Let us first specify that, even if the present subject is found in our Therapies guide, childbirth is not NOT a sickness. Birth centers are based on the principle that childbirth is a natural physiological act and healthy women have the resources to make the choices that are right for them in this situation.

The aim of birth centers is to provide an appropriate technical environment that is human and individualized, with staff able to meet the physical, emotional and psychosocial needs of mothers and their inner circle. They are oriented towards the woman and the family, while the hospitals are oriented towards the “patient”. These are small facilities that have only a few rooms with the character of a private house, but all the infrastructure necessary for a health service. They are sometimes called birth houses autonomous sets to distinguish them from “alternative” maternity services (birth chambers), established in certain hospitals; in english, we call them birthing centers ou chidbearing centers.

In the United States, the first birth house was founded in 1975, in New York; there are now over a hundred. In Europe, the movement was first established in Germany (in 1987), then in Switzerland, Austria, Great Britain… In France, experimental structures, included in the 1998 perinatal plan, are still awaiting the green light from the government. .

In Quebec, there are currently seven of these houses. They are attached to CLSCs (local community service centers) under the authority of the Quebec Ministry of Health and Social Services. They all offer the following services free of charge:

• Complete maternity follow-up

     – Personalized prenatal follow-up.

     – Childbirth (assistance throughout the birthing process).

     – Postnatal mother and baby follow-up, including home visits.

• 24 hour telephone support.
• Collective prenatal meetings.
• Collective postnatal meeting
• Help-natal service.
• Documentation center.
• Information evenings.

Although, since the dawn of time, childbirth has always taken place at home, between women, the medical community in Western countries has gradually taken charge. In Quebec, it is the establishment of new legislative and educational institutions governing medical practice and training, in the XNUMXth century.^e century, which heralds the gradual disappearance of midwives. In 1847, the law creating the College of Physicians gave them control over the interventions surrounding childbirth. Later, obstetrics will become a medical specialty. From the 1960s, almost all births took place in hospitals.

During the 1970s, with far-reaching demands, women sought to regain responsibility and control over several areas of their lives, including childbirth. The work of some humanist scientists, such as the French obstetrician Frédéric Leboyer (author of For a birth without violence) has greatly contributed to legitimizing this approach.

Faced with public pressure and given the stubbornness of some midwives to practice their profession, the Quebec government adopted, in 1990, the Act respecting the practice of midwives as part of pilot projects. In 1999, the National Assembly voted to adopt Bill 28 on the practice of midwives, which authorized the constitution of a professional order whose members would access a profession of exclusive practice and would be governed by the Code of professions.¹

From the right to practice of midwives comes another right, fundamental according to many pressure groups, that of women and families to choose the place of birth of their child. In Quebec, home births accompanied by a midwife have been permitted by law since May 2004.¹⁰

Access to birthing centers is reserved for clients who do not present any particular risks, whose pregnancy is proceeding normally and for whom the need for medical interventions during labor or delivery is not foreseen (i.e. i.e. the vast majority of women). According to a synthesis of American research, the method of selection carried out by birthing centers effectively allows women with normal pregnancies to avoid obstetric practices designed for high-risk pregnancies.². When unnecessary, these practices can interfere with the smooth and peaceful delivery of childbirth.

For this clientele, an American study has shown that birth centers are at least as safe as hospitals. This study, published by the New England Journal of Medecine in 1989, was carried out in 84 birthing centers where 11 women had given birth³; in addition, the satisfaction rate of the surveyed customers reached 98%.

In a subsequent comparative study, conducted between this group and 2 low-risk pregnant women who gave birth in hospital, researchers observed that those giving birth in hospital were more likely to receive interventionist-type care, without any ‘This results in benefits for them or their babies.⁴

In its evaluative research at the time of the establishment of birthing centers, the Quebec government confirmed that certain problems could be reduced thanks to the type of supervision offered by birthing centers, including prematurity and the birth of small babies. weight. He also noted that the practice of midwives could have beneficial effects, such as a reduction in obstetric interventions in the pre- and perinatal period (fewer ultrasounds, artificial ruptures of membranes, use of oxytocics, cesarean sections, forceps, episiotomies and perineal tears of the 3^e and 4^e degree, among others)⁵.

According to some research, the death rate is even lower in birthing centers than in hospitals, for the group of women with normal pregnancy.⁶

A synthesis of six studies (involving nearly 9 women) carried out in 000 by the University of Toronto, however, did not reveal any reduction in mortality in the birth center. As for the other observable benefits in this context, the author says that they may be attributable to the increased attention of both clients and caregivers to the warning signs of complications.⁷

• Because of their advanced age, certain diseases such as diabetes, or difficult previous pregnancies, some women (less than 10%) cannot be accepted in a birth center. Midwives are trained to detect high-risk pregnancies.

In Quebec, there are currently six birth centers, in addition to the Povungnituk Maternity. Their services are covered by the health insurance plan, as are those of hospital centers. They offer information evenings. For European houses, you can get information on several websites. See below.

A peaceful and pleasant place where, in addition to the bedrooms, there is a community hall, consultation office, documentation center (breastfeeding, nutrition, psychology, vaccination, etc.), kitchen and children’s play area. Meals and snacks are prepared by the staff.

A midwife is responsible for follow-up from the beginning of a pregnancy until after the birth of the child; a second midwife assists her during the birth and provides follow-up meetings after the birth. A total of 12 to 15 meetings of approximately 45 minutes, always with people who are familiar and aware of the file.

The spouse (or another person) can attend all stages; more than one person may be present at the birth.

Childbirth takes place in a comfortable and intimate room that is equipped with the necessary equipment to ensure the safety of mother and baby. It also includes: full bathroom, double bed, stereo system, telephone, etc.

The woman has a greater choice of positions for childbirth.

The monitoring of the progress of labor during childbirth is carried out according to recognized standards in obstetrics and in accordance with the regulations on obstetric and neonatal risks.

In the event of complications, the midwife is authorized to intervene; she can request a consultation with a doctor or organize a transfer to a hospital center quickly and safely. In a transfer case, the midwife accompanies the mother and the baby and remains responsible for the care until medical treatment.

The minutes following the birth are marked by calm, warmth and discreet supervision by the midwife who remains at least three hours on the scene after the baby’s arrival in order to monitor his state of health and that of the mother, and help with the first breastfeeding. Thereafter, the birth attendant provides the necessary support throughout the stay (from six to 24 hours, depending on the case).

In Quebec, since the adoption of Bill 28 on the practice of midwives, it is the University of Quebec at Trois-Rivières (UQTR) which offers the baccalaureate program in midwifery practice, a training of four years⁸.

To have the right to practice, Quebec midwives are required to belong to a professional order, the Order of Midwives of Quebec (OSFQ)⁹.

All midwives with a license to practice have been assessed by the admission to practice committee in collaboration with the Laval University Health Sciences Assessment Center. They are more than fifty to practice on the territory of Quebec.

Brabant Isabelle. For a happy birth, Éditions Saint-Martin, 1991. New edition revised and updated: 2001.

A book filled with heart and intelligence written by one of leaders of the movement for the recognition of midwives in Quebec, with magnificent black and white photos.

Grégoire Lysane and St-Amant Stéphanie (Dir). At the heart of birth: testimonies and thoughts on childbirth, Editions du remue-household, Canada, 2004.

Parents tell of the birth of their children by natural childbirth in the hospital, in a birth center or at home. Rich and touching stories, interspersed with information fueling the debate on the medicalization of childbirth. a must for future parents.

Leboyer Frédéric. For a birth without violence, Le Seuil, 1974.

A great classic that allows parents to understand the sensations and the change of scenery that the newborn experiences at the time of birth, and to prepare for childbirth accordingly. Superbly illustrated.

Vadeboncoeur Hélène. Another cesarean? No thanks, Quebec-America, 1989.

This book deals with vaginal birth after cesarean section (VBAC). It shows that all women who have had a Caesarean section can try to give birth naturally. Filled with technical information and statistics, it also contains about twenty testimonials from women or couples who have experienced a VBAC.

The Périnatalité.info site (www.perinatalite.info) offers in its section To learn more a rich and interesting annotated bibliography of books and videos. Also consult the thematic catalog of the PasseportSanté.net library.

Birth Centers Online

Excellent site of the American Association of Birthing Centers, particularly elaborate.

www.birthcenters.org

Doulas – Support the birth

The site of the first French grouping of doulas. A doula is a woman whose vocation is to help another woman and her entourage during pregnancy, childbirth and the postnatal period, thanks to her experience and her training. However, she is not a midwife.

www.doulas.info

Nourri-Source Quebec Federation

Information on breastfeeding and a network of volunteer “breastfeeding mentors”.

www.nourri-source.org

Mimosa birth center

Excellent site of the only house in the Quebec City area. There is a great deal of information and links there.

www.mimosa.qc.ca

Naissance.ws

An information site on what is happening around birth in French-speaking countries. Contains a directory of numerous associations.

www.fraternet.org

NPO Midwives

An association of French midwives working to set up birth centers. Their acronym stands for Neurosciences and Psychology at the service of Obstetrics.

www.nposagesfemmes.org

For a happy birth

Very up-to-date French site with lots of information, addresses and links.

www.chez.com

Birth-Renaissance grouping

This Quebec organization for information, training, education and research on perinatal care has been very active for several years. It brings together many associations.

www.naissance-renaissance.qc.ca

Quebec network of birth attendants

Complete and colorful presentation of the services offered by the accompanying persons: prenatal, postnatal and childbirth assistance, advice of all kinds, breastfeeding support, sharing of emotions, and much more.

www.naissance.ca