Where to give birth in Canada: hospital, birth centre or home

There is no national answer, and that is the answer

Health care in Canada is delivered by the provinces and territories. There is no federal maternity service, no national list of birth centres and no single rule about where you may give birth. What you can choose depends on which province you live in, and sometimes on which part of it.

Two provinces are used here as worked examples because their public health services publish clearly. They are examples, not the national picture. If you live elsewhere, the same questions apply but the answers may differ, and your provincial health service is the authority.

British Columbia: hospital or home

HealthLink BC states it plainly: in British Columbia, women and their partners can choose to have their baby in a hospital or at home. You may be advised to have your baby in hospital if you are carrying more than one baby, or in other higher-risk situations.

The role of the midwife is the part worth reading twice. A midwife can provide labour support for both hospital and home births. If you choose a midwife, she will be with you during your labour. If you have a home birth, a second attendant will also be present, staying for a short time before, during and after the birth.

What happens in the six weeks afterwards

Midwifery care in BC does not stop at the birth. Your midwife continues to provide care and information for you and your baby, including breastfeeding support, for six weeks after the birth. During the first week the midwife sees or contacts you at home every day. Between the second and sixth week you and your baby visit the midwife's office. After that, care transfers back to your family doctor, and a public health nurse gives you information about services in your community.

That is a genuinely different postnatal experience from a doctor-led pathway, and it is the reason many people in BC choose a midwife even when they intend to give birth in hospital.

Ontario: hospital, home or a birth centre

Ontario runs a fully integrated midwifery programme. Since 1994, midwifery has been an integrated part of the Ontario health-care system and is provided free of charge to residents of the province. Midwives there offer clients the option of delivering at a hospital, at home, or at a birth centre.

A midwife in Ontario is a primary care provider, responsible for all the care necessary for a healthy expectant person and the baby throughout pregnancy, birth and for six weeks afterward. Midwives refer clients and newborns to family doctors or specialists such as obstetricians and paediatricians if care becomes complicated, and even if care is transferred to a doctor at the birth, the midwife stays involved as support.

You do not need a referral, and you should call early

Ontario is explicit: you do not need a referral from a physician to use midwifery services, and you can call a midwife directly. The province advises calling as early in pregnancy as possible to make sure your midwife has space for you. There are more than 850 midwives registered with the College of Midwives of Ontario, and Health811 can help you find practices near you.

Ontario midwives usually work in small groups of two to four and are on 24-hour call, so you get to know the small team who will attend your birth. Generally two midwives attend each birth.

Who else might be in the room

In BC you may choose a midwife or family doctor, or in some cases an obstetrician-gynaecologist, to provide primary care through pregnancy. If you need specialised care, because of a health concern or something that happened in a previous pregnancy, your care team expands to include specialists such as an OB-GYN, maternal-fetal medicine, neonatology or a paediatrician, and your primary care provider arranges the referral.

What varies, and what we are not going to invent

Whether a freestanding birth centre exists near you, whether your province funds home birth, how many midwives are practising and whether they have capacity are all provincial or local facts. They change year to year. We are not going to publish a national list of birth centres, because there is no national list to publish.

The dependable route is your provincial health service or health line. In much of the country dialling 811 reaches a free provincial health line staffed by nurses, and in Ontario, Health811 will point you at midwifery practices in your area.

Questions worth asking wherever you live

Which settings does my provider attend? Is midwifery publicly funded here, and is there space? If I plan a home birth, who is the second attendant and what is the transfer plan? Who looks after me in the six weeks after the birth, and where? Book early: in provinces where midwifery is free and popular, capacity, not eligibility, is usually the constraint.

What a midwife is responsible for

Ontario spells the role out, and it is broader than most people expect. Midwives assess and monitor you and the baby through pregnancy, order and interpret tests, attend the birth, examine the newborn, and care for you and your baby for six weeks after the birth. They provide education, counselling, advocacy and emotional support.

Midwifery in Ontario is built around informed choice: midwives provide information so that you can make decisions about your care, allow enough time in prenatal visits to discuss nutrition, birth plans, breastfeeding and parenting, and recognise you as the main decision-maker.

If you are advised to give birth in hospital

In British Columbia you may be advised to have your baby in hospital if you are carrying more than one baby, or in other higher-risk situations. That advice is a clinical recommendation, and the reasons behind it should be explained to you. If specialist input is needed, your care team expands to include an OB-GYN, maternal-fetal medicine, neonatology or a paediatrician, and your primary care provider arranges the referral.