This project established the first systematic examination of planned home births in a regulated setting in Canada. When British Columbia began regulating midwifery in January 1998, midwives and their clients were required to participate in this project, which ran until October 2000. A multi-stakeholder advisory committee developed midwife protocols and a data collection system and then dealt with emerging issues and recommendations. An independent evaluation team identified negative situations and forwarded the cases to a panel of clinical experts, which identified practice and integration issues. In the study, data from 862 planned home births were evaluated and compared with 743 planned low-risk hospital births attended by a physician and 571 planned hospital births attended by a midwife. Researchers found that midwives are able to appropriately screen women, are cautious practitioners of home birth, and cooperated well with other health care workers. Planned home births compared favourably with — and sometimes outshone — hospital births with respect to postpartum hemorrhage rates, infections, and rates of inductions, episiotomies, and other interventions. However, some cases of obstetrical shock, and three of the four incidents of perinatal death, occurred during home births. The authors caution that the sample size was not large enough for valid statistical comparisons of risks.
This project was supported by the Health Transition Fund, which was created in 1997 to provide support for evidence-based decision-making in health care reform by supporting pilot and evaluation projects which test innovative approaches to health care delivery. The views expressed herein do no necessarily represent the official policy of federal, provincial, or territorial governments.