Birth centres: A middle ground between hospital and home

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As Jacky Tuinstra Harrison prepared to welcome her second child, the 35-year-old Toronto mother faced a dilemma: Where should she have her baby?

Her first daughter, Eve, now six, had been born at home, a lovely experience Ms. Tuinstra Harrison hoped to repeat.

But this time, with an older child scampering around and her family's move to a 100-year-old Riverdale home with a cramped, grotty bathtub, she and her husband reluctantly planned to deliver their new baby in a hospital.

Then her midwife offered her a novel option that was neither a home nor a hospital, and Ms. Tuinstra Harrison wound up taking a small place in the history of how women give birth in this city.

On Feb. 3 at 10:05 p.m., she became the first woman to have a baby at the Toronto Birth Centre, a freestanding, publicly funded birth house that opened its doors in late January, 35 years after a local group first conceived of the idea.

"It was a great experience," Ms. Tuinstra Harrison said of the birth of her daughter, Alexandria. "We'll tell her about it for her whole life.

The Toronto Birth Centre is leading the charge for a new kind of maternity care, one the recently dissolved Liberal government endorsed as part of its wider effort to shift as many health services as possible out of expensive hospitals.

The Regent Park location is one of two pilot projects – the other is in Ottawa – that

whoever forms the next government will be watching to see if the midwife-led model can

provide a safe, lower-cost birthing alternative for mothers-to-be, including the poor and Aboriginal women who often struggle to get the care they need.

"When we start with the most marginalized, we're making care more accessible for everyone," said Sara Wolfe, a midwife and president of the TBC's board of directors.

It's too early to say how much money the centres might save. The Ontario Ministry of Health and Long-Term care estimates the cost of a birth at the centre would be between $2,600 and $3,200, but it could not provide corresponding figures for hospital births.

The Canadian Institute for Health Information, which crunched data at The Globe's request, said the average cost of a vaginal delivery in Ontario in 2011, including physician services, was $3,016, rising to $4,427 for caesarean sections.

So far, however, the centre is showing other signs of success: Of the 303 clients booked, 152 self-identified as "priority populations" such as new immigrants, Aboriginals and lesbians, among others; and of 61 labouring women admitted to the centre, only two have been transferred to hospital by ambulance, both of whom had positive, healthy outcomes. (Another seven labouring women decided to go to hospital in a private vehicle.)

Still, there are no doctors on site, something that has sparked concerns about the safety of the birth-centre model.

The Toronto Birth Centre and affiliated midwives from seven practices offer pregnant women essentially the same level of service they would receive at home.

Not only are there no obstetricians, there is no access to epidurals or pain relievers stronger than nitrous oxide and a deep tub.

But unlike a house, the 13,000-square-foot, $6-million TBC, designed by Toronto's LGA Architectural Partners, is perfectly appointed for delivering an expected 450 babies a year. The three private birth rooms feature double-sized hospital beds, freestanding tubs, adjustable lighting, support bars and wall-sized reproductions of art by Métis artist Christi Belcourt.

Outside, there are two comfortable waiting rooms and a bright kitchen stocked with fruit, granola bars and yogurt; hungry families can whip up their own meals while they await the arrival of their newest members.

"I liked the idea that it was that midpoint between a hospital birth and a home birth," said Katherine Bates, 34, who is planning to give birth to her first child at the centre. "I just know that it's common for hospital births to be intervened with medical care, which I'm trying to avoid."

The TBC's safety precautions also reassured Ms. Bates. If something goes wrong during a delivery, the midwives attending the birth can press an emergency button on the wall and summon a birth-centre aide who will call an ambulance to a built-in loading bay. The nearest hospital, St. Michael's, is minutes away and has a liaison arrangement with the centre.

Jon Barrett, the director of fetal-maternal medicine at Sunnybrook Health Sciences Centre, said the limited research on birth centres suggests they are safer than home births, especially if located in urban areas close to hospitals.

"But do I know it's as safe as a hospital? I don't," Dr. Barrett said. "Part of me still worries that if something happens at a freestanding birth centre and you can't do a caesarean section immediately on the spot, what's going to happen?"

Safety concerns are just one of the reasons it took 35 years to open a birth centre in Toronto, although politics and bureaucracy probably played a bigger part. First proposed in 1979 by a group of nurses, midwives, lawyers, social scientists and others calling themselves the Childbirth Education Association of Toronto, a Toronto Birth Centre was nearly opened in the mid-1990s at King and Bathurst streets as one of four birth houses across the province approved by Bob Rae's NDP government.

But Mike Harris's Progressive Conservative government cancelled the centres in 1995, dismissing them as a needless duplication of service. Birth centre supporters took the government to court and lost.

"It was devastating," said Wendy Sutton, a lawyer and former president of Toronto Birth Centre Inc., the non-profit corporation established to found a centre.

For nearly two decades, the non-profit languished. Its members eventually decided to donate the money it had raised through garage sales and baby bonds to Ryerson University as an endowment for bursaries for midwifery students.

In the meantime, midwifery, first regulated in Ontario in 1994, blossomed across the province. Today, more than half of the 1,282 midwives across the country practice in Ontario.

Birth centres began popping up too: One on the Six Nations reserve outside Hamilton, one in Winnipeg, one (partly private) outside Edmonton and 10 in Quebec, where the vast majority of midwives work in birth centres or homes, as opposed to hospitals.

Against that backdrop, the Liberal government revived the birth-centre concept and put out a call for proposals.

When Seventh Generation Midwives Toronto, an Aboriginal-focused practice, began exploring forming a corporation of its own to make a bid, the old Toronto Birth Centre group offered its long-dormant corporation as a gift.

"Those of us that were still hanging around were hoping that the site would have a geriatric wing," Ms. Sutton said, laughing. "I feel proud of what's been done. It was a glorious conclusion to our era to have entered into the marriage with Seventh Generation Midwives."

Ms. Tuinstra Harrison hopes that her story of Alexandria's natural, joyous birth will add to the centre's lore, especially considering the decades her forebears struggled to make her experience possible.

"It does make it extra special," she said. "I didn't realize it was 35 years overdue."