Amy Brillon is on her knees, her head and arms resting on the side of a blue inflatable pool half-filled with water in which she has been labouring for the past hour as her husband murmurs encouragement.
When the moment comes, it's sudden. In one breath, Ms. Brillon, 33, is telling her midwife, Jane Wines, she can feel the baby's head; with the next, she has caught the baby in her hands, swept it through the water to her chest and is lying, beaming and exultant, with her eight-pound daughter in her arms.
"She's beautiful," Ms. Brillon says. Everyone in the room agrees.
It is a touching, intimate moment that makes birth seem both miraculous and miraculously routine. It is also relatively rare. Of the roughly 380,000 women who gave birth last year in Canada, less than 2 per cent, or fewer than 7,000, did so outside of a hospital.
Up until 1998, when B.C. legalized midwifery, a home birth such as Ms. Brillon's would have been illegal. Now, midwives deliver about 14 per cent of the babies born each year in the province, or more than 5,500 infants – and about one-third of those babies are delivered at home. Across the country, demand for midwives is growing and cost-conscious governments are looking to midwives to help stave off a maternity care crunch.
Still, few expectant mothers in Canada or in any other developed nation show much interest in having their babies the "old-fashioned way" – at home. The exception is the Netherlands, where the home birth rate is around 30 per cent.
That reluctance remains so persistent that, to help overcome it, Ms. Brillon has agreed to let two perfect strangers watch her baby be born.
"I wanted to share a positive story," she explains. "You hear all these horror stories [about home birth] and it's not fair. … It's a very private thing but I wanted to help people know what their options are."
Ms. Brillon prefers the comfort of her home to the more clinical surroundings of a hospital, is confident in her ability to deal with the demands of labour and delivery, and trusts Ms. Wines, who has delivered her other two children. Most of all, she believes giving birth at home can transform an experience that, for many women, is fraught with pain and fear.
Why do so few women agree with her? Home birth is a bitterly divisive topic. After then-B.C. health minister Margaret MacDiarmid last year endorsed midwife-assisted home birth as a safe option for women for low-risk pregnancies, the B.C. Medical Association repeated its view that for the safety of mother and child, births should take place in hospitals or in birthing units linked to hospitals.
The controversy is no surprise to Michael Klein. Dr. Klein – emeritus professor of family practice and pediatrics at the University of British Columbia – was one of the authors of a landmark 2009 study that found planned home births under regulated midwives were as safe, and resulted in fewer interventions, than planned hospital births.
A 2009 Ontario report reached similar conclusions.
The research is difficult for some to accept. "When people say as result of our studies that home birth is safe, or appears to be safe, they can't believe it, because in their experience they have had near misses and say, 'Thank God this didn't happen at home,' " says Dr. Klein, adding that in delivering thousands of babies, he's had such near misses himself.
What makes home birth safe in B.C. and Ontario, he maintains, is the system in place to support it, including provisions for transfer to hospital if required.
In B.C., the transfer rate – of women who planned to have their babies at home but end up delivering them in hospital – is between 20 and 30 per cent.
"The vast majority turn out to be just fine. In other words, you over-transfer in order not to be caught at home with a situation you can't handle," he says.
The debate over the safety of home birth continues to rage. In October, the American Journal of Obstetrics and Gynecology published a paper that concluded babies born at home were roughly ten times as likely to be stillborn and four times as likely to have neonatal seizures or other neurological problems than babies born in hospital.
The report's authors said the gap could be even greater, given that problem deliveries reported in hospitals may have begun at home.
Canadian midwifery groups challenged the U.S. report, noting it was based on birth certificates that didn't account for such key variables as whether a home birth was planned or not.
Meanwhile, other troubling trends have emerged. Only about 11 per cent of family doctors in Canada attend births – but those family doctors deliver 30 per cent of the babies, meaning fewer doctors are carrying a heavier load.
At the same time, the average age of obstetricians in Canada is creeping toward 60, signalling a potential shortage as some of those practitioners – who currently deliver most of the babies – retire.
Also, 26 per cent of births in Canada are cesarean sections – an increase of nearly 45 per cent since 1998 and above the World Health Organization's recommended rate of between 10 and 15 per cent. Births attended by midwives, including home births, are associated with lower cesarean section rates.
To Dr. Klein, who teaches at UBC's School of Midwifery, those trends point to the need to turn the current system on its ear – by putting midwives and family doctors in the fore when it comes to normal pregnancies. Such a system, he says, could reduce the number of cesarean sections, save money and provide better training opportunities for young medical students, who currently may only encounter childbirth as an emergency requiring medical intervention.
For Ms. Brillon, the benefits of home birth and midwifery are not abstract but tangible: a healthy baby, a birth that went exactly as she'd hoped, and a conviction that more women could have their babies at home if they had adequate support and education.
"I would like women to just have more trust in their bodies …. in this society, we are told there is something wrong with us. And sometimes there is. But for normal, low-risk women, they shouldn't feel like their body is not going to work."