The hazards of home birth
There are many risks when a woman has a vaginal birth after having had a C-section, said Dr. Thomas Mainprize, head of the department of obstetrics and gynecology at the University of Saskatchewan.
"I've seen blood transfusions, I've seen stillborns, and I've seen ruptured uterine, the problem with the rupture is that people close the uterus in different ways," he said. "Sometimes there's a low grade infection, sometimes there's inflammation, and sometimes it just doesn't heal well, and we don't know that until women actually labour. That's part of the frustration or the difficulty with it."
Opposition to the decision
Julian Wotherspoon is part of a consumer group that is pushing for expanded and improved midwifery services in Saskatchewan. She said decisions around home birth should be made by midwives on a case-by-case basis. While she acknowledges that there is a risk with women giving birth at home after C-sections, she said it doesn't automatically outweigh the ability to birth safely at home.
"I think that taking that decision away from the professionals who are providing care, as well as the people who are receiving care, to look at that risk assessment and say, you know I still think it's worth it to birth at home," she said. "It's just not right, and historically speaking it just creates really dangerous situations. You are essentially saying you are not going to support women with what they want and if someone is determined enough they'll just seek help outside of the system, and most of the time that works out really well, but is that really the safest thing for everyone involved.
'It was unbelievable'
Sasha Veitch had two C-sections at Royal University Hospital. She wanted to try having her third child at home, but wasn't able to get a midwife, so she sought out a new obstetrician who was willing to let her try having a vaginal birth. That doctor had a list of things that she would need to do during labour, such as continuous fetal monitoring, an IV, and an epidural — all things she didn't want to do. So she started researching homebirth.
When she went into labour she stayed home and had a water birth with the support of two doulas.The birth went smoothly and she said she'd make the same choice again.
"It was unbelievable," she said. "The whole time throughout labour I didn't have any pain around my scar. I didn't have discomfort aside from contractions, so I wasn't worried. Like I had a blood pressure cuff. I checked my blood pressure. I checked my temperature. I had a fetoscope, so I checked the baby's heart rate. Without the pressure of having doctors there saying that you only have two hours before we are going to cut you off and give you a Caesarean, it was completely different than anything I've ever experienced I guess."
A Facebook group was created for people who are concerned about the changes. A public meeting is being held in Saskatoon on Thursday night at Birth Rhythms.