Place of Birth

Women labour and birth most successfully in the place they feel the most comfortable. Therefore another step in preparing for the birth of your baby is to choose where to give birth. Your choice of caregiver will affect the options available to you.

Hospital Birth

For a planned hospital birth, you will have to choose a doctor, either a general practitioner or an obstetrician, in most provinces. Ontario, British Columbia and specific Regional Health Authorities in Alberta do have midwife privileging.  It is important to find a caregiver who understands and supports the kind of birth for which you are striving and is prepared to help you towards that goal. When making your first appointment, tell the receptionist that you wish for consultation rather than an examination. Once you have selected a caregiver, it will also be necessary to meet the caregiver's partners in the event one of them attends the birth if the caregiver you are seeing is not on call.

Your choice of hospital will limit your choice of caregivers to those with admitting privileges at that hospital, or vice versa. Hospitals are not all alike. Their styles of care can differ dramatically. Most offer tours to show what facilities they offer and it is worth your while to attend one. But it is even more important to meet the staff and ask them questions. The nurses are the people you will be dealing with and a staff that approaches birth as a normal, natural event rather than a medical crisis makes far more difference than any home-like decor you may be offered. It is a good idea to take a list of questions to ask that cover the issues that are most important to you - the things that you would have a hard time compromising on. Remember, it doesn't matter how cooperative your caregiver is, if hospital policies run counter to your desires, hospital policy generally takes precedence. Some questions you might ask are:

	Do women labour and deliver in the same room?
	Is waterbirth an option?
	Are partners and doulas welcome to remain during all procedures?
	Are siblings welcome at the birth or shortly thereafter?
	Are women allowed to eat and drink lightly during labour, should they so desire? May they bring their own food and beverages?
	Are other support people allowed for both the labour and birth? Is there a limit? Are women allowed to move about during labour?
	Are women allowed to choose to give birth in whatever position they find most comfortable? Does this include kneeling, being on hands and knees and squatting?
	Which of the following are done routinely: intravenous drip, electronic fetal monitors, enemas, shave or mini/shave preps, medications, episiotomies?
	After birth, is immediate and unrestricted contact for mother and baby allowed, or is the baby required to go to the nursery for examination and/or observation? Do you allow 24 hour rooming-in: for the baby? For the partner?
	If the baby requires special care can both parents visit the intensive care unit and touch and hold their baby? Can the mother breastfeed the baby in the intensive care unit?
	What sort of postpartum support is provided with early discharge?
	Is there breastfeeding support? Does this hospital have a lactation consultant on staff?
	What percentage of this hospital's patients had a natural unmedicated birth last year?
	What is the cesarean section rate of this hospital?
	Are partners welcome to attend cesarean sections?
	What percentage of this hospital's patients had a forceps delivery last year?
	Is perineal massage and support practiced by the birth attendants (nurses and caregivers) here?

If you decide to choose a hospital birth, personalizing your birthing room with your own things from home can help relax you as you prepare for the birth of your baby. Including such things as a special ornament for the bedside table, your own nightgown to wear, bring a recording of your favorite music and something to play it with can really help. Being relaxed and calm during your labour and delivery are very important, a woman's flight instinct has slowed down and stopped many labours when a labouring woman arrives at the hospital, to an unknown place where the woman is uncertain as to what is expected of her.

Homebirth

Keeping in mind the statement that "women labour and birth most successfully in the place they feel the most comfortable," the home seems a logical option when deciding where to give birth.

"Some women say that since birth is an act of love. Personal and intimate, it should take place in one's own environment, without unnecessary observers, among friends in a loving atmosphere. They want to know that the father of the baby or a close friend can be present throughout, can take an active part, and can give emotional support through the labour… Often a woman would like to ensure that her baby has a "gentle birth" and is welcomed into the world tenderly, without the machinery and bright lights that are almost inevitable in hospitals." Kitzinger, 1989.

If you have chosen to birth in your own home, you will need to find a midwife to be your caregiver. It is important to select someone that you feel you can grow to trust with whom you can develop a good relationship. You should feel free to ask your midwife any of the questions that you would have asked your caregiver or hospital staff. In addition to the "questions for caregivers" above, you might want to ask the following:

	When do you come to my home?
	What do you bring to the birth?
	Will you be the one to come to my home? Do you bring anyone with you? Who? How do your services differ from that of other birth attendants?
	How do you handle complications?
	How much do you charge? Is there a flexible payment system?
	Do you offer water births, and what are their benefits?

The biggest difference between hospital and home birth is the way in which childbirth is approached - the philosophy. Midwives, who attend home births, believe in the birth process and instill in their clients a confidence in their body's ability to birth the new baby.

If you choose to give birth at home you are not subject to any particular policies or procedures. You alone, with the help of your partner and selected family and friends, create the birth plans ideal for you. For example, you might plan to wear a special nightgown while labouring (or wear nothing at all), you might plan to go for a walk in you neighbourhood with your partner during early labour, you might want to give birth in front of the fireplace, or in the bed where the baby was conceived, or in a warm pool of water. You may want your partner, your 2 children and your 2 best friends with you - or you may choose to have only your partner present. Maybe you will mark the occasion with a celebration following the birth, complete with champagne and birthday cake!

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