In 2011, Winnipeg is planning to open Manitoba's first birthing centre, where mothers can give birth in a less clinical atmosphere with the assistance of midwives, nurses, and doulas. While it's a step forward for natural births in the province, midwifery and natural births are still the minority among birthing practices in Canada. Roughly 99 per cent of Canadian women choose to give birth in a hospital, even though most women are at low risk for the labour complications that require physician care. Most women in Montreal who do give birth in hospitals opt for an epidural, a local anesthetic that eases labour pains. However, many women are renouncing the medicalization of childbirth, and looking to other women to ease their labour pain.

A long, local history

In Canada, informal midwifery has its roots in aboriginal birthing practices, which then extended to medical education and care by the 20th century.

"Doctors were taught by midwives at McGill," says Sarah Berry, McGill professor of health sociology. But the teaching wasn't mutual. "Once new technologies were introduced, physicians excluded women and midwives from those educational processes."

Midwifery was outlawed in Canada at the beginning of the 20th century, be it from doubts over women's capabilities, physicians' protectionist instincts, or a colonialist fear of following aboriginal practices. While lay midwives contintued to practice, it was only after intensive lobbying that midwifery was reintegrated into healthcare in the 1990s, making Canada one of the last developed countries to regulate the practice. Even now, this regulation and coverage varies from province to province.

Natural birthing options

Natural birth can take many forms, including home births, births at a birthing centre, and even hospital births. However, all natural births, by definition, exclude the use of prescription painkillers and medical interventions such as cesarean sections unless they are necessary.

Berry says that many hospital births that are initially at low risk of complications result in a cascade of interventions including painkillers like pitocin (also known as oxytocin), epidurals, and ultimately, in some cases, cesarean sections.

"It may start with pitocin to speed up labour because hospitals work on a schedule," explains Berry, "but speeding it up could increase labour pains … then you have an epidural and that slows things down."

While the evidence for unnecessary cesarean sections is mixed, women are more likely to have a cesarean if they begin their birthing process in a hospital. Cesarean sections can cause a variety of complications, especially for future births if a mother has had multiple c-sections.

All of these interventions have led many mothers to opt for some form of a natural birth. Midwives, who help to deliver babies either within the home or at a birthing centre that has a home-like environment, are becoming increasingly well respected by the medical community.

Berry emphasizes that the media often focusses too much on the risky parts of birth, "rather than the majority of births where midwives could provide good care for low risk women." This focus on risk undermines a woman's confidence in giving birth naturally, which is very safe.

Midwives are not the only options for natural births. A doula can act as a midwife's assistant, or provide assistance to the mother and family during hospital births.

"Midwives are generally very respectful of what a woman wants to do during a birth," says Lesley Everest, founder of Mother Wit Doula Care in Montreal. While midwives focus on the actual delivery of the baby, doulas provide much needed assistance to both the midwife and mother.

They take on an even more personal role during hospital care, and provide continuity of care during long labour.

"In a hospital, we're going into a very clinical place," says Everest. "It's very big, it's not personal; most of the time the woman's doctor is not there, and she's being taken care of by people that she does not know." The doula's job is to provide continuous care to the mother, father, and newborn baby in the clinical environment, where shift changes and new personnel are the norm.

With conflicting methods, it is surprising that doulas and physicians work well together.

"We respect the fact that our client is choosing to have a hospital birth and we're just trying to make that as good of an experience for her as possible within the system," says Everest. Doulas will outline a woman's choices, always with deference to her doctor.

Additionally, doulas help to make the birthing experience easier for a woman's partner.

"A lot of partners have never seen a birth before and it can be very tense to see how intensely a woman expresses her pain in labour," says Everest, "and a lot of times the partner might not know that this is okay. We expect way too much from [women’s partners]." Doulas and midwives diffuse the tension and act as communicators between midwife or physician and the family.

"We help the partner be free to really loving to the woman without having to do anything else."

While over 90 per cent of women giving birth in Montreal hospitals receive an epidural, women who are accompanied by a doula typically only receive an epidural 10 per cent of the time. Everest credits the presence and support of another women during birth for this ability to withstand the pain.

Future of natural births

While natural births are less popular, they are also significantly less expensive, something that is appealing to policy makers.

"We see a trend in de-hospitalization because it's so expensive," says Berry. "Midwifery looks appealing because it not only provides good care but the scientific evidence suggests that midwives provide really good care for birthing women and particularly for low-risk birthing women."

Giving birth in a hospital can cost up to $10,000, while midwife costs in Canada range from $800 to $3,000. But midwives also follow wives throughout pregnancy and afterwards.

However, reintegrating midwifery and natural births into the healthcare system won't be easy. Canada and the United States were anomalies in abolishing midwifery, and so reintegration will have to begin from scratch.

"I think generally [doula and midwife care] are a reasonably rare practice," says Everest, "but it is getting more and more well known." Everest, who is overbooked, credits physicians who readily give referrals to natural birthing practices for this increase in popularity.

"The nurses and doctors … are usually really happy that we're there," says Everest. "We help to make their jobs easier too."

Making the decision

Even if natural births don't become the norm, many women are now discovering the empowerment and bonding that comes with labour. An increase in natural births will require a working relationship between midwives, doulas, and doctors, as well as the expectation of the mother to thoroughly examine her choices. However, medical intervention will always have to be an option in the event of complications.

Ultimately, the birthing trends will depend on what women want from their birthing experience, aside from a healthy child.

"I know lots of women who have gone in, they haven't had any thought about the experience and they have an epidural right away and they come out with a baby and they're all very happy," says Everest. However, she also claims that women may not be aware of what they're missing.

"The discomfort that's inherent in labour is there for a reason: it helps to create this beautiful cocktail of hormones that the mother and the baby are bathed in," says Everest. This cocktail of hormones allows the mother and baby to bond, and is noticeably absent in hospital environments.

While hospital births rarely result in long-term health problems for either the mother or the child, it is worth exploring t
he older, less complicated ways of bringing a baby into the world.

"When moms are left to birth in a way that makes them feel very powerful, they tend to forge really happy relationships with their babies."