New birth centers in Ontario = more choice, lower costs

Midwives attending a birth in Toronto. Photo: Geoffrey Wiseman, CC some rights reserved

This post is about having babies and saving money.

The first topic doesn't interest everyone. But saving money usually matters. Since health care in Ontario is largely funded and delivered under the supervision of the province, getting a better return on spending should be a general concern.

The more expensive way to have a baby is to give birth in a hospital. Hospital beds, OB/GYN physicians and specialized equipment represent scarce resources that should be allocated wisely. The least expensive way to have a baby is to give birth at home while biting on a stick. Slightly more expensive is giving birth at home with with a skilled attendant.

But a home birth is too scary for many expectant parents. That's why birth centers emerge as a sound and happy compromise. While high risk deliveries should happen in hospitals, most low risk, "normal" deliveries just don't need to be a medical situation. A range of choices is the solution.

This week those involved in birth issues were quite excited by an announcement of a new birth center for Ottawa. (Spelled "Centre" in Canada, of course.)

Deb Matthews, Ontario’s minister of health and long-term care spoke about what's coming, surrounded by pregnant women, new moms and a number of babies. From the official news release:

Expectant moms in the Ottawa region will soon benefit from a new birth centre, scheduled to open this summer.

The Ottawa Birth and Wellness Centre will provide mothers-to-be and their families with a broad range of programs and services led by midwives, with special attention to meeting the needs of the Francophone population. The centre expects to assist with 450-500 births each year, offering more choice as to where women can deliver healthy babies, while helping to keep hospital beds free to focus on high-risk births.

Matthews made the announcement at the Midwifery Group of Ottawa on Carling Avenue. The new birth center will be on Walkley Road. A similar birth center is also slated to open this summer in Toronto. As reported in the Toronto Star:

“It’s a historical moment for midwifery in Ontario,” said midwife Sara Wolfe, who practises with Seventh Generation and is executive director of the Toronto Birth Centre Corp., a non-profit group that put together the application.

“We’re thrilled to be given this opportunity. It’s a very exciting time.”

According the an earlier report in the Ottawa Citizen, there are also "midwifery practices in nearby Carleton Place, Winchester and Cornwall." (Which are not the same as birth centers.) According to this CBC article:

The one slated for the capital will be open for all clients of an Ottawa midwife from any of the five local midwifery groups that applied for one of the two birthing centres.

(That's not totally clear to me, but Ottawa midwives can probably explain how to access the new services.)

When it comes to health and medicine, there are some things that are well-known, but hard to fix.

Obesity contributes to many serious health issues. We all know the answer: eat less, eat healthier food and exercise more. But making that happen is a challenge.

Antibiotics are life-saving drugs that lose effectiveness when over-used. Intellectually, we know they should be taken sparingly, only as needed. But when the nasty viral cold has lasted for weeks and the cough is driving you nuts, it's easy to think getting that Rx will deliver some relief – even though antibiotics won't kill viruses.

Caesarian sections fall into this spectrum too. When needed, this procedure saves lives. Very often – too often – women end up getting C-sections that were not warranted. There's even a rise in what are called "on-demand" C-sections, to fit a doctor's schedule, or calm a patient's concerns. In the U.K. this debate has a nickname "too posh to push". Here's one mom's defense of an on-demand c-section.

Unnecessary C-sections happen more often in hospital deliveries. C-sections are costly and present a number of higher health risks for mom and baby than in normal deliveries. More birth centers, more use of midwives should reduce the incidence of unnecessary surgery, which would be win-win.

Most prospective parents would prefer a range of safe options that take their needs and values into account.

Some expectant mothers want the Ina May Gaskin granola home birth. Others want the best high-tech medical facilities on earth! And lots and lots of pain killing drugs! Or an on-demand C-section.

Birth centers are the middle path, an excellent way to expand choice and reduce over-all costs.

Here are some plugs, the first from the provincially-funded Ontario Midwives (association of):

There are more than 600 registered midwives in Ontario, serving communities in 90 clinics across the province. Midwives have privileges at most Ontario hospitals. Since midwifery became a regulated health profession in 1994, almost 150,000 babies have been born under midwifery care, including more than 35,000 births at home.

Here's a search page from the College of Midwives of Ontario on finding  a midwife.

Across the border here are links for Q & A about licensed midwives from a New York State site.

And another site for Upstate New York Homebirth Midwives. There's also the Vermont Nurse Midwives, the  Vermont Midwives Alliance and a Vermont Birth Network.

This isn't a full list, and some might caution "not all midwives are created equal". Actually, that goes for doctors and hospitals too. It's wise to do some research about the choices available in your area.

Where and how women give birth can be controversial – as well as political. In many cases the medical profession frowns on home births. Laws about who may practice as a midwife – or who may attend a home birth - vary from state to state.

Anyway, there are many reasons to support birth centers which address safety concerns – without turning normal birth into a medical procedure.

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